Adult Attention Deficit Disorder
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"ADHD (attention deficit/hyperactivity disorder) in adults is a more complex pathological condition than ADHD seen in children and adolescents. The number of reports of impaired self-regulation are on the increase. Psychiatric comorbities are being found ever more frequently, and negative life experiences are coloring the clinical presentation to an ever greater extent. Therapeutic strategies involving the use of stimulants and antidepressants are often needed to pave the way for individual and group psychotherapy. Despite the fact that it is currently considered to be "fashionable", the diagnosis of ADHD is a clinically relevant and persisting psychological disorder".

Laufkotter R, Eichhammer P, Hajak G.
Klinik und Poliklinik fur Psychiatrie und Psychotherapie der Universitat Regensburg. rainer.laufkoetter@medbo.de [Article in German]
MMW Fortschr Med. 2004 Aug 19;146(33-34):31-4
PMID: 15526623 [PubMed - in process]


   The attention deficit would be rather a variability of the attention, in specific situations, often mixing with features of hyperactivity or sometimes of opposition. But it seems to appear as mental hyperactivity, with split interests, daydream and lack of organisation. Without taking the time to reflect, it becomes almost inevitable to face frustrations, which one could barely avoid. In the daily routine, the lapses of memory multiply, as to neglect the dates, to miss a meeting or give to many appointments at the same time, to lose belongings, to live present time without much concern of the past or following day, to work in the disorder and improvisation. Those are some of the difficulties that these people have with this unstable attention disorder. Curiously, the emergency improves the level of attention, as some activities, being more physical, visual, or concrete. The inattentive individual will have little of interest for the detailed organisation and followed planning. He is a person of need. Who really concentrates in the strong tension, but will have little interest for the banality of the daily routine. This tension could become a source of pleasure; the routine, a cause for troubles and errors of attention. The unstable attention is shown often selective. One often recognises it among popular and leading characters of men history; at those who needed challenges and intensity, who did not fear the danger, unable to foresee it all. A condition of this nature can deserves a person (the daydream, for example, who supports the creativity) as much as he manages it effectively, but can become an actual invite for failures, if he is not aware of the level of his vulnerability. There will be always a certain degree of activism if not hyperactivity, under almost all the conditions of ADHD, but varying largely according to the temperaments, interests, or abilities.

Comments:
    It's a pity that up to now this problem is often ignored in general psychiatry, if not exaggerated with arbitrary diagnosis. In general, confusion comes mainly from the activism, which one confuses with mania, or of the states of exhaustion, which are equivalent of depression. However, other states, as soon as the stresses disappear, the emotive level improves quickly.
    The difficulty of the child, who suffers from it, always does not disappear with age. Undoubtedly it changes as the adult chooses its activity and is thus likely to better perform on the level of his interests. This person will be able to better function in chosen sectors of activity. Often it prefers what is more visual, manual, bodily, the inductive over the deductive or the pure abstract matter. For Saint-Ex, the physical intense activity was used as an activator for his talents of poet and philosopher. Einstein worked into an inductive way, calculating, according to its sister, the movement of the volutes of smoke flying from its own pipe. It should be believed that, according to Howard Gardner, there are indeed several types of intelligence: linguistic, logico-mathematic, spacial, kinaesthetic or bodily, musical, intra-personnal, interpersonal, others still to discover. With an attention deficit, the adult can medicate himself with coffee, alcohol or even drug. But the drama does happen when the individual improvises his life, like this man, a high level manager, driving his car without even thinking of having an accident assurances. These situations of failure add with the years. The depression appears one day. Even close relationships do not want to help any more and give more support, in front of a friend or relative who always burns his chances with an apparent lack of concern.

Time and space:
   The relation at time remains fundamental. " Time, writes Dr. E J Hallowell in an autobiography note, is what prevents everything happens at the same moment. It is subdivided in pieces that organise themselves ones after the others. In the attention deficit, time breaks down, it becomes a black hole; it is as if all arrived at the same time. The individual loses the prospect and the capacity to give priorities. " For lack of reflection and overstimulation of ideas, the individual invests the only present time, a kind of infinite present, which is connected neither to past nor the future, and lives in a space without limits. It does not refer to the gained experience and foreseen future event. In a way, the attention deficit protects from misfortunes of the past or anxieties of to-morrow. As said a patient who went through the worst life trauma, from incest problems to the multiple foster families and losses, " I see the past like a film ", without very acute emotions. An indifference which would not be possible with the temporal notion. What preserved her energetic and creative. This deficit also protects from the distressing future, towards the phobic fears which emphasise this dimension at the expense of the present or of the insecure person who looks only towards the past. A temporary attention deficit can occur under any condition of physical or mental tiredness, and also mental illnesses like the bipolar disease (manic-depression).

Make order:
   To give better priorities will be able to form the base of a better future. Each situation is to be better organise in time. Some people will require a coach, as a friend for confidence. A 40-year-old journalist who had never read a complete book, was thus unable to do his office work, to structure his agenda, and especially meets the dateline. Since he had stopped with emergency missions, the routine had lost him. A 35 year old lady never managed to pay her tickets before the last warnings, event threats of worse sentences. She had all the money needed, but forgot constantly, at the last moment having a new idea. The automatic payments saved her many nuisances. The credit companies would benefit largely of this problem. A 41 year old lady who had known all the schools of the city (at least 20), and had three years of day-care follow-up, decides for medical treatment after having seen an ADD on her young girl; " it is the first time that the notes of the piano do not float ", she testifies after a few weeks, being able to perform long and difficult plays, never possible before.

Behaviour to be followed:
   
The adult has the capacity of self-criticism, the ability to mirror, to criticize oneself before others can do. It is an asset, which occurs rather late in life, after the twenties, at least. Being able to well structure its daily agenda, to avoid overstimulation, to foresee obstacles, to put some limits, with the need, sometimes, to hire a professional coach. But in front of failures which sum up, the inability to improve his condition or to carry out a significant part of its potential, the occurrence of depressive states, bad relationships, this is also necessary to go towards the medical assistance which can distinguish between side-effects of the ADHD difficulties and other conditions like bipolar or unipolar (manic-depression) diseases. Sometimes medication becomes necessary when the personal effort and coaching are not enough any more and it is necessary to avoid more suffering.
   However, the medical resources are almost entirely lacking towards the adult and the science has made a malicious pleasure to complicate the life, when it could be more simple. Prevention could be done with few expenses, by having early diagnosis. But the official psychiatry which carries the load of the heavy diseases and is capable of achieving so much in high mountains seems paralysed in the small foothills. Almost a quarter or third of the emergencies will have a direct links with ADHD through burn-out, depression, drug abuses. What a useless drama!

General references:
. " The Nature of ADHD and Self-Control ", Russell A. Barkley, Guilford Press, 1997.
. " Driven to Distraction ", Dr. E J Hallowell and J J. Ratey, Touch-tone edition, 1994.
. " Answers to Distraction ", Dr. E J Hallowell and J J Ratey, Bantam edition, 1996.
. " ADHD in Adulthood ", Weiss, Hechtman and Weiss, Johns Hopkins, 1999. Very recommended as these Canadian authors, as childpsychiatrists, make an overview of childhood psychiatry, their first expertise, as that of the adult.

 

Dr. Claude Jolicoeur, childpsychiatrist,
Montreal, revision 2000.