The Impact of the Mind on the Body

Science continues to find more evidence of the connection between the mind and the body.  Mental health has an enormous impact upon one’s physical health such that you cannot have one without the other.  Though society continues to be more comfortable  treating mental health issues with the seriousness they deserve, many continue to feel that they should be “strong enough” to cope with mental health issues without seeking treatment.

The following article from CNN.com presents the findings of a study in which depression was found to be correlated with heart disease in young women and solidifies the importance of caring for one’s mental health in the same way one would be concerned about their physical health:

Young women are twice as likely to suffer a heart attack or die of heart disease if they suffer from depression, a new study suggests.

Researchers looked at 3,237 patients with suspected or established heart disease who were undergoing coronary angiography – a medical procedure used to diagnose narrowing in the arteries that supply blood to the heart. On the same day of the procedure, the patients answered nine questions assessing their state of mind.

If the patient was experiencing moderate to severe depression, and was under 55 years old, researchers found she had double the chance of experiencing a heart attack in the next few years. Depressed women under 55 were also twice as likely to have heart disease or to die from any cause during that time period than those who were not depressed. Men and those women older than 55 with depression did not show the same increased risk.

Depression is as powerful a risk factor for heart disease as diabetes and smoking, study author Dr. Amit Shah, a cardiologist at Emory University in Atlanta, concluded.

Shah believes there’s a biological reason as to why depression harms young females’ hearts in particular. Mechanisms underlying the association of depression and heart disease could be inflammation or hormonal regulation, the study author wrote. However, the exact reasons for the link are still unclear.

“When people get depressed, they stop taking care of themselves. And when they stop taking care of themselves, they get sick,” said Dr. Suzanne Steinbaum, a spokesperson for the American Heart Association, who was not involved the study.

Dr. Jared Maloff

(310) 712-5480

Bar Exam Testing Accommodations

As a clinical psychologist who specializes in assisting students gain much needed testing accommodations on the Bar Exam I am aware that there is a pervasive misconception about this process in the minds of test takers.  Most students believe that it is next to impossible to be granted testing accommodations (such as extra time, a private testing room, taking the exam in 6 days as opposed to 3 days etc…), but this simply is not the case.  As someone who has interacted with the State Bar of California countless times on behalf of students, I can firmly say that I find them to be generally fair and at times even sympathetic to students who require testing accommodations.  I believe that the misconception that it is next to impossible to be granted these types of accommodations on the exam stem from many students’ past experiences attempting to gain accommodations on the LSAT.  LSAC is difficult and generally unfair in their dealings with students’ needs.  They deny the vast majority of applications for accommodations within populations of students who legitimately do provide evidence that accommodated testing is necessary.  As a result they have been sued myriad times for not abiding with the American’s with Disabilities Act.  The State Bar of California has proven to be more even handed in their dealings with students who require accommodated testing.

The American’s with Disabilities Act stipulates that students with current verification that they experience substantial limitations in major life activities such as concentrating, thinking and reading should be provided testing accommodations. Clearly concentrating, thinking and reading are not only major life activities, but ESSENTIAL ACTIVITIES with respect to taking and passing the California State Bar Exam.  Students with diagnoses such as ADHD, learning disorders (including information processing deficits), anxiety disorders and mood disorders often require extended time on the Bar Exam because they may be unable to read, comprehend and process information as quickly as their peers.  Being unable to complete the Bar Exam certainly presents an undue burden on a student hoping to pass the exam.  Students with long and documented histories of receiving accommodations in school for these issues are able to present very strong evidence to the Bar that they should continue receiving accommodations, but those without any history of ever receiving testing accommodations are not automatically denied.  In fact, I have seen many students who have completed law school without ever even asking for testing accommodations be approved for testing accommodations on the Bar Exam.  The reason for this is that while one’s history matters, it is essential to any petition for accommodations that substantial, persuasive and current data is presented to support one’s application.

The most common reason a deserving applicant is denied accommodations is because an evaluator did not present information regarding the nature of a student’s weaknesses in a cogent, linear and persuasive manner.  Many physicians and psychologists believe that if they simply recommend accommodations and provide cursory rationale, the Bar will approve the application.  This is not the case.  When assisting a student with a request for testing accommodations I write a 20-25 page report explaining in detail why accommodations are necessary while addressing all the relevant points that the Bar requires.  I address a student’s life history, educational history, current test results and an explanation of how all of the information fits together in a way that presents compelling evidence that a student requires testing accommodations.

Any student who struggles with attention, concentration, reading speed, reading comprehension, time management or severe test anxiety should seek consultation with an expert well versed in Bar Exam testing accommodations, regardless of their past history or lack thereof accommodations.  Those with significant weaknesses in the aforementioned areas are at a serious competitive disadvantage on the Bar Exam, and require accommodations to have a fair chance at expressing the full extent of their intelligence and legal knowledge.

 

Dr. Jared Maloff

(310) 712-5480

Taking a Cautious Approach to the New Test Available for ADHD Diagnosis

A test which can offer a more accurate diagnosis of ADHD in children and therefore reduce the prescription of unnecessary medications is an appealing prospect, particularly as 66% of children in the US who receive a diagnosis currently take medication. This is what a new screening tool that has been approved by the FDA is promising to do. However, rather than taking into account the full clinical picture, the Neuropsychiatric EEG-Based Assessment Aid (NEBA), as the name suggests, measures someone’s brain waves; lasting around quarter of an hour, electrodes are placed on a child’s head to measure their brain activity. This is based on findings that, in general, a child with ADHD does not have the same pattern of brainwaves as someone without the condition; the ratio of theta and beta waves is reported to be higher in youngsters with ADHD, which may explain their altered focus and attention. However, is this information really sufficient to be able to make a diagnosis?

Simplifying a complex diagnosis

Concerns have been raised that the development of this new tool will lead to an over-reliance on the device for the diagnosis of ADHD and that it may try to simplify what is a complex diagnosis, with time-poor physicians using this without gathering the necessary background information or referring on to a specialist. Rahn Bailey, who is the National Medical Association’s president, spoke of being “cautiously optimistic” about the device, but warned that no matter what technological advances there are, a diagnosis should always be based on clinical decision-making, considering all the information available. His thoughts are echoed by the fact that the FDA has approved that the NEBA device can only be marketed for use in conjunction with medical and psychological assessment of ADHD, so that its use does not replace clinical evaluation; it would merely help to inform the decision.

Too small and narrow a sample

Although accuracy in the diagnosis may have increased from 61% to 88% when NEBA was used, the study itself has been called into question with regards to both sample size and diversity. While the clinical study for the device met the standards set out by the FDA, it only involved 275 children and just 17% of children in the study were African-American. However, according to CDC figures, rates of ADHD are nearly as high amongst African-American children as those who are white, so this should have been reflected more accurately in those participating in the study. The findings indicated that the accuracy of diagnosis was lower in African-American children (85% compared to 90% among white children), so without adequate diversity in the study it is difficult to know whether the electrical activity in the brain in ADHD is similar across different ethnic groups. As African-American children are already at a disadvantage with regards to receiving a diagnosis and treatment for ADHD, use of this device if it could not accurately provide a diagnosis, could simply lead to further inequalities.

An unnecessary and costly test

Parents may have read about the measurements of brainwaves to diagnose epilepsy, but while that has a clear neurological basis, ADHD is complex disorder with a behavioral basis, so diagnosis is not straightforward. It is important that parents are therefore aware of the NEBA device’s limitations, as receiving the test may be costly in more ways than one if it fails to meet their expectations. It cannot provide a definitive diagnosis of ADHD, as this needs to take into account symptoms, functional impairment and what impact this has, which the device can provide no information on. There is also no real evidence that use of the device can reduce the number of false positive diagnoses; in the study it improved overall accuracy of diagnosis, but what this translates to in clinical practice remains to be seen. While these are the two most likely reasons for their interest in pursuing the test, parents are therefore best advised to seek the help of a child psychiatrist or psychologist if they suspect their child has ADHD. This way using more conventional methods, a comprehensive assessment can be performed and individually tailored advice provided on diagnosis of ADHD, or alternatively on another condition if that is the conclusion. As yet it is also unclear as to whether NEBA can differentiate between ADHD and say a disorder of mood or a learning disability, which is another reason why specialist assessment is needed to ensure the correct diagnosis is reached.

While some see NEBA as a breakthrough owing to the increasing number of cases of ADHD, what we really need is greater access to mental health services, rather than the development of technological devices.
By,
Lisa Pritchard

Treating Chronic Pain to Improve Function

The following article written by Mel Pohl M.D. in A Day Without Pain is particularly relevant to my practice because many of my clients suffer from chronic pain as a result of a physical injury that they have suffered.  When one suffers from pain the instinct is to reduce activity and cease behavior that causes pain.  With many severe injuries however leading a pain free life is simply not possible, and maintaining muscle and activity is extremely important.

While narcotic pain medication can be effective in reducing the experience of acute pain it is not an effective treatment for chronic pain and frequently creates dependency both emotionally and physically.  Building motivation, hopefulness and a realistic understanding of chronic pain is essential for chronic pain patients to regain control of their lives:

Unlike other injuries, chronic pain is unrelenting, lasts longer than six months, and is characterized by decreased function. The desire to avoid feeling more pain or aggravating the pain one does feel leads patients to avoid movement, which, over time, erodes function. The old “use it or lose it” mantra is definitely applicable here.

It’s understandable that patients with chronic pain fear worsening their pain by moving, but what most people don’t realize is that maintaining mobility is essential if function is to be preserved for the present and the future. Body parts that go unmoved for any length of time eventually become “frozen.” This can happen with the back, the abdomen, the joints (e.g., knees and shoulders), etc. Furthermore, with decreased movement, circulation decreases, scar tissue eventually forms, and pain increases.

The consequences of this are not merely limited to decreased mobility and lingering pain. Avoidance of movement ultimately leads to complete non-function. When people are limited, they may become ashamed of their disability and want to hide, want to do nothing. If I can’t get my shirt on by myself in the morning, why would I want to go out in public and expose any other problems I have to friends and strangers alike? This response to pain, this avoidance, leads to feelings of depression and helplessness that only feed into the cycle of immobility and worsening pain until the patient is entirely non-functioning. This is called the Fear Avoidance Cycle

Now, some people will try to function around all of this by taking drugs. If I go to a physician or a prescriber and I say that my shoulder or back hurts, what will I be prescribed? Painkillers in the form of opioids (narcotics). Many people who take these medications and as a result feel less pain assume that their treatment is working for them. Successful treatment of chronic pain must include improvement of function as well as reduction of the level of pain.

When people whose only treatment has been medication to reduce the pain come to treatment at my center, I notice that their function is deceased and they are sleepy, less active, and cognitively impaired. This lethargy affects all aspects of their life, from digestion to social interactions. We see people medicated for pain, but their function overall has suffered as a consequence. This is not the proper treatment of chronic pain.

The root of this problem is fear. People need to be supported to walk through their fear of pain. Numerous studies that have proven that if someone is afraid of a certain activity, he or she will avoid that activity, and as a consequence won’t progress in his or her treatment. If we expose the person to the activity with support and gentle movement, the fear slowly diminishes. If fear diminishes, pain does as well, and the person regains mobility and confidence. There is a direct correlation between fear, anxiety, and pain. The solution for Fear Avoidance is increased movement, which will cause some discomfort initially. But it is on a temporary basis because at first patients are breaking up the fibrous tissue that has built up as a result of their inactivity. But with increased mobility we get increased function, and improved self-esteem and lower social isolation. The person overall becomes healthier.

When using medications, it is essential to make sure that the function of the patient improves. Simply taking the pain away and putting someone to bed for 20-plus hours a day is bad pain treatment. Unfortunately that is the cycle that people get into. They can’t sleep because of their pain meds, and then they are given sleeping pills. This makes them anxious during the day, so they are given anti-anxiety pills, and then pills to wake up. The result is that they are over-medicated and they are not living life to the fullest. Their quality of life is diminished. The solution is to decrease or eliminate the use of these medications until overall function improves and life gets better even though there is pain present. It is this delicate balance that defines pain recovery.

Attention Span Self Test

The following self test posted below will give the test taker a snapshot of their attention and concentration abilities. It is a screening tool and the results are not meant to diagnose any condition, but rather to provide insight into what could be a potential weakness. For example, poor concentration and attention does not necessarily equate with ADHD which requires a combination of a variety of symptoms as well as measured weaknesses with the frontal lobe’s executive functions. Nevertheless self tests are a good way to confirm or disconfirm the presence of a strength or weakness. The link below will take you to the test which was posted on the Psychology Today website.

http://psychologytoday.tests.psychtests.com/take_test.php?idRegTest=336

If you think you may have ADHD please contact me for a formal assessment.

Dr. Jared Maloff
(310) 712-5480

The Importance of Differential Diagnosis

Here is an article that I found today on AOL.  It brings up a very important point which is that ADHD is most likely over-diagnosed in this country.  It is a disorder that shares overlapping symptoms with other diagnoses which reinforces how important appropriate, expert diagnosis is when assessing one’s symptoms.  Especially when dealing with children and the prospect of using medications, it is incredibly important to get the diagnosis right!  This article highlights this point:

Nearly 10 percent of children and 4 percent of adults in the U.S. have been diagnosed with ADHD. But studies suggest that while many people with ADHD still go undiagnosed, others are wrongly diagnosed with ADHD when they are instead suffering from a range of other disorders. The most common cause of misdiagnosis is a misunderstanding of what ADHD really is, according to Dr. Russell Barkley, clinical professor of psychiatry at the Medical University of South Carolina and author of “Taking Charge of ADHD: the Complete, Authoritative Guide for Parents.” “People rather superficially see that someone has difficulty paying attention and think they may have ADHD,” he says. “But the differential diagnosis of ADHD is not based on inattention — it’s based on the other deficits that go along with inattention: lack of self control, heedlessness, recklessness, thoughtlessness, an inability to think of what you’re doing before you do it.” So which conditions are most often mistaken for ADHD, and how can such misdiagnoses be avoided?Autism
“ADHD is rarely misdiagnosed as autism, but sometimes autism can be misdiagnosed as ADHD in its early stages,” says Barkley. That’s because the two conditions overlap, according to studies. Forty percent of autistic children have ADHD, and a portion of ADHD children have some autistic traits. Parents and practitioners often pick up on one condition but not the other. Barkley cautions parents and doctors to look for the signs of autism. Children with autism are not merely inattentive: They may have problems with language, stand too close to others, find social situations awkward or completely uninteresting, be unable to make eye contact, or engage in behaviors like hand flapping.

Bipolar Disorder

ADHD symptoms are present in people suffering from bipolar disorder, especially during the manic phase of the illness. “Don’t focus on ADHD symptoms because the ADHD symptoms are present,” says Barkley, referring to the ADHD triad of inattention, hyperactivity and impulsiveness — all of which emerge when a person with bipolar disorder has a manic episode. “Instead, focus on emotional and social symptoms of manic episodes.” These symptoms, which are unique to bipolar disorder, include elation, grandiosity, sleeplessness and an extremely positive mood state, followed by a crash during which the person is irritable, depressed, withdrawn and explosive for hours or days.

The age of onset also determines the diagnosis, since symptoms of bipolar disorder usually emerge when a person is in late adolescence or early adulthood, while ADHD’s onset is in childhood. That said, there’s a significant overlap of the two. A 2003 study at Massachusetts General Hospital of 51 adult ADHD patients found that 24 of the patients also had bipolar disorder. According to Barkley, the earlier the onset of bipolar disorder, the more likely that it will be accompanied by ADHD: “If bipolar disorder starts in adulthood, only 20 to 25 percent of people will have ADHD with it,” says Barkley. “If the bipolar disorder starts during teenage years, 45 to 50 percent have ADHD along with that bipolar disorder. And if your bipolar starts in childhood, 80 to 97 percent of those cases will have ADHD with it.”

The CDC Reports a 22% Rise in ADHD

Just before Thanksgiving a report was released by the CDC claiming that between 2003 and 2007 the prevalence of ADHD in children jumped a startling 22% and that now 1 in 10 children have ADHD!  The media sensationalized the story most likely adding to parent’s fears throughout the country who may now be more likely to pathologize behavior in their children that is actually within the normal range.

As a practitioner with expertise in assessing ADHD, learning disabilities and other disorders usually associated with childhood misbehavior and underachievement, I believe that the report of this large increase of ADHD in children is false.  What the 22% increase actually means is that when people were polled by the CDC and asked if their child has been diagnosed with ADHD, 22% more parents indicated that they had.  To me, this is another example of how easy it is to misdiagnose ADHD. 

The diagnosis of ADHD is actually tricky though it often seems quite simple to laypeople given the huge amount of press coverage this disorder gets.  Most people seem to believe that if their child is hyperactive, misbehaves, underachieves in school, or is forgetful, they have ADHD.  Compounding the problem is that many professionals in the medical and mental health fields share the same beliefs, and are more likely to make a diagnosis of ADHD when dealing with zealous parents seeking an explanation for their children’s perceived shortcomings. 

Part of being a good parent is believing that your child is capable of being a straight A student, well rounded, likeable, and perfectly behaved, but even parents with the best of intentions must be aware that a departure from these virtues, momentarily or otherwise, do not necessarily suggest pathology.   Many parents cling to the ADHD label because this is a disorder that can be effectively medicated and in essence, “fixed”.  The reality is that the qualities of ADHD overlap greatly with many kinds of learning disabilities (which cannot be treated with medication), mood disorders (which require therapy and a different class of medications), behavioral disorders (which may be made worse by stimulant medication), and the simple, normal range of human behaviors. 

There is no doubt that ADHD is over-diagnosed, and this fact only serves to diminish the difficulties that people who actually have ADHD experience. The overlapping nature of many ADHD symptoms with other diagnoses makes procuring a proper ADHD assessment essential to the diagnostic process.  This assessment should be conducted by a qualified professional and should include a review of life history, educational history, medical history, and the administration of a battery of tests including a cognitive measure, an achievement measure and an assessment of memory. 

As a psychologist who frequently administers these tests I can say that there are many times that a patient seems like they have ADHD, but when tested it becomes clear that there is something entirely different occurring.  Objective testing measures need to be sought out and utilized by parents more frequently in order to ensure that their children are receiving appropriate diagnoses which would eliminate the risk of being needlessly, or inappropriately medicated.  More knowledgeable parents and practitioners about this issue will undoubtedly lead to more effective treatment of a variety of mental health issues.

Jared Maloff Psy.D.

(310) 712-5480

New Study Suggests a Cause for ADHD

The following is an article from health.com: 

Children exposed to higher levels of a type of pesticide found in trace amounts on commercially grown fruit and vegetables are more likely to have attention deficit hyperactivity disorder (ADHD) than children with less exposure, a nationwide study suggests.

Researchers measured the levels of pesticide byproducts in the urine of 1,139 children from across the United States. Children with above-average levels of one common byproduct had roughly twice the odds of being diagnosed with ADHD, according to the study, which appears in the journal Pediatrics.

Exposure to the pesticides, known as organophosphates, has been linked to behavioral and cognitive problems in children in the past, but previous studies have focused on communities of farm workers and other high-risk populations. This study is the first to examine the effects of exposure in the population at large.

Organophosphates are “designed” to have toxic effects on the nervous system, says the lead author of the study, Maryse Bouchard, PhD, a researcher in the department of environmental and occupational health at the University of Montreal. “That’s how they kill pests.”

The pesticides act on a set of brain chemicals closely related to those involved in ADHD, Bouchard explains, “so it seems plausible that exposure to organophosphates could be associated with ADHD-like symptoms.”

Environmental Protection Agency (EPA) regulations have eliminated most residential uses for the pesticides (including lawn care and termite extermination), so the largest source of exposure for children is believed to be food, especially commercially grown produce. Adults are exposed to the pesticides as well, but young children appear to be especially sensitive to them, the researchers say.

Detectable levels of pesticides are present in a large number of fruits and vegetables sold in the U.S., according to a 2008 report from the U.S. Department of Agriculture (USDA) cited in the study. In a representative sample of produce tested by the agency, 28% of frozen blueberries, 20% of celery, and 25% of strawberries contained traces of one type of organophosphate. Other types of organophosphates were found in 27% of green beans, 17% of peaches, and 8% of broccoli.

Although kids should not stop eating fruits and vegetables, buying organic or local produce whenever possible is a good idea, says Bouchard.

“Organic fruits and vegetables contain much less pesticides, so I would certainly advise getting those for children,” she says. “National surveys have also shown that fruits and vegetables from farmers’ markets contain less pesticides even if they’re not organic. If you can buy local and from farmers’ markets, that’s a good way to go.”

A direct cause-and-effect link between pesticides and ADHD “is really hard to establish,” says Dana Boyd Barr, PhD, a professor of environmental and occupational health at Emory University. However, she says, “There appears to be some relation between organophosphate pesticide exposure and the development of ADHD.”

This is the largest study of its kind to date, according to Barr, who researched pesticides for more than 20 years in her previous job with the Centers for Disease Control and Prevention (CDC) but was not involved in the study.

Bouchard and her colleagues analyzed urine samples from children ages 8 to 15. The samples were collected during an annual, nationwide survey conducted by the CDC, known as the National Health and Nutrition Examination Survey.

The researchers tested the samples for six chemical byproducts (known as metabolites) that result when the body breaks down more than 28 different pesticides. Nearly 95% of the children had at least one byproduct detected in their urine.

Just over 10% of the children in the study were diagnosed with ADHD. The kids were judged to have ADHD if their symptoms (as reported by parents) met established criteria for the disorder, or if they had taken ADHD medication regularly in the previous year.

One group of pesticide byproducts was associated with a substantially increased risk of ADHD. Compared to kids who had the lowest levels, the kids whose levels were 10 times higher were 55% more likely to have ADHD. (Another group of byproducts did not appear to be linked to the disorder.)

In addition, children with higher-than-average levels of the most commonly detected byproduct—found in roughly 6 in 10 kids—were nearly twice as likely to have ADHD.

“It’s not a small effect,” says Bouchard. “This is 100% more risk.”

To isolate the effect of the pesticide exposure on ADHD symptoms, the researchers controlled for a variety of health and demographic factors that could have skewed the results.

Still, the study had some limitations and is not definitive, Bouchard says. Most notably, she and her colleagues measured only one urine sample for each child, and therefore weren’t able to track whether the levels of pesticide byproducts were constant, or whether the association between exposure and ADHD changed over time.

Long-term studies including multiple urine samples from the same children are needed, Bouchard says. She suspects such studies would show an even stronger link between pesticide byproducts and ADHD.

EPA spokesman Dale Kemery said in a statement that the agency routinely reviews the safety of all pesticides, including organophosphates. “We are currently developing a framework to incorporate data from studies similar to this one into our risk assessment,” Kemery said. “We will look at this study and use the framework to decide how it fits into our overall risk assessment.”

Kemery recommended that parents try other pest-control tactics before resorting to pesticide use in the home or garden. Washing and peeling fruits and vegetables and eating “a varied diet” will also help reduce potential exposure to pesticides, he said.

“I would hope that this study raises awareness as to the risk associated with pesticide exposure,” Bouchard says. “There’s really only a handful of studies on this subject out there, so there’s room for more awareness.”

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Wall St Journal Article on Adult ADHD

The symptoms of adult attention-deficit hyperactivity disorder seem to describe half the people in New York City: restlessness, impatience, impulsivity, procrastination, chronic lateness, and difficulty getting organized, focusing and finishing tasks.

How do you know you have ADHD, which experts compare to having a mind like a pinball, with thoughts flitting in multiple directions. Maybe you’re just overcaffeinated and overworked? And if you do have it, will there be a stigma? Should you try medication? Will it work?

Parents of children with suspected ADHD face a myriad of similar questions. But the concerns can be just as troubling for adults, whose ADHD often goes unrecognized.

An estimated 8% of U.S. children have ADHD, which is also known as ADD, for attention-deficit disorder, and some 50% of them outgrow it, according to government data. About 4.4% of U.S. adults—some 10 million people—also have ADHD and less than one-quarter of them are aware of it.

That’s because while ADHD always starts in childhood, according to official diagnostic criteria, many adults with the disorder went unnoticed when they were young. And it’s only been since the 1980s that therapists even recognized the disorder could persist in adults.

Even now, getting an accurate diagnosis is tricky. Some experts think that too many adults—and children—are being put on medications for ADHD, often by doctors with little experience with the disorder. Others think that many more people could benefit from ADHD drugs and behavioral therapy.

[HEALTHCOL_illo] Photo Illustration by WSJ

[HEALTHCOLjp] Photo Illustration by WSJ

10 Million

Estimated number of U.S. adults, or 4.4% of the adult population, that have ADHD. Less than one-quarter of them are aware they have the condition.

Health Mailbox

Complicating the picture further, ADHD frequently goes hand in hand with depression, anxiety and bipolar disorder, and it can be difficult to untangle which came first. “It’s very common for someone to be treated for depression or anxiety for years, and have the therapist not notice the ADHD,” says Mary Solanto, director of the AD/HD Center at the Mount Sinai Medical Center in New York City. But adults whose ADHD is left untreated face a high incidence of substance abuse, automobile accidents, difficultly staying employed and maintaining relationships.

That said, some adults with ADHD are highly intelligent, energetic, charismatic and creative, and are able to focus intently on a narrow range of topics that interest them. David Neeleman, the founder of JetBlue Airways, and Paul Orfalea, founder of Kinko’s, have spoken out about how the disorder helped them come up with innovative ideas for their corporations, despite their having done poorly in school.

“It’s amazing how successful some people are able to be despite these symptoms, and some people are totally paralyzed—there’s a whole spectrum of outcomes,” says Ivan K. Goldberg, a psychiatrist in New York City who co-developed a commonly used screening test.

Generally, ADHD can make life very difficult. It’s thought to be an imbalance in neurotransmitters, the chemical messengers that relay signals in the brain, particularly in the frontal cortex that governs planning and impulse control. Children with the disorder, particularly boys, are likely to be hyperactive, with an intense need to move constantly, which can interfere with learning. (Girls tend to be talkative and dreamy, but they are often overlooked because they aren’t as disruptive.)

Adults more typically have trouble with paying attention, focusing and prioritizing. Managing time and money are particularly difficult.

“What it really is is a disturbance of the executive functions of the brain — it’s the inability to plan things, to initiate them at the appropriate time, not to skip any of the steps and to terminate them at the appropriate time,” says Dr. Goldberg. “An awful lot of these people are very bright but they can’t keep it together. They keep screwing things up.”

“It’s extremely hard for me to sit my butt in a chair. I get fidgety. I want to get up,” says Linda Hensens, 46, a medical transcriptionist in Clayton, N.C., who discovered she has ADHD when a bariatric surgeon asked about her working habits. “I’ll think of the wash that needs to be done and clothes that need to be folded and dusting that needs to be done and, Oh my god, I promised my nephew I’d make a cheese cake, and I’ve got Easter dinner to plan. My mind is going like that all the time.”

Some people with ADHD are able to compensate for their distractibility, at least for a while. Some excel in school early on but run into problems once they get to college or get a job where they have to stay organized on their own.

“I see adults with ADHD who are in medical and law school or running companies, and at some point, they hit a ceiling. Their coping mechanisms aren’t effective anymore,” says Peter Jaksa, a clinical psychologist who works with ADHD patients in Chicago.

Dr. Jaksa says he recognized the symptoms of ADHD in himself long after graduate school when he was working with underachieving kids. “Once you know what it is, things make sense that didn’t make sense previously,” he says, such as his pattern of writing every paper in college the night before it was due, with a six-pack of Dr. Pepper and a bottle of No-Doz.

“We see people from all of the professions who have managed to succeed despite the limitations, but they have often done it at significant cost,” says Dr. Solanto. “They don’t have time to enjoy life. They don’t get their work done in the course of a day. They have to stay late after hours, or they are doing without sleep, frantically trying to meet deadlines. It ultimately takes a toll on their wellbeing and a toll on the people around them.”

Do You Have Adult ADHD?

[AdultADHDpromo]

Take a screening test.

ADHD Resources

  • CHADD.org — Children and Adults with Attention Deficit/Hyperactivity Disorder, a national non-profit education and advocacy group
  • ADD.org — National Attention Deficit Disorder Association
  • Additudemag.com — ADDitude magazine
  • ADDCenters.com — Peter Jaksa’s clinical practice

Reading List

  • “Driven to Distraction: Recognizing and Coping With Attention Deficit Disorder from Childhood Through Adulthood,” by Edward M. Hallowell, M.D., and John J. Ratey, M.D.
  • “The Disorganized Mind: Coaching Your ADHD Brain to Take Control of Your Time, Tasks and Talents” by Nancy Ratey
  • “The Everything Health Guide to Adult ADD/ADHD” by Carole Jacobs and Isadore Wendel
  • “Is It You, Me, or Adult A.D.D.” by Gina Pera
  • “Copy This!: Lessons from a Hyperactive Dyslexic Who Turned a Bright Idea Into One of America’s Best Companies,” by Paul Orfalea

While that sounds like many people who are simply driven or trying to do too much in an uncertain economy, experts say it may be ADHD when it interferes with the basics of life. “The magic word is impairment,” says Dr. Jaksa. “Everyone gets distracted. Who’s not late occasionally? But if you are chronically late, you lose your job and maybe your friends as well.”

“I was a textbook case,” says Ali Bauman, a 38-year-old writer in Chicago. “I had a messy bedroom and a string of minor car accidents that I could never explain. I couldn’t keep the house clean, pay bills, get things done on time. It wasn’t that I didn’t want to do it, I just wasn’t capable of doing it.”

As with other psychiatric conditions, there is no blood test or brain scan that can diagnose ADHD. Experts say people who suspect they have it should have a thorough evaluation, ideally with a psychologist or psychiatrist who specializes in the disorder, looking at how they functioned in early childhood, in school and social settings and personal relationships. A screening test can help determine if you should see a mental-health professional, but shouldn’t be used for diagnosis.

Once ADHD is diagnosed, most experts recommend treatment with both medication and behavioral therapy.

As counterintuitive as it may seem to give stimulants to people who can’t sit down, drugs such as Ritalin, Adderall, Concerta and Vyvanse increase neurotransmitters in parts of the brain that help people focus and control impulses. “They wake up the parts of the brain that are sluggish, so they regulate the brain at a more normal level,” Dr. Jaksa says.

There are some concerns that stimulant medications can be abused by people who don’t need them. Dr. Goldberg notes that drugs for ADHD can make anybody focus better. But for people with true ADHD, they bring significantly more mental clarity. “My brain felt like it was screwed on more tightly. Everything came into focus. I could be active and do things with my life,” Ms. Bauman says.

There also have been concerns that such medications could make some people with ADHD lose their creative edge. But, says Dr. Jaksa, “In my experience, that only happens when the dosage is too high, or it’s not the right medicine.” He also recommends at least 30 minutes a day of vigorous exercise, which can also increase neurotransmitters.

While medication can help ADHD sufferers focus better, behavioral therapy can teach them what to focus on, how to schedule their lives and set priorities.

Dr. Solanto developed a 12-week program to help people with ADHD learn to manage time, break down daunting tasks into manageable steps and keep themselves organized. One mantra of the program is: “If it’s not in the planner, it doesn’t exist,” says Dr. Solanto. In a study of 88 patients published last month in the American Journal of Psychiatry, they found that those who participated in the program improved significantly more than those who received more standard supportive therapy.

ADHD coaching services provide some of the same lessons, for anywhere from $60 to $300 an hour. “People contact me when they’re sick of themselves. They keep repeating the same patterns and can’t get a grip on how to change it,” says Nancy Ratey, a Boston-based coach who has ADHD herself. She designs individual strategies to help clients meet their responsibilities, which could run the gamut from hiring an administrative assistant to programming their cellphones to ring every hour to make sure they are staying on schedule. “There’s nothing worse than an ADHD boss,” who keeps saying “this is urgent,” “no, this is urgent,” she says.

Many ADHD sufferers learn their own tricks to stay organized.

“I buy socks in only one color so I don’t confuse them,” says Ms. Bauman. “I use one purse a week and my keys stay in there.” And because she gets overwhelmed wandering around the grocery store, Ms. Bauman says she’s begun ordering groceries online to save time.

Besides learning such organizing skills, many people with ADHD say the biggest challenge is learning not to let the disorder erode their self-confidence, and not to blame themselves for shortcomings.

“There’s a huge incidence of depression with ADHD because you are continually failing in the eyes of others, not reaching your potential. People recognize you are smart, and you can’t find your niche,” says Rob Cahill, 38, an ADHD sufferer who works in social service agency in New York.

Still, Mr. Cahill says that understanding his disorder has helped him empathize with the social-service clients he serves. “The ADHD is a gift in some ways, it’s just sometimes hard to recognize.”

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