One of the most rewarding diagnoses a medical professional can make is adult Attention Deficit Disorder (ADD). I have had many opportunities to treat ADD and have been repeatedly amazed at the dramatic results. Job performance skyrockets, relationships improve, and lives become significantly more enjoyable. It is as close to changing a life as I have seen in primary care medicine. A few times patients have expressed irritation that they lived so long before someone offered them treatment.
Most people, understandably, associate ADD with children. Some terms we use to describe the behavior are ADHD, which is Attention Deficit Disorder with Hyperactivity, and Hyperkinetic Disorder. It is estimated that 8 percent of American kids have been diagnosed with ADD or a related condition. Unknown to most people, 29 percent of them carry the disorder into adulthood.
Diagnoses of adult ADD are most often made when a patient comes to see the physician for a seemingly unrelated issue. For example, quite often patients may tell me they believe they are depressed. They describe frustration about an inability to be productive at work and home. They are pulling their hair out because they are unable to complete projects. Or they have difficulty being on time for friend and family engagements, and understandably, these relationships suffer.
One of the most common signs is having more than one new email open at the same time. When I ask possible ADD patients about that, their eyes get wide and they ask, "How did you know?" That is often the "aha" moment of the interview.
Although we aren't sure what causes ADD, there is evidence that it may be caused by a low iron level at birth, particularly in low-birth-weight infants. There is definitely a familial connection. Beginning in 1970, researchers noticed low-concentration tendencies in parents of children with ADD. Adult ADD became an official diagnosis in 1978.
There is no lab test or imaging that provides a definitive diagnosis. The closest test we have is an electroencephalogram, an EEG, which detects brain-neural signals. With ADD, there may be a recognizable brain signal pattern. As of yet, though, there is not enough data to rely on an EEG to diagnose or rule out ADD.
ADD diagnoses are always made in the office during an interview with a medical professional. If a patient exhibits enough classic ADD symptoms, medication can be used to treat and to verify the diagnosis. A true ADD sufferer will respond dramatically to medication.
One personality type that mimics ADD is the right-brained extrovert. You see these folks at parties bouncing from one person to the next. They often involve themselves in many different projects. But when necessary, they can "switch on" their concentration, and they do not respond to ADD medication.
One of the side effects of medication treatment is a racing heart. Before starting treatment, it is prudent to obtain a baseline electrocardiogram, or EKG, to assess heart rhythm stability. An EKG is done in the office and takes about five minutes. The other principle side effect is weight loss. For folks who are borderline underweight, it may not be possible to increase the medication dosage to a desired level of efficacy.
From a medication standpoint, adult ADD can typically be treated with Ritalin or Adderall, although the new ADD medications such as Vyvanse, while more expensive, may have a slightly better side-effect profile. These medications are Schedule II drugs, which mean they require a special prescription from the physician.
Another medication, Strattera, is helpful for most ADD sufferers and is not Schedule II. However, it takes about two to three weeks for the patient to feel the treatment effect. If the response is sub-par, the dose can be raised. Again, there is a wait of another two to three weeks.
Exercise can also be a potent tool in treatment. A Journal of Pediatrics study revealed that children who exercise for 20 minutes a day are able to focus much better in class. Although there isn't similar data for adults, I recommend exercise for all my ADD patients.
Treatment is critical. In addition to the life-changing concentration improvement we see, there is data showing that it keeps people out of jail. Non-treated ADD sufferers are 30 percent more likely to be incarcerated, and it is estimated that 30 to 40 percent of long-serving criminals have ADD. Clearly, untreated adult ADD can be detrimental.