Written by Ron Sterling, M.D. and Published in Northwest Prime Time Magazine
by Ron Sterling, M.D. -- March 2004
It used to be thought that children with ADD grew out of it, but it became evident that what they were actually 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). They often experienced failures in higher education and had 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.
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, driving recklessly. 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 neurotransmitter norepinephrine 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.
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 usuable roads for information processing. If people with normal levels of neurotransmitters take these medications, all they may get are 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 system, 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.
There are likely as many older adults as there are younger adults who have undiagnosed and untreated ADD. Please visit Aging Brain Web Page for more information on ADD. -- Best wishes, Dr. Ron.
Ron Sterling, M.D. is a 64 year-old General and Geriatric Psychiatrist with a private practice in Seattle. He invites you to e-mail him at with any questions about mental wellness or emotional, relationship, or aging concerns. He is the only person who reads e-mail sent to Dr. Ron. Please be assured that your questions and identities are completely confidential and protected. For more information about Dr. Ron and for resources related to senior mental health, please go to SeniorMentalHealth.org. Read our Disclaimer. If you wish to understand more about Dr. Sterling's potential biases in health care advocacy, please check his Conflicts of Interest Disclosure Statement
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RON STERLING, M.D.
General Psychiatry with Specialization in Adult Attention Deficit Disorder
Updated October 7, 2007
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