Mind Matters -- March 2005
Written by Ron Sterling, M.D. and Published in Northwest Prime Time Magazine

Born to be Rude
by Ron Sterling, M.D. -- March 2005


    Dear Dr. Ron:

      My mother, now 72, was diagnosed with adult attention deficit disorder (ADD) about four months ago. I became very estranged from her over the years due to her impatience, hostility, constant criticism, and rudeness, among other things. Because of the huge amount of hurt feelings that have taken place, I am having a very difficult time believing that her ADD is responsible for her very self-centered style. I am not in any mood to forgive her for all those hurts. Can you help me with this? -- Signed: Still Reeling From Rudeness.

    Dear Still Reeling:

      Thank you for writing! I can sympathize with your situation. Dealing with or changing feelings about a lifetime of unpredictable and rude behavior from a parent can be a very big challenge. However, if your mother's adult attention deficit disorder (ADD) diagnosis is correct, most likely, many of the hurtful behaviors that you have experienced over the years could be attributed to your mother's ADD.

      You did not mention whether your mother has been started on a medication for her ADD. Typically, medications for ADD, such as methylphenidate (Ritalin®), will make noticeable differences in thinking and behavior. However, four months may not be long enough for your mother and her physician to have found the correct medication and dosage. If, after a proper trial of at least three of the well-known medications for ADD, there is no improvement, it could be concluded that her behaviors are not likely due to ADD.

      Once proper medication has been found, follow-up psychotherapy or counseling is very important so that old habits can be examined. Looking at old behavior patterns and discovering that changes are possible is a new experience for people with ADD -- many gave up on themselves long ago. With proper follow-up and medication, dramatic changes in the so-called "self-centered style" attributed to people with ADD can take place in less than a year.

      Medications that are known to assist with ADD symptoms are methylphenidate (Ritalin ®), atomoxetine (Strattera®), bupropion (Wellbutrin®) and a mixture of amphetamines called Adderall®. They all have very similar effects -- they increase the levels of norepinephrine and dopamine in the prefrontal cortex of the brain. Evidence from several types of research indicate that people with ADD have lower than normal levels of such neurotransmitters.

      Because it used to be thought that ADD was an illness that children grew out of, many children with ADD became adults with untreated ADD. Older adults were never educated about ADD because the disorder did not even have its name until 1980. Common signs of ADD in adults include: (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.

      Without a diagnosis of ADD, adults with ADD characteristics would likely be thought of as self-centered, erratic, rude, deceitful, manipulative, and undisciplined, among other things. Many of the characteristics of adult ADD also significantly overlap with the signs of narcissistic and antisocial personality disorders.

      We might be able to accept or be sympathetic towards a child who displays many difficult ADD symptoms thinking "kids will be kids." However, the same behavior in an adult will not generally be accorded a similar sympathetic reaction. The adult who talks before thinking, acts before pondering, is easily upset and seems to be always angry about something will hurt many people's feelings.

      I hope this is helpful. For more information about adult attention deficit disorder, please visit www.AdultADDFacts.com. Best wishes, Dr. Ron.

        Author Bio:

        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. The content offered through Mind Matters is for information only and is not intended for medical, psychiatric, or psychological diagnosis or treatment. Never disregard professional advice or delay seeking it because of something you have read in this column. 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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      Have a great day!


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RON STERLING, M.D.
General Psychiatry with Specialization in Adult Attention Deficit Disorder
SeniorMentalHealth.org
Phone: 206-784-7842
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Updated October 7, 2007
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