ADD is a disorder of the frontal lobe supervisory system, parietal lobe and its
connections. Symptoms of ADD resemble what has traditionally been termed a "frontal lobe
disorder" characterized by problems with planning and organization, sequencing, utilization
of feedback and modification of behavior as a consequence of feedback, maintaining and
switching of sets and information processing skills. There is decreased arousal and
vigilance resulting in inconsistent and variable behavior. Behavioral symptoms include a
range of symptoms including a loss of internal excitement, a craving for stimulation,
forgetfulness, carelessness, lack of tolerance, avoidance and procrastination, hypo- and
hyperactivity, inappropriate behavior, distractibility, lack of insight and awareness and
both slow and quick movement.
ADD is also represented as an attention and concentration disorder theoretically involving
subcortical connections to the frontal lobe that serve as a gating mechanism in the brain.
Irrelevant information needs to be gated out thus allowing the individual to focus on some
information and not be overwhelmed by all of the incoming stimuli from the external
ADD is a biochemical disorder involving neurotransmitters or brain messengers. The disorder
is basically genetic and a consequence of a biochemical imbalance in the brain. Those with
the disorder usually present symptoms quite early in life and continue to present symptoms
throughout their adult life. This is not a disorder that can be outgrown as formerly
believed. By the time of adulthood the entire fabric of the individual's life has been
Deficiencies that are present in early childhood are chronic in nature. They do improve
with maturation but deficits persist and can be observed when compared to same-age peers.
Deficiencies can lead to social problems and increased controlling responses by those in
the external environment. Lack of success to control this disorder leaves those significant
in the individual's life frustrated and the ADD individual rejected.
Common Conditions Associated with ADD
- 1. Conduct Problems (60+%):
- Oppositional, defiant behavior
- Temper tantrums
- Anger outbursts
- Verbal and physical aggression
- 2. Academic Performance Problems (90+%):
- Variability of performance
- Learning disabilities
- 3. Emotional Immaturity (50+%):
- Over-reaction to situations
- Low frustration tolerance
- Low self-esteem
- 4. Social Skills Problems (50+%):
- Selfish, self-centered
- Rejected by peers due to intrusive, aggressive behavior
- Little regard for social consequences
- Immature play and social interests
- Poor self-awareness
- 5. Immature Motor Coordination (30-60%):
- Enuresis (20%)
- Encopresis (10%)
- Allergies, colds, otitis
- Increased minor physical anomalies
- Increased sleep disturbance (30%)
Attention Deficit Disorder: A Definition
The syndrome develops in early childhood and is not accounted for by other
gross disturbances or impairments.
- ADD is a developmental disorder characterized by:
- Poor sustained attention
- Difficulty maintaining vigilance
- Difficulty with delay of gratification
- Increased variability of task performance
ADD Without Hyperactivity:
These children will be classified in the DSM-IV as Attention Deficit
Hyperactivity Disorder, Predominantly Inattentive Type. Children must
have at least 6 items from the following list and there is a disturbance of
6 months duration. The items must be to the degree of being developmentally
inappropriate and there is no evidence of impulsivity or hyperactivity for
the past 6 months.
- These children appear to have the most predominant general trait of
inattentiveness. The following behaviors can be observed:
- Excessive daydreaming, "spacey" appearance
- Cognitive sluggishness (processing disorder is possible)
- Hypoactive, lethargic
- Excessive confusion or mental "fogginess"
- Inconsistent memory retrieval
- Increased anxiety
- Socially reticent or diminished social involvement
- Rarely aggressive or oppositional
- Rarely impulsive
- Often fails to give close attention to details or makes careless mistakes
in schoolwork, work or other activities
- Often has difficulty sustaining attention in tasks or play activities
- Often seems not to listen when spoken to directly
- Often does not follow through on instructions and fails to finish
schoolwork, chores or duties in the workplace (not due to oppositional
behavior or failure to understand instructions)
- Often has difficulty organizing tasks and activities
- Often avoids, dislikes or is reluctant to engage in tasks that require
sustained mental effort (such as schoolwork or housework)
- Often loses things necessary for tasks or activities (e.g., toys, school
assignments, pencils, books or tools)
- Often in easily distracted by extraneous stimuli
- Often is forgetful in daily activities
ADD With Hyperactivity
The disorder is to be classified predominantly as a disturbance of
hyperactive-impulsive behavior that can be associated with inattention.
According to the DSM-IV, the age of onset is around 7 years; there is a
disturbance of 6 months duration; it is classified as Attention Deficit
Disorder, Predominantly Hyperactive-Impulsive Type. There is no evidence
of inattention for the past 6 months.
- Often leaves seat in classroom or in other situations in which remaining
seated is expected
- Often fidgets with hands or feet or squirms in seat
- Often runs about or climbs excessively in situations in which it is
inappropriate (in adolescents or adults, may be limited to subjective
feelings of restlessness)
- Often has difficulty playing or engaging in leisure activities quietly
- Often is "on the go" or often acts as if "driven by a motor"
- Often talks excessively
- Often interrupts or intrudes on others (i.e., butts into other children's games)
- Often blurts out answers to questions before they have been completed
- Often has difficulty waiting for his or her turn in games or group situations
There is a combined type disorder if both criteria of Inattention and
Hyperactive-Impulsivity have been met for a duration of 6 months. There
must be clear evidence of significant impairment in social, academic or
occupational functioning. The above is in accordance with the DSM-IV.
However, clinically, this does not appear to be the case. What would
qualify as the combined type of disorder may well be the
Overfocused Subtype of Attention Deficit Disorder without
- The basic characteristics are:
- Diminished rule-governed behavior
- Variability of task performance
This Overfocused Subtype is characterized by the tendency to become
overfocused, almost to the point of perseveration, on thoughts, ideas,
things, events and so on. These individuals tend to be very sensitive to
clothing and touch. This can be observed in infancy (sometimes in the form
of being described as "colicky"). They are highly anxious, susceptible to
allergies and asthma.
Oppositional Defiant Disorder is viewed as a disorder of
hostile and defiant behavior towards others, arising in childhood and
frequently culminating in Conduct Disorder.
To be defined as ODD, children must have 4 items of the following list:
To be defined as CD, the individual must have at least 3 of the following 15
items in the past 12 months with at least one criterion present in the past
- Often loses temper
- Argues with adults
- Actively defies or refuses adults' requests or rules
- Deliberately does things that annoy other people
- Blames others for his or her own mistakes or misbehavior
- Often touchy or easily annoyed by others
- Angry and resentful
- Often spiteful or vindictive
Aggression to people and animals:
- Bullies, threatens or intimidates others
- Often initiates physical fights with others
- Has used a weapon that can cause serious physical harm to others (such
as a bat, brick, broken bottle, knife, gun)
- Has been physically cruel to people
- Has been physically cruel to animals
- Has stolen while confronting a victim (such as mugging, purse-snatching,
extortion or armed robbery)
- Has forced someone into sexual activity
Destruction of property:
- Has deliberately engaged in fire-setting with the intention of causing
- Has deliberately destroyed others' property (other than by fire-setting)
Deceitfulness or theft:
- Has broken into someone else's home, building or car
- Often lies to obtain goods or favors or obligations (i.e., "cons" others)
- Has stolen items of nontrivial value without confronting a victim
(such as shoplifting, but without breaking and entering; forgery)
Serious violations of rules:
- Often stays out at night despite parental prohibitions, beginning before
the age of 13 years
- Has run away from home overnight at least twice while living in
parental or parental-surrogate home (or once without returning for a
lengthy period of time)
- Often is truant from school beginning before 13 years of age
ADD in Adults
- 70% of those diagnosed as having ADD continue to be affected into
adulthood. The following characteristics are observed in adults:
- Inability to complete tasks
- Impulsivity and non-reflectiveness (which leads to poor judgment in
both personal and work decisions)
- Problematic interpersonal relationships
- Lack of insight
- Hot or explosive temper
- Lack of organization
- Lack of reward or feedback system (which leads to a chronic unhappiness
and dissatisfaction with frequent job and relationship changes)
- Low stress tolerance
- Vulnerable to stress
- "Flies off the handle quickly"
- Planning disorder
- Low frustration tolerance
- Lack of foresight
- Difficulty keeping promises
- Problems with day-to-day organization of family life
- Mental and physical restlessness
- Notetaking and paperwork problems
- Financial problems
- Missed appointments: missing times, dates, events
- Mild to severe communication problems
Problems increase with complexity of life, job, marriage and family as well
as the aging process.
- It has been shown through research that adults suffering from residual
ADD exhibit the following:
- More auto accidents
- More geographically mobile (location change more often)
- More antisocial behavior in general
- Poor performance in later schooling
- Less job success
- Self-esteem problems (low self-esteem)
- Relationship problems
According to the DSM-IV, Adult ADD can be characterized by symptoms of
both Inattention and Hyperactive-Impulsive behavior.
- Trouble directing and sustaining attention
- Difficulty completing projects
- Easily overwhelmed by tasks of daily living
- Trouble maintaining an organized living or work place
- Inconsistent work performance
- Lacks attention to detail
- Makes decisions impulsively, fails to anticipate consequences
- Difficulty delaying gratification, involved in stimulation-seeking
- Restless and fidgety
- Makes statements and comments without considering their impact
- Impatient and easily frustrated
- Frequent traffic violations
- Positive Attributes:
- Life is exciting and interesting
- Movers and shakers
- Builders of businesses
- Great in sales
- Passionate individuals
- Self-employed individuals
- Any situation where a great deal of emotionality is helpful
There is grief and loss after discovery of an attention disorder as an adult
for all that was missed.
There is a phenomenon called "alexithymia" meaning "feelings without
words" that clearly characterizes the presence of this disorder.
Adult ADD Cognitive Mistakes Checklist
- Do you find that you read something and need to read it again?
- Do you forget what you went to another part of the house for?
- Do you fail to hear people speaking to you when you are doing something else?
- Do you have important letters that have gone unanswered for days?
- Do you fail to see what you want in the supermarket even though it is there?
- Do you forget what you wanted when you walk into the store to buy it?
- Do you forget what you wanted to say even though it is on the tip of your tongue?
- Do you find there are times you can't think of anything to say?
- Do you find yourself throwing things away that you did not mean to throw away?
- Does your mind wander while watching TV?
- Do you have difficulty sustaining conversation when there are other voices in the house?
- Do you find yourself not listening to someone you are talking to?
- Do you find yourself suddenly losing track of what you wanted to say in the middle of speaking?
- Do you find yourself starting to do something and then getting distracted into doing something else?
- Do you find it difficult to do more than one thing at a time?
This page based on a handout prepared by United Psychological Services,
P.C., Attention Deficit Disorder Clinic, 14210 Timberwyck, Shelby Twp, MI
48315. Barbara C. Fisher, Ph.D., fully licensed psychologist. Ross A.
Beckley, Ed.S., L.L.P., limited licensed psychologist.