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Interrupt-Driven

Short takes. Quick cuts. Channel surfing. Restlessness. Anxiety. High stim. Feeling wired? Or do you have Attention Deficit Disorder, the Yuppie Flu of the '90s?

By Evan I. Schwartz

Hang out with Dave deBronkart and you will see why Attention Deficit Disorder (ADD) should be dubbed the official brain syndrome of the information age.

A desktop publishing consultant, deBronkart, 44, inhabits a home office in Salem, New Hampshire, that contains one thermos of coffee, two laser printers, three personal computers, four telephone/modem lines, and 500 little, yellow, sticky Post-its, each screaming its own reminder. He's often talking on the phone while responding to e-mail and printing out a newsletter - and thinking about something else entirely. "Technology lets me keep up with my mind," he says. "It lets me try my ideas as soon as I can come up with them."

The only problem is that deBronkart has trouble getting anything done. The smallest bit of incoming information, the quickest fleeting thought, or the slightest peep from a family member has the potential to derail deBronkart from whatever work he really should be doing. He might not get back to the task at hand for hours, days, weeks.

As it affects adults such as deBronkart, ADD is a little-understood but surprisingly common brain imbalance. The disorder is genetic, according to some researchers, and it usually manifests itself first as childhood hyperactivity. But as the physical restlessness wears away during puberty, leaving mainly the attention span symptoms, the syndrome becomes harder to spot. While studies have shown than between 2 percent and 4 percent of kids show signs of hyperactivity, there haven't been any such studies on adults. Many psychiatrists who specialize in the disorder now believe that a similar proportion of adults have ADD - anywhere between three and ten million people in the United States.

Those numbers get even higher when you consider all the people who just seem to have ADD. The symptoms of the disorder are "culturally syntonic," according to Drs. Edward M. Hallowell and John J. Ratey, two psychiatrists who authored a new book on the subject, Driven to Distraction. In other words, the ADD-type personality fits right into life in the high-tech, high-stim, fast-food, instant-gratification, short-attention-span, information-overloaded, overworked, media-saturated lifestyle that is America in the 1990s.

Adult ADD is marked not only by a short attention span but also by a multitasking mind. Anxious to avoid boredom, those afflicted are constantly scanning their environment, searching for all things captivating. They may read lots of books, but they finish few. They misplace things and require constant reminders. They are risk takers, thrill seekers, and, often, caffeine addicts. They are news junkies and channel-clicker/cable-surfers. In conversation, they often detour into parenthetical tangents, never returning to the main point. On the Net, they can't help getting lost in cyberspace for hours. Back on planet Earth, they interrupt people. They can't stand waiting in lines. They juggle too many projects and are chronically late.

But when something grabs their full attention, they can launch into hyperfocus marathons that last well into the night. It's not so much that they lack the ability to pay attention. It's more that they cannot control what they pay attention to and how long their attention lasts. Channeled properly, an ADD person can be explosively productive and brilliantly intuitive. On the other hand, ADD can ruin relationships and careers. Not surprisingly, many ADD adults can't hold down a traditional office job. That's why many set up shop surrounded by high-tech information tools in a home office, where they can impulsively act on swirling bits of information without driving other people crazy.

DeBronkart, for one, was a bit hyperactive as a kid, though not impulsive or aggressive enough to cause real trouble. At college, however, he couldn't cope with the unstructured nature of his time. Too many things vied for his attention, and he became distracted. After barely passing freshman calculus, he was advised never to take another math course again --- an odd evaluation for a kid who had scored a perfect 800 on his math SAT.

In many respects, deBronkart is a rather typical case, says Dr. Hallowell, who practices in Cambridge, Massachusetts. It was Hallowell who in May 1992 diagnosed deBronkart as having ADD. Like a growing number of psychiatrists, Hallowell and Ratey, an associate professor at Harvard Medical School, are frustrated that the American Psychiatric Association and other national groups have been slow to classify adult ADD as its own syndrome, distinct from the related childhood trait, which is known as Attention deficit and Hyperactivity Disorder, or ADHD. The conventional wisdom in the psychiatric community is that because grown-up ADHD patients are no longer physically restless, they are no longer afflicted with any disorder at all.

In the fall of 1990, that view seemed to be proven wrong. The New England Journal of Medicine published the results of a study prepared by a group of eight doctors. The article repeated much of what was well known about ADHD - that it affects between 2 percent and 4 percent of school-age children, that the disorder tends to be inherited, and that treatment of the syndrome with medication, such as the central nervous system stimulant Ritalin, remains controversial.

But the article detailed this breakthrough: Using positron emission tomography to scan the brain, the study demonstrated that the adults with attention deficit symptoms in the study group had lower than normal levels of activity in the areas of the brain that control concentration and the ability to get back on track when distracted.

"The study provided credibility for the adult form of ADHD," says Benjamin Lahey, a psychiatric researcher at the University of Chicago. Since the article was published, there has been a growing awareness of adult ADD in the medical community. And thousands of adults with attention problems have been coming out of the closet.

One of the places these wired ones congregate is the Attention Deficit Disorder Forum on the CompuServe information service, where computer owners can dial in to read and respond to messages posted on electronic bulletin boards. The movement for such a forum began in 1991, when several members of the Desktop Publishing Forum began noticing unexplained symptoms about themselves. One member, an entrepreneur in Atlanta named Thom Hartmann, had already suspected he had ADD and thought it would be a good idea to start a dedicated forum, which required approval from CompuServe executives in Ohio. After it was sanctioned and went online in May 1993, it quickly became one of the most visited of CompuServe's many health and fitness forums, as members were dialing in to post an average of 200 messages per day in the first month. Within eight months this little corner of cyberspace grew to 7,000 active members - perhaps the world's largest ongoing support group for the disorder.

Every day now, it seems, a new ADD patient wanders in. A typical one is 46- year-old Francis Lawrence. Lawrence found out he had ADD at the same time his 8-year-old son was diagnosed with ADHD. He wrote:

I've just discovered this forum. And apart from my wife, this will be the first time that I've discussed my problem with other people. I have my own business, of course, after all I'm practically unemployable. In fact, I have two businesses, and true to form I dither between the two of them to the detriment of both. I now have two desks and three computers in my work space! Strange as it may seem I sometimes forget I have this problem and I think I can accomplish what normal people can. This however is a mistake. I need to work a lot harder at coming up with compensatory techniques. My biggest compensatory technique is to never let a client pin me down to a deadline. I will say that PCs are a godsend. It seems to me that using the PC to help organize your life is a heck of a compensatory mechanism for ADDers.

A favorite pastime for ADD Forum members is outing famous people who they suspect have ADD. According to various members, the history of ADD includes the likes of Einstein (he was nearly thrown out of college because of his intense daydreaming), Edison (he greatly misjudged time and was threatened with lawsuits because he never got around to paying his bills), and John F. Kennedy (he would never sit still). Current favorites are Bill Clinton (he keeps a lot of balls in the air at once but catches few of them) and Bill Gates (he rocks back and forth and can't help getting immersed in new projects and hobbies). Having such successful people as ADD role models seems to make the forum members feel better.

Sometimes, the members reveal very personal symptoms. Carolyne Brown, 31, is trying to determine whether her love life is being ruined by ADD. She wrote:

All my relationships have pretty much ended the same. I love my partners very much but monotony ("boredom") sets in and it ends up drastically affecting our sex life (I avoid it because I know it will pretty much be the same), and I begin getting more and more distracted (accused of being "non-feeling," "self-centered," "not caring about the other person," etc.). I get excited again when something happens, e.g.: new kitten, vacation, job change, etc. but "boredom" always returns.

Within six days of Brown's posting this note, there were more than 150 messages in response - offering advice, sympathy, and similar experiences. Certain stories have the markings of ADD classics. While rushing to get ready for the beach one day, an ADD adult named Nancy took multitasking a bit too far. Nancy massaged some 15-minute conditioner into her hair, put on a facial mud pack, stepped both of her feet into trays of water for a pedicure, and applied Nair to her bikini area. Then, she got a phone call. While talking, she forgot about her hair, face, feet and the rest of her beautifying. By the time she hung up the phone, the Nair had taken over new and unintended territory - a big surprise for her boyfriend.

With all this intrigue going down, it's no wonder that deBronkart became one of the ADD Forum's sysops. The pay is minuscule, and it eats up an enormous chunk of his time. But he feels he owes a lot to his fellow cyberspacelings, for it was on CompuServe that it was first suggested to him that he had ADD. For most of his life, deBronkart couldn't explain why his mind wandered everywhere at once. Once he started to understand ADD, it all began to make sense.

For treatment, deBronkart went to Hallowell, who prescribed Ritalin, a stimulant that is believed to activate the same part of the brain that was observed in the New England Journal of Medicine study. "The first day I took Ritalin, a thought came into my mind and I said, 'No. It isn't time for that now,' " deBronkart recalls gleefully. ADD patients compare Ritalin to putting a new antenna on a radio: It eliminates the constant static, distraction, and interference commonly picked up by an ADD brain. Although he is no longer on it, the drug helped deBronkart get his life and thoughts organized. "I now have the ability to go back to whatever I was talking about."

Ritalin may indeed be too effective. Some psychiatrists are now beginning to worry that ADD is becoming somewhat of a fad, sort of how "chronic fatigue syndrome" became the yuppie flu a few years back. They also worry that Ritalin is fast becoming another popular personality pill - like Prozac.

Lahey, at the University of Chicago, warns doctors about inappropriate treatment of patients who might not have any real disorder at all or who might have a more severe mental illness, such as schizophrenia.

Perhaps most worrisome of all is that thousands of people with no genetic predisposition to ADD or ADHD seem to be coming down with it. Hallowell has a theory about this phenomenon. He calls it "culturally induced ADD," or "pseudo-ADD." While as many as ten million adults in the US may have the genetic, inherited form of ADD, untold millions may be experiencing pseudo- ADD, according to Hallowell.

"Everyone is distractible to some extent," Hallowell says. And it's getting difficult to distinguish between real ADD and pseudo-ADD.

Other doctors have encountered the same phenomenon. "People seem to be developing a form of ADD without inheriting it," says Dr. Theodore Gross, a pediatrician in La Jolla, California. "The information explosion has something to do with it - all the faxes and e-mail and calls come in, and people can't keep up with it." Gross started a software company called PVA Systems to market a surprisingly successful program that helps people cope with one of the common byproducts of ADD - an inability to read for more than a few minutes. The program, FlashRead, tries to improve concentration by quickly flashing successive segments of sentences. Gross created it for kids. But adults have become its main users.

Could ADD be subverting our culture in subtle ways? Consider this list from the Hallowell-Ratey book: "The fast pace. The sound bite. The bottom line. Short takes, quick cuts. The TV remote-control clicker. Restlessness. Anxiety. Ingenuity. Creativity. Speed. Present-centered. No future. No past. Disorganization. Mavericks. A mistrust of authority. Video. Going for the gusto. Making it on the run. The fast track. Whatever works. Hollywood. The stock exchange. Fads. High stim." All of these hallmarks of America's high-tech culture are also typical of the ADD and pseudo-ADD personality. With so many of these people running around, we could be becoming the first society with Attention Deficit Disorder.

As we went to press, we learned of an Internet support group for ADD:

alt.support.attn-deficit. FTP: ftp.netcom.com:/pub/lds/add.

SIDEBAR:
How Do You ADD Up?

The following criteria for diagnosing Attention Deficit Disorder in adults are suggested only. They are based upon the clinical experience of Edward M. Hallowell, M.D., and John J. Ratey, M.D., and constitute what they consider to be the most commonly encountered symptoms in adults with ADD. These criteria have not been validated by field trials and should be regarded only as an informal guide.

A person with a chronic disturbance would answer "yes" to at least fifteen of the following questions:

1. Do you have a sense of underachievement, of not meeting your goals, regardless of how much you have actually accomplished?
   
2. Do you have difficulty getting organized?
3. Are you a chronic procrastinator?
4. Do you often juggle many projects simultaneously, but balk at follow- through?
5. Do you have a tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark?
6. Do you find yourself in an ongoing, restive search for high stimulation?
7. Do you have a tendency to be easily bored?
8. Are you easily distractible, with trouble focusing attention and a tendency to tune out or drift away in the middle of a page or a conversation - often coupled with an ability to hyperfocus?
9. Are you considered creative, intuitive, or highly intelligent?
10. Do you have trouble going through established channels or following proper procedure?
11. Are you impatient, with a low tolerance for frustration?
12. Are you impulsive, either verbally or in action - as in impulsively spending money, changing plans, enacting new schemes, or altering career plans?
13. Do you have a tendency to worry needlessly, alternating with inattention to or disregard for actual dangers?
14. Do you have a sense of impending doom, insecurity, alternating with high risk taking?
15. Do you experience mood swings or depression, especially when disengaged from a person or a project?
16. Are you frequently restless, with lots of "nervous energy"?
17. Do you have a tendency toward addictive behavior, be it alcohol, caffeine, shopping, eating, or overwork?
18. Do you have a chronic problem with self-esteem?
19. Are you inaccurate at self-observation, often misjudging the impact you have on others?
20. Do you have a family history of ADD, manic-depressive illness, depression, substance abuse, or other disorders of impulse control?

Modified January 9, 2003