When a child is diagnosed with ADHD, parents often have lots of questions. Dr. Edward Hallowell, one of the country's top experts on ADHD, is here to help. Care.com interviewed him to get his take on the disorder and what families need to know.
What Is ADHD?
Attention deficit hyperactivity disorder (ADHD), or just attention deficit disorder (ADD) are confusing medical terms. Don't be afraid, though, because if you manage it right, ADHD can become your friend, a major asset in your life.
The terms ADD and ADHD, as well as AD/HD, refer to a syndrome found in both children and adults characterized by distractibility, impulsivity and restlessness or hyperactivity.
In my opinion, ADHD is a terrible term. As I see it, ADHD is neither a disorder, nor is there a deficit of attention. I see ADHD as a trait, not a disability. When it is managed properly, it can become a huge asset in one's life. I both have ADHD myself and I wrote a book with Catherine Corman called "Positively ADD," profiling a collection of fabulously successful adults all of whom have ADHD -- so I know whereof I speak. As I like to describe it, having ADD is like having a powerful race car for a brain, but with bicycle brakes. Treating ADD is like strengthening your brakes -- so you start to win races in your life.
In my work, as a psychiatrist who treats ADHD, I see myself not as a doctor who treats a disability, but rather as a doctor who helps people, adults and children alike, identify, develop, and celebrate their talents. That's why I love my work!
What Is the Difference between ADD and ADHD?
It's very simple. ADHD includes the symptom of physical hyperactivity or excessive restlessness-that's the "H." in ADD (or what is called in the diagnostic manual, ADHD, inattentive subtype), the symptom of hyperactivity is absent. Indeed, people with ADD can be calm and serene, not in the least hyperactive or disruptive. This syndrome is often found in girls and women, but it also occurs in boys and men. It is often missed, because the absence of hyperactivity leads others to assume the child or adult is simply shy, quiet or slow. In fact, they are dynamos in the making.
What Are the Positive Qualities Associated with ADD?
People with ADD typically are creative, intuitive, original, and full of positive energy. They tend to be independent thinkers. They are persistent to the point of being stubborn. They usually are quite sensitive, but often cover this over with a kind of bravado. They are big-hearted and generous. They often have charisma or a special something, a twinkle in the eye, a zany sense of humor or an ability to inspire others. With the right kind of guidance, these people can become hugely successful in their lives.
What Are the Negative Qualities Associated with ADD?
People with ADD typically have trouble paying attention and focusing, especially when they are not interested. On the other hand they can super-focus at times. They also can be impulsive and sometimes hyperactive and disruptive. They can have trouble getting organized, prioritizing their activities, managing time and completing tasks. They can be unaware of the impact they have on others, and so they can be socially awkward or inappropriate. They can be forgetful, inconsistent in follow-through and often late. They have trouble with planning and what mental health professionals call "executive functioning." The good news is that treatment can ameliorate or correct all of this, so that the positive attributes can carry the day.
What Should Treatment for ADD Include?
Treatment should start with education. You need to learn what ADD is and what it isn't. You need to understand ADD well enough to embrace it, and realize that while it may be holding you back right now, in time, with the right help, it can propel you to the fulfillment of your dreams. You need to understand what a positive attribute ADD can be in your life.
Once you learn about ADD -- its positives and its negatives -- then you get to work, with a good guide, a therapist of some sort who understands ADD and takes a strength-based approach, to change whatever it is in your life that is causing you problems. Usually you need to work with a coach to get more organized. You need to get on a regular sleep schedule and build exercise into your life. You need to consider the nutritional aspects of treatment. You will want to reconsider your job or school situation in light of ADD. Various structural changes in your life can make a big difference: the right filing system, the right organization scheme, the right daily schedule. In addition, you will likely want to talk with your therapist about your family life. If you are a child, some family therapy will help. If you are an adult, couples therapy can make a big difference.
Beyond education, coaching and therapy, it is important to have a plan for developing your talents and interests. This will take time, but it is key. You build a life not on weaknesses you have repaired, but on talents you have developed. Of course, fixing weaknesses can help you in developing your talents, so the two go hand in hand.
What About Medication?
When medication works, it works as safely and dramatically as eyeglasses. Medication helps about 80 percent of the time in the treatment of ADD. Make sure you work with a doctor who can explain the issues around medication to you clearly. Most people do not realize how safe and effective stimulant medications truly are, when they are used properly. Make sure you work with a doctor who has plenty of experience with these medications. The stimulants include medications like Ritalin, Concerta, Adderall, Vyvanse, Focalin and others. As long as you take them under proper medical supervision, they can help you immensely.
How About Alternative Treatments for ADD?
I have a completely open mind when it comes to alternative treatments. We have a lot to learn. All you have to be careful of is that whatever you try is safe, and that it has been proven beneficial for at least some people. The alternative treatments that I have solid, positive experience with include: LENS, a form of biofeedback; Learning Breakthrough, cerebellar stimulation in the form of physical exercise; Kolbe coaching, which is based on innovative research into a person's innate style of solving problems; Cogmed, a computer game geared to improving active working memory; My Sensory Solutions, auditory and sensory stimulation via custom iPod and headphones; Reading Plus, a computer home-based program to improve tracking and speed required for reading and comprehension; and various nutritional interventions.
What Would You Say Is the Single Most Important Element in a Successful Treatment Program?
Above all, what matters most is taking a positive approach. Of course, you need to see a professional who is highly knowledgeable and experienced. But you also want to make sure you see a professional you like, a person you feel understands you or your child and a person you can be open and real with. Treating ADD takes time, often years, so you want to be sure you are in the hands of a person you trust implicitly, a person you feel cares for you and your family and, perhaps most important, a person who sees a clear way for you or your child to fulfill your dreams.
What Is Your Background in the Field of ADHD/ADD?
I have both ADD and dyslexia myself. I was diagnosed with a reading problem early in my school years, but my ADD was not recognized until I had completed college (Harvard, where I was an English major and graduated with high honors while also doing pre-med -- not to brag, just to point out that ADD doesn't have to hold a person back!), medical school (Tulane, which I loved, largely because of New Orleans and the wonderful people I met in medical school) and finished a residency in psychiatry back at Harvard at the Mass. Mental Health Center, where I was lucky enough to find stellar teachers who deeply understood the human heart. After residency, when I was doing a fellowship in child psychiatry, I learned about ADD and realized I had it. I was 31 years old at the time. What an a-ha moment!
Now I am 59 years old. I have been treating ADD and other learning differences for 28 years. I have authored or co-authored five books on the subject. I still carry on an active private practice in my offices in the Boston area and in New York City. I see individual patients of all ages, as well as couples, families and groups.
My offices are staffed by people who share my passion for ADD and the marvelous people who have it.
What Distinguishes Your Approach to Treating ADHD/ADD from Other Approaches?
In my centers, we see ADD not as a disability or a deficit, but as a trait, a way of being. It is characterized by a host of qualities -- some positive, some negative. Our job is to promote the positive qualities, while limiting the damage done by the negative. The standard, medical approach looks at ADD entirely as a disorder. By disregarding the positive attributes, this approach often creates new serious disabilities: shame, fear, loss of hope, lowered self-esteem, broken dreams.