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A chronic disturbance in which at least twelve of the following
are present:
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A sense of underachievement, of not meeting one's goals
(regardless of how much one has accomplished). We put this symptom first
because it is the most common reason an adult seeks help. "I just can't get
my act together," is the frequent refrain. The person may be highly
accomplished by objective standards, or may be floundering, stuck with a
sense of being lost in a maze, unable to capitalize on innate potential.
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Difficulty getting organized. A major problem for most
adults with ADD. Without the structure of school, without parents around to
get things organized for him or her, the adult may stagger under the
organizational demands of everyday life. The supposed "little things" may
mount up to create huge obstacles. For the want of a proverbial nail -- a
missed appointment, a lost check, a forgotten deadline -- their kingdom may
be lost.
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Chronic procrastination or trouble getting started.
Adults with ADD associate so much anxiety with beginning a task, due to
their fears that they won't do it right, that they put it off, and off,
which, of course, only adds to the anxiety around the task.
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Many projects going simultaneously; trouble with
follow-through. A corollary of #3. As one task is put off, another is taken
up. By the end of the day, or week, or year, countless projects have been
undertaken, while few have found completion.
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Tendency to say what comes to mind without necessarily
considering the timing or appropriateness of the remark. Like the child with
ADD in the classroom, the adult with ADD gets carried away in enthusiasm. An
idea comes and it must be spoken, tact or guile yielding to child-like
exuberance.
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An ongoing search for high stimulation. The adult with
ADD is always on the lookout for something novel, something in the outside
world that can catch up with the whirlwind that's rushing inside.
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A tendency to be easily bored. A corollary of #6. Boredom
surrounds the adult with ADD like a sinkhole, ever ready to drain off energy
and leave the individual hungry for more stimulation. This can easily be
misinterpreted as a lack of interest; actually it is a relative inability to
sustain interest over time. As much as the person cares, his battery pack
runs low quickly.
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Easy distractibility, trouble focusing attention,
tendency to tune out or drift away in the middle of a page or a
conversation, often coupled with an ability to hyperfocus at times. The
hallmark symptom of ADD. The "tuning out" is quite involuntary. It happens
when the person isn't looking, so to speak, and the next thing you know, he
or she isn't there. The often extraordinary ability to hyperfocus is also
usually present, emphasizing the fact that this is a syndrome not of
attention deficit but of attention inconsistency.
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Often creative, intuitive, highly intelligent. Not a
symptom, but a trait deserving of mention. Adults with ADD often have
unusually creative minds. In the midst of their disorganization and
distractibility, they show flashes of brilliance. Capturing this "special
something" is one of the goals of treatment.
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Trouble going through established channels, following
proper procedure. Contrary to what one might think, this is not due to some
unresolved problem with authority figures. Rather it is a manifestation of
boredom and frustration: boredom with routine ways of doing things and
excitement around novel approaches, and frustration with being unable to do
things the way they're supposed to be done.
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Impatient, low tolerance for frustration. Frustration of
any sort reminds the adult with ADD of all the failures in the past. "oh
no," he thinks, "here we go again." So he gets angry or withdraws. The
impatience has to do with the need for stimulation and can lead others to
think of the individual as immature or insatiable.
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Impulsive, either verbally or in action, as in impulsive
spending of money, changing plans, enacting new schemes or career plans, and
the like. This is one of the more dangerous of the adult symptoms, or,
depending on the impulse, one of the more advantageous.
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Tendency to worry needlessly, endlessly; tendency to scan
the horizon looking for something to worry about alternating with
inattention to or disregard for actual dangers. Worry becomes what attention
turns into when it isn't focused on some task.
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Sense of impending doom, insecurity, alternating with
high-risk-taking. This symptom is related to both the tendency to worry
needlessly and the tendency to be impulsive.
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Mood swings, depression, especially when disengaged from
a person or a project. Adults with ADD, more than children, are given to
unstable moods. Much of this is due to their experience of frustration
and/or failure, while some of it is due to the biology of the disorder.
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Restlessness. One usually does not see, in an adult, the
full-blown hyperactivity one may see in a child. Instead one sees what looks
like "nervous energy": pacing, drumming of fingers, shifting position while
sitting, leaving a table or room frequently, feeling edgy while at rest.
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Tendency toward addictive behavior. The addiction may be
to a substance such as alcohol or cocaine, or to an activity, such as
gambling, or shopping, or eating, or overwork.
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Chronic problems with self-esteem. These are the direct
and unhappy result of years of conditioning: years of being told one is a
klutz, a spaceshot, an underachiever, lazy, weird, different, out of it, and
the like. Years of frustration, failure, or of just not getting it right to
do lead to problems with self-esteem. What is impressive is how resilient
most adults are, despite all the setbacks.
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Inaccurate self-observation. People with ADD are poor
self-observers. They do not accurately gauge the impact they have on other
people. This can often lead to big misunderstandings and deeply hurt
feelings.
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Family history of ADD or manic-depressive illness or
depression or substance abuse or other disorders of impulse control or mood.
Since ADD is genetically transmitted and related to the other considerations
mentioned, it is not uncommon (but not necessary) to find such a family
history.
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Childhood history of ADD (It may not have been formally
diagnosed, but in reviewing the history the signs and symptoms were there).
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Situation not explained by other medical or psychiatric
condition.
Note: These criteria are based on
extensive clinical experience but have not yet been statistically validated by
field trials. Consider a criterion met only if the behavior is considerably
more frequent than that of most people of the same mental age.
It cannot be stressed too firmly how important it is not to
diagnose oneself. From the information and examples presented here it is hoped
that your suspicion may be raised, but an evaluation by a physician to rule
out other conditions is essential.
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