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Dear Dr. Debug:
My mother, now 58, 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.
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.
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.
Once proper medication has been found, follow-up psychotherapy or counseling is very important for people experiencing the symptoms of ADD 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. I prefer to use the term Adult Attention Deficit Disorder rather than Adult Attention Deficit Hyperactivity Disorder because there is a misperception that hyperactivity is required to make the diagnosis. It is not.
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. Many adults over the age of 50 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 are often 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 Mental Wellness
Ron Sterling, M.D. (Dr. Debug) is an award-winning psychiatrist in Seattle, Washington. He has been writing for newspapers and magazines since 1998 on subjects ranging from good manners to senior mental health. He hosts and maintains the well-known Internet mental health center, DearShrink.com. The Doctor Debug column is dedicated to assisting with the "debugging of malfunctioning elements in our own personal programming."
Adult Attention Deficit Disorder
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