JUST WHAT DOES ADHD (ATTENTION DEFICIT HYPERACTIVITY DISORDER) LOOK LIKE IN AN ADULT?
Monday, March 21st, 2011JUST WHAT DOES ADHD (ATTENTION DEFICIT HYPERACTIVITY DISORDER) LOOK LIKE IN AN ADULT?The primary symptoms of ADHD—inattention, hyperactivity, impulsivity, etc.—don’t really change in adults, but their presentation does. They’re often less pronounced, but seldom do they disappear completely.It’s important to remember that our adult lives resemble childhood and adolescence in many ways. Instead of going to school, we go to work. But we must still interact with our peers, pay attention to our superiors, and complete our assignments as instructed and on time. In social situations, we interact with others, read their faces and emotions, and react appropriately. The same goes for our interaction with members of the opposite sex. These tasks are often difficult for children with ADHD and equally so for adults with the syndrome.In adulthood, common signs of ADHD include the following.An inability to concentrate for any length of time.An inability to finish assigned projects on deadline.Poor organizational skills.Procrastination, especially where work is concerned.Difficulty in sustaining interest and focus over a length of time or through to completion of a project.Few interests and hobbies; a tendency toward boredom.Difficulty interacting with superiors and co-workers (and often family and friends).Difficulty coping with the small “waits” in life, such as traffic lights, supermarket checkout lines, and business meetings.Poor memory. Many ADHD sufferers overcome this problem by writing down everything they need to remember throughout the day or placing reminders in visible locations.Extreme distractibility and restlessness.Impulsivity, such as blurting out an answer before being asked, interrupting another speaker, or saying something before considering the consequences. This may also manifest in impulsive actions, like frequently changing jobs, impulsively shopping or spending money, impulsive eating, and rapidly changing one’s mind.An overwhelming need to be in motion. Adults with ADHD usually don’t run around the room like they did when they were children, but it’s not uncommon for them to constantly jiggle a leg, tap their fingers, or suddenly stand up in a meeting and walk out of the room.An addictive personality.Poor self-esteem, based on years of perceived failure.A hair-trigger temper.A tendency toward physical aggression.Obviously, not all adults demonstrate every one of these symptoms. And as with any condition, the presentation of symptoms may be very obvious or very subtle. It all depends on the individual. I will illustrate this picture by describing Leslie, who first came to my attention when she was twenty-eight years old.
Leslie, a twenty-eight-year-old womanLeslie, an attractive, slender brunette, came to see me in a state of great distress and anguish. She informed me that she had moved to a large country town near my northern Connecticut practice determined to start a new life. She hated the southern city she had recently moved from, but now feared the country wasn’t the place for her, either. She felt her life was slipping through her fingers and that she would never have the husband and children she longed for. She hated all the jobs she’d had, did not know what to do with herself, and hoped that by talking to me a few times, she-could make the right decision regarding where to move.Her mother had died during her sophomore year in college, and since then Leslie had roamed around lost and mainly unattached. She changed colleges several times, took time off in between and took many years to finally graduate. Her older brother had been out of contact for years, and her father, devastated by his wife’s death, had been emotionally unavailable and now was remarried. She did not connect grief regarding her mother’s death to her ten years of wandering. In fact, she asserted, she never even cried and certainly did not miss her mother. She felt she had always been depressed and anxious, “since she was born,” and now it seemed obvious to her why anyone would be so depressed in her situation. She was sure she was getting old, losing her looks, had no talents or intelligence, and feared no man would ever love her because there were so many younger and more attractive women to be had.As we began to meet frequently and I got to know Leslie better, certain features stood out. One was her emotional storminess. Frequently our sessions were filled with deluges of crying, angry yelling, panicky anxiety, and states of enormous anguish and pain. She would speak continually, moving from one incomplete sentence to another, constantly changing her mind as to what she wanted to say and rarely even attempting to explain any connections between her emotions and an immediate event. It seemed as though she experienced her life as a globally painful experience, with no meaning or reasons, and that all she needed to do in therapy was to show me the pain. She described regularly waking up at night in terror, convinced that it was too late, that she was already growing old and ugly and would never be loved by a man. And she seemed unable to find any way to calm herself down or to soothe herself, other than to put herself into a sleepy state, when she would nap on and off during the day, or to exercise excessively, often running ten miles a day.Leslie’s difficulty in speaking about herself, either in terms of her feelings or in terms of her life history, was another feature. She did not seem able or willing to use language as a way of describing or of investigating pain. She even seemed unable to describe to me, or narrate, her daily experience. However, at times she showed that she had quite an unusually rich vocabulary. And her fund of knowledge indicated an intelligence well above average. She did not have the disordered thoughts characteristic of a psychotic person. In fact, her difficulty in communicating clearly and, I suspected, in thinking clearly mainly centered around her own life story and her emotional states.Another striking feature was her lack of interests. There seemed to be nothing that she cared about or felt passionately about. She went from one activity to another, taking courses that she dropped after one class, starting jobs that she left within the first week, and meeting people that she lost interest in on the first encounter. For her, any choice about where to live, what to do, or what kind of work to engage in was totally arbitrary, as she had never been interested in anything.Leslie claimed that she could not understand things, was confused, and had an impaired memory. She said school had always been difficult for her, even though at times she had done well. It was terribly hard for her to remember anything she read, and although she tried to read novels, she couldn’t describe what one was about after she finished it. She claimed that reading anything else was just too much of a struggle and that this was why she could never go to graduate school. She remembered having enormous difficulties organizing her thoughts to write papers. College was a constant nightmare for her.*31\173\2*