Synopsis
Book by Edward M Hallowell Ratey John J
Extrait
Chapter 1
THE SKINNY ON ADD:
READ THIS IF YOU CAN’T READ THE WHOLE BOOK
Most people who have ADD don’t read books all the way through. It’s not because they don’t want to; it’s because reading entire books is very difficult—sort of like singing an entire song in just one breath.
We want to make this book accessible to people who don’t read books all the way through. For those people, our most dear and treasured brothers and sisters in ADD, we offer this first chapter, set off from the rest of the book. Reading this will give you a good idea of what ADD is all about. If you want to learn more, ask someone who loves you to read the whole book and tell you about it. Or you can listen to it on a tape or CD.
We offer this chapter in the ADD-friendly format of Q&A. You can get the skinny on ADD in these thirty questions and answers. For more detail and research-based answers, you can refer to the chapters of particular interest.
For those blessed readers who intend to read the entire book, some of what’s in this Q&A will appear again, but some of it won’t, so you too should read this section.
Q&A ON ADD
Q: What is ADD?
A: Attention deficit disorder, or ADD, is a misleading name for an intriguing kind of mind. ADD is a name for a collection of symptoms, some positive, some negative. For many people, ADD is not a disorder but a trait, a way of being in the world. When it impairs their lives, then it becomes a disorder. But once they learn to manage its disorderly aspects, they can take full advantage of the many talents and gifts embedded in this sparkling kind of mind.
Having ADD is like having a turbocharged race-car brain. If you take certain specific steps, then you can take advantage of the benefits ADD conveys—while avoiding the disasters it can create.
The diagnostic manual of mental problems, called the DSM-IV, defines ADD by a set of eighteen symptoms. To qualify for the diagnosis you need six. These diagnostic criteria are listed in chapter 12. But be careful when you read them. They describe only the downside of ADD. The more you emphasize the downside, the more you create additional pathology: a nasty set of avoidable, secondary problems, like shame, fear, and a sharply diminished sense of what’s possible in life.
The pathology of ADD—its disorderly side—represents only one part of the total picture.
The other part, the part that the DSM-IV and other catalogs of pathology leave out, is the zesty side of ADD. People with ADD have special gifts, even if they are hidden. The most common include originality, creativity, charisma, energy, liveliness, an unusual sense of humor, areas of intellectual brilliance, and spunk. Some of our most successful entrepreneurs have ADD, as do some of our most creative actors, writers, doctors, scientists, attorneys, architects, athletes, and dynamic people in all walks of life.
Q: What is the difference between ADHD and ADD?
A: It’s just a matter of nosology, the classification of disorders. There is an arbitrariness to it all. By the current DSM-IV definition, ADD technically does not exist. By the DSM-IV definition, the term ADHD includes both ADHD with hyperactivity (the H in ADHD) and ADHD without hyperactivity. Technically, this means you can have ADHD with no symptoms of H, hence there is no need for the term ADD. But ADD, the old term, is still used by many clinicians, including the authors of this book. Whichever term you use, the important point to know is that you can have ADHD (or ADD) without showing any signs of hyperactivity or impulsivity whatsoever. ADHD without hyperactivity or impulsivity is more common among females.
Q: What is the typical profile of a person who has ADD?
A: The core symptoms of ADD are excessive distractibility, impulsivity, and restlessness. These can lead both children and adults to underachieve at school, at work, in relationships and marriage, and in all other settings.
In addition, people who have ADD often also exhibit:
Advantageous characteristics:
· Many creative talents, usually underdeveloped until the diagnosis is made
· Original, out-of-the-box thinking
· Tendency toward an unusual way of looking at life, a zany sense of humor, an unpredictable approach to anything and everything
· Remarkable persistence and resilience, if not stubbornness
· Warm-hearted and generous behavior
· Highly intuitive style
Disadvantageous characteristics:
· Difficulty in turning their great ideas into significant actions
· Difficulty in explaining themselves to others
· Chronic underachievement. They may be floundering in school or at work, or they may achieve at a high level (getting good grades or being president of the company does not rule out the diagnosis of ADHD), but they know they could be achieving at a higher level if only they could “find the key.”
· Mood often angry or down in the dumps due to frustration
· Major problems in handling money and making sensible financial plans
· Poor tolerance of frustration
· Inconsistent performance despite great effort. People with ADHD do great one hour and lousy the next, or great one day and lousy the next, regardless of effort and time in preparation. They go from the penthouse to the outhouse in no time at all!
· History of being labeled “lazy” or “a spaceshot” or “an attitude problem” by teachers or employers who do not understand what is really going on (i.e., having ADD)
· Trouble with organization. Kids with ADD organize by stuffing book bags and closets. Adults organize by putting everything into piles. The piles metastasize, soon covering most available space.
· Trouble with time management. People with ADD are terrible at estimating in advance how long a task will take. They typically procrastinate and develop a pattern of getting things done at the last minute.
· Search for high stimulation. People with ADD often are drawn to danger or excitement as a means of focusing. They will drive 100 mph in order to think clearly, for example.
· Tendency to be a maverick (This can be an advantage or a disadvantage!)
· Impatience. People with ADD can’t stand waiting in lines or waiting for others to get to the point.
· Chronic wandering of the mind, or what is called distractibility. Tendency to tune out or drift away in the middle of a page or a conversation. Tendency to change subjects abruptly.
· Alternately highly empathic and highly unempathic, depending upon the level of attention and engagement
· Poor ability to appreciate own strengths or perceive own shortcomings
· Tendency to self-medicate with alcohol or other drugs, or with addictive activities such as gambling, shopping, sexualizing, eating, or risk-taking
· Trouble staying put with one activity until it is done
· Tendency to change channels, change plans, change direction, for no apparent reason
· Failure to learn from mistakes. People with ADD will often use the same strategy that failed them before.
· Easily forgetful of their own failings and those of others. They are quick to forgive, in part because they are quick to forget.
· Difficulty in reading social cues, which can lead to difficulty in making and keeping friends
· Tendency to get lost in own thoughts, no matter what else might be going on
Q: Aren’t most people somewhat like this?
A: The diagnosis of ADD is based not upon the presence of these symptoms—which most people have now and then—but upon the intensity and duration of the symptoms. If you have the symptoms intensely, as compared to a group of your peers, and if you have had them all your life, you may have ADD. An apt comparison can be made with depression. While everyone has been sad, not everyone has been depressed. The difference lies in the intensity and the duration of the sadness. So it is with ADD. If you are intensely distractible, and have been forever, you may have ADD.
Q: What causes ADD? Is it inherited?
A: We don’t know exactly what causes ADD, but we do know it runs in families. Like many traits of behavior and temperament, ADD is genetically influenced, but not genetically determined. Environment combines with genetics to create ADD. Environmental toxins may play a role, watching too much television may play a role, and excessive stimulation may play a role.
You can see the role of genetics just by glancing at basic numbers. We estimate that about 5 to 8 percent of a random sample of children have ADD. But if one parent has it, the chances of a child developing it shoot up to about 30 percent; if both parents have it, the chances leap to more than 50 percent. But genetics don’t tell the whole story. You can also acquire ADD through a lack of oxygen at birth; or from a head injury; or if your mother drank too much alcohol during pregnancy; or from elevated lead levels; perhaps from food allergies and environmental or chemical sensitivities; from too much television, video games, and the like; and in other ways we don’t yet understand.
Q: Other than its being heritable, is there any other evidence that ADD has a biological, physical basis to it, as opposed to psychological or environmental?
A: Brain scans of various kinds have shown differences between the ADD and the non-ADD brain. Four different studies done in the past decade using MRI (magnetic resonance imaging) all found a slight reduction in the size of four regions of the brain: the corpus callosum, the basal ganglia, the frontal lobes, and the cerebellar vermis. While the differences are not consistent enough to provide a diagnostic test for AD...
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