September 2, 1997
More Adults Diagnosed With Attention Deficit Disorder
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Related Article
Attention Deficit Disorder: The Symptoms
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By DAVID J. MORROW
or Sally Furbish, life once seemed almost unbearable. By the time she
turned 30, she had attended five colleges, nearly set her house on fire and
struggled to find her way driving from one town to the next. She had worked
as a waitress and a flight attendant but seldom showed up on time.
A doctor finally identified the trouble as attention deficit disorder. With
medication and therapy, Ms. Furbish eventually returned to college,
graduated six years later and is now, at 37, a special-education teacher in
Gainesville, Ga.
Her life is far from simple, though. In her classroom, dozens of Post-It
notes adorn her bulletin board to remind her of impending chores, and
color-coded files are strewn across a table. Put the files away, and it
could take Ms. Furbish hours to find them.
"Being diagnosed with ADD gave me my life back," she said. "I still have
trouble planning, but I'm making much more progress than I had before I
knew what was wrong."
Once diagnosed primarily in school-age children, ADD -- commonly known as
attention deficit disorder but clinically defined as attention-deficit
hyperactivity disorder -- is now being diagnosed in a record number of
adults. Several recent studies estimate that 6 million to 9.5 million
American adults have the disorder, making it as common as severe clinical
depression or drug abuse.
Through a combination of medication and intensive counseling on ways to
organize themselves and function in an office, many people who have the
disorder, like Ms. Furbish, build successful careers. For many others,
though, the remedies are too little and too late, and their careers suffer
irreversible damage.
ADD, unlike other mental illnesses, is only now being treated in adults. At
the current pace, adults will receive 729,000 prescriptions or
recommendations this year for Ritalin -- a mild stimulant commonly used to
treat the disorder -- according to IMS America Ltd., a pharmaceutical
research company. In 1992, the number was just 217,000.
For some adults, a remedy cannot come too soon. Left untreated, people with
the disorder are often inattentive, impulsive and hyperactive. They talk
incessantly, move frequently from job to job and seldom finish a project.
Therapy can be so successful, though, that it is often impossible to pick
out a person with the disorder who is undergoing treatment.
"Having ADD is not a curse," said Dr. Edward M. Hallowell, a psychiatrist
at Harvard Medical School who has the disorder. "It's like having a Ferrari
engine under the hood. It can take you to plenty of interesting places, if
you know how to manage it." Or, of course, it can take you into plenty of
brick walls.
Several factors are fueling the surge in adult cases of attention deficit
disorder. After spotting it in generations of children, psychiatrists have
only recently accepted that the illness carries over into adulthood. In
fact, like depression and bulimia, the disorder has become the disease du
jour, no doubt prompting a growing number of panicked adults to land in
psychiatrists' offices.
This has caused some critics to assert that the illness is being
overdiagnosed. Of particular concern is the growing use of Ritalin as a
recreational stimulant by college students and fast-track professionals.
The trend is already affecting America's corporate insurance claims. Ten
years ago, virtually no employees who had group disability coverage from
UNUM Corp. had ever filed a claim based on ADD. Last year, the disease
showed up in less than half of 1 percent of the company's 53,000 cases.
This has not gone unnoticed by employers. Typically, large companies like
IBM consider the disorder a mental illness and cover it under an outpatient
or hospitalization plan. But because people with ADD could stay out
indefinitely on disability claims, companies worry that they may not be
able to tell an authentic case from a fraud.
"Employers have to make accommodations," said John S. Woyke, a principal at
Towers Perrin, the management consultants in New York. "The problem is that
from a legal standpoint, it's difficult to determine what a reasonable
accommodation is."
The confusion over ADD is not new. Even though it was first diagnosed by a
British pediatrician in 1902, no one knows what causes it. Most
epidemiologists say the disorder stems from a genetic dysfunction, probably
a short circuit in the brain. Yet other studies point to fetal exposure to
environmental toxins like lead, cigarettes and alcohol.
All this can make it difficult to diagnose. The disorder, which begins
before the age of 7, has nine symptoms of either inattentiveness or
impulsiveness. The presence of any six can constitute a positive diagnosis,
but psychiatrists cannot always distinguish the disorder from mania or
depression. Oddly, many ADD cases over the last five years have been
discovered not by doctors but by elementary school teachers. Notes about
troubled students were sent home to quizzical parents. And even though they
have struggled with lifelong inattentiveness, many adults never learn they
have the disorder until it is diagnosed in one of their children.
For most of them, the diagnosis is nothing short of a revelation. Unlike
depression, the disorder has symptoms that can come and go, creating
numerous unexplained calamities.
Bill Kennedy, a 40-year-old waiter at an Atlanta restaurant, struggled so
hard at Florida State University that he blatantly cheated just to pass.
Kennedy, who did not learn to read with any proficiency until he was 23,
sneaked exam answers from classmates, hired friends to write his term
papers and only dated women who would do his homework.
The strategy fell apart in his junior year. After a doctor said he had ADD,
Kennedy was put on Ritalin and assigned a full-time note-taker and tutor,
who helped him graduate with a degree in social science. But his problems
were far from over.
Kennedy took a job as a salesman in a fur store and immediately ran into
trouble. He had to count the furs daily. "That was really hard for me," he
said, "because I couldn't pay attention, and I always had a problem with
numbers. Eventually, I changed jobs and got into something that suited me
better, like teaching reading to the disabled and working in the restaurant."
One common characteristic among adults is their inability to plan or follow
instructions. Invited to her father's wedding five years ago, Ms. Furbish
drove aimlessly for an hour, searching for a church less than 10 miles from
her home. When she finally arrived, the ceremony was over.
Unable to negotiate the land mines of office politics, executives who
suffer from the disorder might offend bosses with brash remarks or
decisions that appear to lack forethought. This often means getting bounced
from one job to the next.
To be sure, an employee with untreated ADD could tax any supervisor's
patience. One 26-year-old New York stockbroker, who insisted on anonymity,
sought help after flunking out of the University of Miami and failing his
brokerage licensing exam. He goes to bed at 2 a.m., gets up at 6, then
spends the rest of the day in constant motion, talking on the phone and
frequently disturbing his colleagues.
Therapy and medication have helped, but he has yet to become as focused as
he would like.
"My mind just moves too fast," he said. "No one can keep up. People I speak
to are talking about one thing and my mind has already moved on to the next
subject. I feel like a leopard in a lion's cage."
Ritalin, the most commonly prescribed drug, does help. It is thought to
increase levels of dopamine, a chemical that appears to be in short supply
in ADD sufferers. While the drug stimulates virtually anyone who takes it
-- roughly with the jolt of a strong cup of coffee -- it helps most of
those with the disorder to concentrate.
Yet even this treatment has drawbacks. Ritalin -- or methylphenidate
hydrochloride, as it is sold generically -- stays in the bloodstream only
four hours. Anyone who takes it has to time the dose exactly or risk a
period in which mishaps are likely. Ritalin is also relatively expensive --
$9.45 for an average adult's weekly supply -- and can cause irritability.
Even with drugs, people have considerable trouble regaining control of
their lives, especially at work. Supervisors who are in their 40s when the
illness is diagnosed have had decades to learn bad work habits that are
difficult to overcome.
"People think Ritalin is a miracle cure," said Dr. Martha Denckla, a
learning disabilities expert at the Kennedy Krieger Institute, a Baltimore
research facility for children with brain disorders. "It can't teach
someone how to organize himself or make lists."
Most people learn to become resourceful. Daniel Barrett, a recent college
graduate from Newtonville, Mass., uses five alarm clocks to be on time for
his job as a Web page designer.
After years of forgetting what was on the menu, Kennedy, the waiter in
Atlanta, sometimes keeps notes in his pockets.
"Part of living with ADD is knowing what you have trouble doing," Kennedy
said. "I can never remember how the dishes are served, so I started keeping
notes. More importantly, I know that when people question me, I can
sometimes get defensive. So I go out of my way and try to be funny."
Experts say people can function well in careers that capitalize on their
symptoms. People with ADD tend to excel during a crisis, leading some to
become stockbrokers, doctors and police officers.
Andre Fulton, a former police officer in an Atlanta suburb, had trouble
with paperwork. Yet, for his work during several emergencies, he said, he
had won more service medals than any other officer of his rank.
"When the bullets began to fly," he said, "I was calmer than anyone. Life
had finally climbed up to my natural speed."
Three years ago, Fulton's doctor diagnosed the trouble as ADD. On
medication, Fulton was much more focused. Still, after routinely offending
his superior officers and missing court dates, Fulton was dismissed in
1994. He now works for SmithKline Beecham in Atlanta.
Most people with the disorder eventually learn to compensate. It is common
for people with ADD not only to marry people who are especially attentive
to detail but to hire secretaries competent enough to cover their blunders.
Once comfortable, people with ADD often abandon their medication, which is
usually a prescription for disaster.
When Tyler Bunch went on Ritalin, his grade point average at Radford
University in Virginia had fallen to 1.8. Within a year and a half, it rose
to 3.3, tempting Bunch to stop taking his medicine. After a few months, he
stopped going to classes, putting his grade point average in the cellar. He
then dropped out.
While most experts accept the number of Ritalin prescriptions as a rough
indicator for the growing number of ADD cases, the true sales volume for
ADD may be distorted. Not only is Ritalin used to treat a number of
conditions -- like narcolepsy -- it is fast becoming a popular substitute
for methamphetamine, which is better known as speed.
While virtually all psychiatrists frown on recreational use of Ritalin,
many point out that it is preferable to speed or cocaine. Because Ritalin
stays in the body only four hours, overdosing is difficult, they say.
"Years ago, few people were aware of what ADD was when it came to adults,"
said Dr. Charles W. Popper, a Harvard psychiatrist and editor of the
Journal of Child and Adolescent Psychopharmacology. "Now there should be
more understanding. Society may look at people with ADD as being from
another planet. We shouldn't forget that they think normal people are
boring."
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