Welcome to Dr. Sterling's Adult Attention Deficit Disorder Web Page!

The mission of this page is to provide you with information and resources for understanding Adult Attention Deficit Disorder (Adult ADD).

Attention Deficit Disorder (ADD) is technically called Attention Deficit Hyperactivity Disoder (ADHD). I use the term ADD because the more technical term tends to mislead people into thinking that hyperactivity must be present to make the diagnosis. Not true. Adult ADD only started receiving proper attention in the last ten years. This means that the diagnosis and treatment of ADD in adults has lagged behind. It is not a "fad" diagnosis. It has historically been underdiagnosed and undertreated, so all of us are catching up on our awareness and proper treatment of ADD. Historically, ADD in children has received the most attention because of the challenges that hyperactive, impulsive children caused for school systems. ADD has at least two types of expression -- a hyperactive type and what I call a "day-dreamer" type.

It used to be thought that children with ADD grew out of it, but it became evident that what they were often growing out of was just the hyperactive component. Many children with ADD became adults with untreated ADD. Many were never diagnosed during their school years because they weren't causing problems (the day-dreamer type) and because awareness of the many characteristics and subtleties of the disorder have not been and still are not well-known.

People with ADD often experience failures in higher education and have lifestyles of rapidly changing jobs, poor work skills, and difficult relationships. Due to frequent failures, adults with ADD often get depressed and experience chronic low self-esteem. In addition, adults with ADD often experience significant negative daydreaming (worrying), which sets them up for chronic mild depression and substantial moodiness. They also can get easily overwhelmed, which translates into a feeling of chronic anxiety.

In their book Driven to Distraction, Edward M. Hallowell, M.D. and John J. Ratey, M.D. use the term "attention inconsistency disorder" to more accurately describe the attentional problems related to ADD. ADD is not a "deficit" in attention as much as it is distractibility which leads to inconsistent attention, or "flitting" attention. I call it "serial single-tasking," which I will write more about soon. The true "deficit" in Attention Deficit Disorder consists of less-than-normal levels of certain neurotransmitters in a certain part of the brain.

Here are a few signs of ADD in adults: (1) Inattention and memory problems -- losing or forgetting things, being absent-minded, not finishing things, misjudging time, trouble getting started ("procrastination"); (2) Hyperactivity and restlessness; and, (3) Impulsivity and emotional instability -- saying things without thinking first, interrupting others, easily frustrated and angered, unpredictable moods, risky driving behavior. ADD seems to be distributed equally between women and men.

We do not yet have the ability to directly study the living human brain at the microscopic level, so we do not yet know the precise causes of ADD symptoms. Research points toward a deficit of the neurotransmitters norepinephrine and dopamine in the prefrontal cortex of the brain. A well-functioning prefrontal cortex is crucial to judgment, organization, attention span, planning, impulse control, problem solving, critical thinking, forward thinking, and empathy. However, there are several specialized areas of the prefrontal cortex that we do not yet fully understand. We do know that all ADD is not the same. There are neurotransmitter and neuroanatomical differences and, thus, there are subtypes of ADD. This is likely the reason that some medications work with some people, but not with others.

To help people understand the deficit in ADD, I use the "bridges-out" concept. The brain is made up of billions of little pieces of road (nerve cells). The pieces of road are connected by bridges (chemicals called neurotransmitters). In the human brain, there are no long roads without bridges. So, if a lot of bridges are out (low neurotransmitter levels), there are fewer roads available for transporting data. When there are only a few roads for information to travel on, much information doesn't get processed properly. People with ADD can be very good at single-tasking, but generally do not multi-task very well.

All medications that help with ADD symptoms do similar things -- they increase certain neurotransmitters in the prefrontal cortex. Thus, they put more bridges back into operation creating more usable roads for information processing. If people with normal levels of neurotransmitters take these medications, they may get mostly side-effects. There are no advantages to increasing neurotransmitter levels to above normal. Unfortunately, these medications do not permanently repair the brain, but just add a missing component.

Not all people with ADD have difficulties and problems. There are people who, because of their particular circumstances, intelligence level, or support systems, do very well. They may be very creative and energetic, and accomplish a lot. However, in those people who are experiencing mostly the downside of ADD, I recommend a thorough evaluation and a treatment plan.

Below are a few links for further information about Attention Deficit Hyperactivity Disorder.

• Driven to Distraction at Amazon.com -- written in 1995, but, still, the best book to read to get a good understanding of Attention Deficit Disorder.

• Thoughts on ADHD and Marriage by Dr. Ned Hallowell and Melissa Orlov -- great website for learning about and discussing the ups and downs of relationships that involve partners with ADHD.

• National Institute of Mental Health -- Attention Deficit Hyperactivity Disorder (ADHD) page.

• WebMD.com -- Attention Deficit Hyperactivity Disorder (ADHD) page.

• ADD Resources is non-profit organization, based in Tacoma, Washington, whose focus is adults with Attention Deficit/Hyperactivity Disorder (ADHD), but whose purpose is to help all ADHD people achieve their full potential. Their site contains links to excellent articles about ADHD.

• The Northwest Children and Adults with Attention Deficit/Hyperactivity Disorder Web site has information and links to many ADHD support groups throughout Washington.

• ADDitude Magazine contains a large amount of resources for understanding and dealing with the symptoms of Attention Deficit Disorder.

Dr. Sterling is in the process of writing several articles about ADD, including "Quiet Brain, Unquiet Mind," "The Genetics of ADD," and "Is ADD a Fad Diagnosis?" Please come back and visit soon.

Dr. Sterling is very experienced in the treatment of ADD with all the techniques that are available, including coaching, relationship counseling, psychotherapy, and medication. Please visit his office website at BellevuePsychiatry.com to read more about Dr. Sterling's practice or give him a call at 206-784-7842 to set up an appointment. You will often reach him directly during the week.

Thank You for Stopping By!

-- Best wishes, Dr. Sterling