Signs of ADHD

By Donovan Baldwin

I have ADHD. I was not diagnosed until I was in my 60's. Here's some facts about people like me:

1. I might explode if I don't say everything, right now, no matter what.
2. Once a conversation gets past the first sentence I'm lost.
3. The answer to a question in the middle of a conversation is uhhhh.
4. Post-it notes and scraps of paper are how I keep track.
5. Grown-ups do things that don't really matter to me
6. A repetitive system works for me...until it doesn't any more
7. A calendar or appointment book...which I forgot I had anyway
8. Trying to decide which white socks to buy
9. Taking out the garbage and winding up washing the car
10 Finding strange things in strange places, with no idea why.
11.Remembering why
12. Wanting to keep driving because your mind is quiet...or busy
13. Lying awake for three hours because your mind won't shut up
14. Thinking of something and doing it...right then...no matter what
16. You clean a room by throwing everything away, or stacking it
17. You need a pet that cares for itself (spouse)
18. "Fun" equals "sensory overload" equals "not fun"
19. Multiple "Windows" open on your computer (5 - doing good)
20. Out of sight, out of mind...literally.
21. You stop studying an instrument as soon as you know how it works.

The Difference Between Bipolar Disorder, Borderline Personality Disorder and Adult ADHD

By Scott Shapiro

It can be very challenging for even the most experienced clinician to distinguish the differences between Bipolar Disorder, Type II, Borderline Personality Disorder and Adult ADHD. Symptoms often overlap and these disorders frequently co-occur; however, there can be clues from the history and presentation that often help determine the diagnosis and the appropriate types of treatments. Below, is a case of a patient with a challenging diagnosis followed by tips on differentiating Bipolar Disorder, Type II, Borderline Personality Disorder, and Adult ADHD.

Case:

Anna* is a 46 year-old, married nurse with three children. She presented with persistent low-grade depression, anxiety, and irritability. She was on probation at work for poor performance. She also had a long-standing history of difficulty with friendships.

She complained of life-long depression with intermittent episodes of more severe symptoms. During the more extreme episodes, she overslept, felt more irritable and anxious. She reported chronic racing thoughts and difficulty concentrating.

She had a chaotic childhood. Her father was a successful, workaholic attorney who was also an alcoholic. There were frequent, explosive fights between her parents. Anna was the oldest of 3 children and at the age of 10, her parents divorced. She became ensnarled in their long, drawn-out divorce process. In pre-school and elementary school, she had been quite precocious, according to school reports. She listened well, followed instructions, and had many close friends.

However, as the fighting intensified at home around third and fourth grades her grades dropped and she began to exhibit behavioral problems at school.

The above case represents a challenging diagnosis. Below are tips to help determine the diagnosis and whether there is the possibility of more than one diagnosis.

Mood Swings

Mood swings in Bipolar Disorder, Type II last for one to four days and include the person feeling "hyper", "on top of the world", irritable, invincible, elated, or even depressed despite being in a hypomanic episode.

People with Borderline Personality Disorder also have mood swings but they have feelings of sadness, anger, rage, or depression that is more chronically present and triggered by criticism, disappointment or stress. Also, people with Borderline Personality Disorder rarely feel elation.

People with Adult ADHD also describe mood swings and difficulty with managing moods; however, the duration is usually brief and due to low frustration tolerance. Also, in Adult ADHD there are feelings of shame, irritability, frustration, and sadness secondary to difficulty with school, work and relationships.

Impulsivity

Similarly, the symptoms of impulsivity are present in all the disorders but with different histories. Impulsivity may manifest as sexual promiscuity, excessive shopping binges, poor decision-making, automobile accidents or speeding tickets, and careless mistakes. With Bipolar Disorder, Type II, the impulsivity is present only during the periods of hypomania compared to Borderline Personality Disorder and Adult ADHD, when the impulsivity occurs chronically or due to an emotional trigger.

Concentration

All three disorders present with difficulty concentrating or focusing. This creates challenges with completing tasks, jumping from task to task, and starting projects without completing them. These symptoms occur in Bipolar Disorder, Type II only during the hypomanic phase but can be chronic with the other two disorders.

History

In Borderline Personality Disorder, there is more frequently a history of feeling empty and lonely, chaotic relationships, self-injury, and an extreme fear of abandonment. There is often a history of significant physical or sexual abuse during childhood or severe emotional neglect.

In Bipolar Disorder, Type II, there is frequently a family history of depression or Bipolar Disorder, and the symptoms of depression start at an earlier age. Also, depression is the more frequent complaint than hypomania.

In Adult ADHD, the person has persistent challenges with sustained attention, focus, executive functioning, distractibility, time management, procrastination, and significant difficulty with organization.

These symptoms may appear in the other two disorders; however, in Adult ADHD, the symptoms must have existed since childhood. In addition, ADHD has the highest genetic component of all three disorders and is estimated to have a concordance rate ranging from 60-80%. Thus, eliciting a history of other family members with ADHD increases the likelihood that the person may be dealing with Adult ADHD.

All three disorders can manifest "racing thoughts". In Adult ADHD, these thoughts are intermittently present and are exacerbated when there is greater stress or challenge in the environment.

With Bipolar Disorder, Type II, the symptom of racing thoughts occurs only during the hypomanic phase. The racing thoughts are often described as "crowded thoughts" and thinking of new and creative projects.

In Borderline Personality Disorder, the racing thoughts are usually precipitated by an emotionally laden experience such as a fight with or criticism from a friend or colleague.

Case Continued:

Upon further discussion with Anna, she denied having hypomanic episodes. However, she described feeling empty, lonely and having low self-esteem. Under severe stress, she would become acutely agitated, suicidal, have feelings of worthlessness, and be absent from work.

Over her life, she has gone to the psychiatric emergency room 6 times for suicidal thoughts, but has never made an attempt. She has also had a partial hospitalization. In addition, she has a long history of self-injuring behaviors including anorexia, cutting, and unprotected sex with casual contacts.

Anna has Borderline Personality Disorder as well as dysthymia. My recommendation was to start schema therapy twice a week as well as start on an MAOI and to start treatment in an intensive Dialectical Behavioral Treatment Program (CBT). Even though a MAOI is not FDA approved for Borderline Personality Disorder or dysthymia, there research shows its efficacy.

Two years later, Anna's mood has stabilized and she feels much less anxious. In addition, she has been able to enjoy more pleasure in her personal life and career. She has currently been in a relationship for 14 months, and although the direction of the relationship is unclear, she feels more comfortable tolerating the unknown.

This case presents the diagnostic challenges distinguishing Bipolar Disorder, Type II, Borderline Personality Disorder, and Adult ADHD. Using the above distinguishing features and taking a thorough assessment improves the accuracy of the diagnosis and helps in the determination of an effective treatment plan.

References:

Hirschfeld RM,Cass AR, Hot DC, Carlson CA. Screening for bipolar disorder in patients treated for depression in a family medicine clinic. J Am Board Family Practice. 2005:18: 233-239

McIntyre, Roger. Differential Diagnosis of Bipolar Disorder. Supplement to Current Psychiatry. Bipolar Disorder. 2011: 3-22.

* To Maintain confidentiality

Scott Shapiro, MD is an Assistant Professor at New York Medical College and specializes in Adult ADHD. He has a private private in New York City. For more information contact him at 212-631-8010 or visit his website at http://www.scottshapiromd.com.

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Adult ADHD - One Man's Story

Adult ADHD

By Dr. Robert Sprackland

"Robert, stop it!"

Those words haunted me most of my life, whenever people became overwhelmed by my behavior. I just didn't understand what their problem was. Neither did any of the voices in my head.

The voices were constant and all mine, not God or spirits, and they didn't tell me to do anything antisocial. Rather, each (I counted eight) was a stream of regular thoughts, running concurrently, like an eight-track tape playing all tracks simultaneously. I often wandered into a conversational mode described by friends as a "Robin Williams monologue," telling jokes, making puns, jumping from topic to topic, and even changing voices and character.

But my head had always been like that. To me, everyone else moved and thought slowly, took forever to get to the point. I was driving my friends, coworkers and family nuts, and I couldn't to do anything about it. I was also a compulsive eater, injuring my health. Even my decades of meditation practice could not control the internal restlessness.

Then an odd conjunction of events led to help. My sister-in-law, Tina, an Army physician, suffered an injury and needed help driving home from Illinois to New York. I was available, so I spent three weeks with the family, during which time Tina got to observe me at close hand. She soon bluntly told me, "I really, really, really think you have ADHD." When Tina, a lieutenant colonel and formidable diagnostician, uses three "reallys" in a sentence, you had better take her seriously.

But ADHD? Attention Deficit Hyperactivity Disorder? Me? I had thought ADHD, ADD, and all those other new acronyms were children's ailments. I couldn't have ADHD; I was from the generation that found super-fast flashing of movie trailers and TV shows with handheld camerawork difficult, indeed painful, to watch. My attention span could be measured in minutes and hours, not milliseconds and sound bites. I was a trained systematic zoologist, a profession dedicated to compulsive organization of vast amounts of data. No, I couldn't have ADHD.

But as we discussed my symptoms, it became clear that kids do not have a monopoly on brain chemical imbalances. I had all the usual symptomatic suspects. Despite earning my two masters and a doctorate, school had always been excruciatingly painful for me, from staying still in my seat to following laboriously slow lectures. I tested poorly because I either read too much into a question or knew about the rare exceptions. In conversations, I often completed other people's sentences.

Getting to sleep was always an ordeal because my thoughts would not turn off. Though I am very goal oriented, I found it difficult to complete some tasks because I had so many projects going on simultaneously. For example, I had spent a year writing a CD-ROM key to the sharks and rays of the world, but had put off getting it commercially published. On some tasks I focused like a laser, while on others I was dim as a candle. I saw my own physician and a neuropsychologist and, sure enough, got the ADHD diagnosis.

ADHD, first described as "defect of moral control" by an English physician in 1902, is a simple failure of the brain to balance levels of neurotransmitters called dopamine and norepinephrine, which help regulate moods. My diagnosis and subsequent treatment with Adderall radically and swiftly changed my life for the better. This amphetamine--an "upper"--actually quiets the ADHD personality. My hunger cravings are gone, I sleep well, get more things done, do them better, and haven't gotten on anyone's nerves lately--especially my long-suffering wife of thirty years! Overall, I have been clam and happy--not excited or ecstatic--every day since treatment began. Best and strangest of all, I now have only one thought in my head at any time. It is the psychological equivalent, I think, of having sent all the kids off to college, and I get the house to myself.

There has always been stigma attached to mental illness; it's "all in our heads." Mental difficulties are still seen as other than physical or physiological, and even Congress refuses to recognize mental illness for what it is. This stigma is devastating. As a zoologist, I understand how my insides work, so it didn't affect my decision to be treated, but for most people, being "mentally ill" ranks in the bad news category with heart problems or cancer--or worse! People who could benefit deny themselves help that could substantially improve the quality of their lives. We do not mock a person with a faulty heart for taking nitroglycerin; a person with a defective pancreas for taking insulin; or any of us with an overwhelmed or compromised immune system for taking antibiotics.

Even Viagra jokes are rare these days. Why, then, do we see such intolerance when another organ, the brain, is ill? Many influential people had ADHD, including Dustin Hoffman, Will Smith, Jimmy Stewart, Vincent van Gogh, Leonardo da Vinci, Benjamin Franklin, Albert Einstein, Winston Churchill, and, of course, Robin Williams. Brain disorders are real physical manifestations that can often be simply treated. Unless our brains get moved elsewhere, mental illnesses will always "be in our heads." Those of us who can benefit from medication should take it, and the rest of us should support our loved ones who need it. It will make things much happier in our hearts and in our heads.

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How Do You Think I Feel?

I know that it has to be frustrating to live or work with me. Hell! It can be frustrating to ask me for directions!

A few years ago, I published an article When Every Day is Christmas. At the time, I was perfectly aware that I was a little, well, wierd. However, it was later that I was actually diagnosed as having ADHD/ADD.

Looking back at the article, I can see how it delineates, in a hopeful, sort of positive, manner what having ADHD is like...and what it can be like for the people I come in contact with.

A friend of mine, who has ADHD himself, silently walks over and turns on a switch that I have regularly forgotten to turn on for the last six months. He understands, but how would YOU handle someone that "stupid".

I'm on my second wife, and I am sure that the first one took a walk, at least partly, because I just didn't seem to care.

I did, but somehow, I could not convey. I could not explain why a 40+ year-old genius with college degree (dean's list, no less) could barely hold a job and never seemed to progress beyond the lowest rungs of the ladder.

Every day has been filled with recriminations and self loathing, but, at least since getting the diagnosis and learning more about the condition, I have been a little better able to forgive myself...but it's still hard.

After all, I'm supposed to be the provider, the solid citizen, the person looked up to and respected. As it is, I'm the person who survives, and sometimes I wonder why...or how.

If I cannot understand and accept, how can those around me? On the other hand, if I cannot understand and accept, how can anyone else.
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One man's story: Conquer ADD/ADHD

The Beginning Is Usually a Good Place to Start

To tell the truth, I am not sure exactly where this ADD ADHD blog of mine is going for more than one reason.

For one thing, all this is new to me, and I will be incorporating what I learn as I go along. Hopefully, both you and I will benefit from this. If there is no "you" then maybe I will still benefit from the process.

For another, I don't really know what direction I want to take, or, if I even want to take one at all! After all, despite being on medication for ADHD for the first time in my life, I AM still affected by ADHD, and what comes out of my fingers, and supposedly my brain, is not always what I expected or intended.

Finally, this is going to be written by a "person" who did not exist before February 10, 2010.

So, here goes!

My name is Don (Donovan) Baldwin. I am 65 years old (not a typo - born 1945), and have not preveiosly been diagnosed with any sort of mental abberation or unique condition prior to last week...although I suspected that I might be struggleing with ADHD for the last few years...through two marriages, a multitude of jobs, several changes of address, and a few million failed dreams, it seemed.

Learning that I probably had ADHD was actually a relief, as it explained several things which I had simply beat myself up about since about 1950, when I started the first grade. While we usually all have some measure of control over what we do, even with ADHD, it sometimes is a reality that some other power also has a certain measure of control as well.

If you have the condition known variously as Attention Deficit Disorder (ADD) and/or Attention Deficit Hyperactivity Disorder (ADHD), things happen and you don't know why.

Perhaps, like me, you think to yourself, "Either I am like everybody else, or I am different. If everyone else is like me, why don't they all have the problems I have? There must be something about ME that makes me not be able to do what they do. What is wrong with me? If we are different, what is the difference, and what is wrong with me that I cannot live like they do?"

"...what is wrong with me."

As I learn more about ADHD, that's an attitude that I find many of us have.

After all, teachers tell us that if we just try harder...or to concentrate...or to be more like Jimmy or Suzie (apologies to all the Jimmies and Suzies who might read this).

Parents get phone calls from teachers, or simply from personal exasperation tell us to "work harder", "do better", be like....well, you get the idea.

For anyone reading this who does not have ADHD please understand this...

MAYBE WE ARE TRYING HARDER, WORKING HARDER, DOING BETTER...MORE THAN YOU WILL EVER KNOW!

As a kid, I could not keep up in school despite a genius IQ. I managed to read my way through a couple of libraries trying to find tips and techniques that would help me make c's in my classes. I wanted my mother and father to be proud of me, but within two minutes of the teacher beginning a class, I was in a completely other world...aware of the noise and events around me, but not a part of it.

Homework?

It's hard to do homework when you did not learn the stuff in class that the homework was related to.

High School and College?

More of the same.

Even at this moment, with the Adderall coursing through my bloodstream, and a strong desire to understand myself and perhaps help you as well, I am fighting getting up and going to do something else.

The fantastic outline for this starting post has completely disintegrated and I am now fumbling for words.

Let me just fall back on one symptom of ADHD and how it may have contributed to the course of my life.

People with ADHD often blurt out information or statements which a "normal" person has sense enough to keep to themselves. Now, these are not always "fightin' words", but sometimes it's just better NOT to say something than to say it.

I was married for 20 years to one woman and have been married for 16 years to another. Over that 36 year period, BOTH (entirely different personalities) have constantly complained that I "correct" them.

I have. No denying it. However, in just about every instance, I felt compelled to make the statement because what they had just said did not quite fit into the way my mind wanted to comprehend the meaning. Sometimes it was a trivial distinction of words or facts. Sometimes it was just an additional comment that had no purpose.

In most instances, however, it was out of my mouth before I even realized it was on its way. Also, in most instances, it made perfect sense TO ME and NEEDED TO BE SAID.

I have noticed just in the few days that I have been taking Adderall, that this urge has abated. I spent the day with my wife and let three different opportunities for such remarks pass by without feeling any pressure to activate the Sicilian blood in my beloved wife.

Hope this makes sense to you. It does to me...sorta

I just re-read what I had written and noticed that it wanders around and reaches no real conclusion. So have I for the last 60 years.

The book I am currently reading to learn more about the problem I live with daily is Delivered from Distraction: Getting the Most out of Life with Attention Deficit Disorder
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