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HEALTH SENSE

Hyperactive adults need help, too

Like many young mothers, Sophie Currier is a busy woman. There's all the family stuff at the Brookline home she shares with her partner, Jeremie Gallien , and their 7-month-old son, Theo. There's work -- a teaching assistantship for a biochemistry course at Harvard University.

And there's school. After majoring in biology at the Massachusetts Institute of Technology, Currier got a PhD in neuroscience from Harvard and is on track to get her medical degree a year from now.

The striking thing is that Currier does all this not only with severe dyslexia -- she couldn't read until she was 8 -- but with ADHD, or attention-deficit hyperactivity disorder, as well.

The impulsivity, inattentiveness, and hyperactivity of people with ADHD can limit the quality of their work, interfere in their relationships, and damage their self-esteem.

Researchers used to think that ADHD, which is often accompanied by dyslexia, or problems with reading, was primarily a problem for children. About 8 percent of American children -- roughly 4.5 million -- have been diagnosed with ADHD.

Researchers also used to think that children would grow out of it.

But it's clear now, as more of those children become adults, that many, perhaps more than half, of the children with ADHD do not grow out of it, which explains why so many adults -- 8 million in the United States -- have the condition.

Another thing research has made quite clear: ADHD is a biological, inherited disorder. It is not, as had been once thought, ``caused by bad parenting or weak character," said Dr. David W. Goodman , a psychiatrist and adult ADHD specialist at Johns Hopkins University School of Medicine who also consults for companies that make ADHD drugs. ``It is a neurological condition validated by medical research whose impairments can be reduced by effective treatment."

The sad part is that unlike children, whose teachers often spot the symptoms, many adults do not acknowledge the symptoms in themselves, even when spouses, friends, and co-workers try to tell them. That means that they often do not get diagnosed until their child is diagnosed, Goodman said.

Dr. Ned Hallowell, a Sudbury psychiatrist, said drug companies have been marketing aggressively to adults as well as children, ``and there are people who are taking the medications who don't need them, but there are also others who take medication and say it changes their lives for the better."

There's no objective screen like a blood test for ADHD, but psychiatrists have developed criteria for deciding when a person may have it (see below).

Adults with ADHD live lives characterized by ``unexplained underachievement," said Hallowell, who says he does not consult for drug companies and is the author, with Dr. John J. Ratey, of several books on ADHD, including ``Driven to Distraction" and ``Delivered from Distraction."

People with ADHD are chronically late, said Hallowell, who has ADHD. They're disorganized. They lose things. They can't pay attention. They manage money poorly. They can't understand why everybody's always mad at them.

``These people are a pain in the butt," said Hallowell. ``But what I've learned in 25 years of treating them is that when you reframe this in a medical context, a life can turn around. They go on to become the kind of person they are meant to be."

Currier is a high achiever, but her days are punctuated by the things -- both small and big -- that she does to overcome her ADHD. She keeps lists of everything. She sets her clocks ahead so she'll have a prayer of making it anywhere on time. She uses her PDA constantly to remind her of where she needs to be and what she needs to be doing.

``I'm very disorganized. . . . I am not a fact holder," she said. ``The biggest thing is distraction. . . . I have trouble starting a project, then I have a hard time stopping it."

Like many people with ADHD, Currier has family members with the disorder. Her father, Richard, a Cambridge real estate broker, has it. The family thinks his father had it, too, as does her brother, Blake, a construction project manager in Wellesley and Framingham. Richard's wife, Barbara, puts up with it all. ``I print out a list of what he has to do every day," she said one Sunday afternoon in their kitchen. They both laugh. ``Then he loses it."

Family studies suggest that about three-quarters of the risk of developing ADHD is genetic, said Susan Smalley , a behavioral geneticist at the Semel Institute for Neuroscience and Human Behavior at UCLA.

Smalley's lab is now searching among families with ADHD worldwide for the genes that predispose to ADHD. She estimated that 20 to 30 genes are probably linked to ADHD, some of which are involved in the regulation of dopamine, a natural brain chemical that plays a role in attention.

Studies suggest that people with ADHD have a wide variety of cognitive and behavioral difficulties. Some have trouble with ``working memory" -- the ability to remember a phone number you were just told or where you just put your glasses. Brain imaging studies suggest that people with ADHD also have less electrical activity in the prefrontal cortex, the area of the brain responsible for planning, organizing, and prioritizing tasks. Studies also suggest that people with ADHD perceive the passage of time differently, perhaps accounting for their chronic lateness.

Some people with ADHD also have atypical patterns of brain activity, said Smalley. These abnormal patterns correspond with the trouble many people with ADHD have suppressing distracting information. For instance, people with ADHD often do poorly on the Stroop test, in which a person has to name the color ink a word is printed in -- such as blue -- rather than read what the word actually says -- ``green."

If you are an adult and think you may have ADHD, there's a lot you can do.

First, don't resist the diagnosis. ``People with ADHD are not good self-observers," said Hallowell. If your child has been diagnosed with ADHD and your spouse, friends, or co-workers suggest that you might, too, take that seriously.

Then consider medication. An estimated 80 percent of people with ADHD improve on medications, said Hallowell, who does not take any money from drug companies.

The US Food and Drug Administration is debating whether to put its most serious, ``black box" warnings on prescription ADHD drugs because of rare cardiovascular and psychiatric side effects, but an advisory panel recently recommended against such a warning.

The drugs most often used are stimulants called methylphenidates (Ritalin and Concerta) that boost dopamine levels or another class of stimulants called amphetamines (Adderall and Dexedrine) that also boost dopamine as well as another brain hormone, norepinephrine. A skin patch containing methylphenidates was approved in April.

A different kind of drug called Strattera also works by boosting norepinephrine; the medication carries a ``black box" warning saying that suicidal thinking may increase on the drug. A pine-bark extract called Pycnogenol also may help, according to a study in this month's European Child and Adolescent Psychiatry.

But there are nondrug solutions, too. Most important: Get help when you need it.

Sophie Currier made it through MIT -- brilliantly -- in part because the school paid other students to read books to her and share their class notes.

By the time she was in graduate school, MIT provided computers that scanned books and read them aloud to Currier; she was also allowed extra time on exams. ``MIT is a haven for someone like me," said Currier, who plans to put her education to use by studying the genetics of ADHD among other neurological disorders. ``It was very easy because I was in an environment that supported me."

You can also get a ``life coach," said Hallowell -- not necessarily a trained mental health professional but someone who can help you get organized, make lists, and check up to make sure you get things done.

Do the little things right -- like always putting your keys in a basket by the door. Find a good accountant to help with money matters. Post reminder signs around your house.

And, as Richard Currier put it, ``marry someone without ADHD."

Judy Foreman is a freelance columnist who can be contacted at foreman@globe.com.

Signs of attention deficit disorder

In diagnosing attention-deficit hyperactivity disorder, doctors use the following criteria:

Clear evidence of significant problems in social, academic, or occupational functioning.

Some of the symptoms were present before age 7.

Some impairment from the symptoms is present in two or more settings, such as home and work.

The symptoms are not better accounted for by another mental disorder, such as a mood or anxiety disorder.

Exhibits six or more of following symptoms of inattention for at least six months:

  • Often fails to give close attention to details or makes careless mistakes

  • Often has difficulty sustaining attention

  • Often does not seem to listen when spoken to directly

  • Often does not follow through on instructions and fails to finish school work, chores, or work duties

  • Often has difficulty organizing tasks and activities

  • Often avoids tasks that require sustained mental effort

  • Often loses important things

  • Often easily distracted

  • Often forgetful

    Exhibits six or more of following symptoms of hyperactivity or impulsivity for at least six months:

  • Often fidgets or squirms in seat

  • Often leaves seat inappropriately

  • Often feels restless

  • Often has difficulty playing or engaging in leisure activities quietly

  • Often acts as if ``driven by a motor."

  • Often talks excessively

  • Often blurts out answers before questions have been completed

  • Often has difficulty awaiting turn

  • Often butts into conversations or intrudes on others

    SOURCE: Diagnostic and Statistical Manual of Mental Disorders, fourth edition, 2000

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