I Advance Medical Science

Geez, pay attention:

CHICAGO (Reuters) - A growing number of older U.S. children are being diagnosed with attention deficit hyperactivity disorder, while diagnoses among younger children have held steady, government researchers said on Wednesday.

The report by the Centers for Disease Control and Prevention found ADHD diagnoses among children aged 12 to 17 increased by an average of 4 percent a year from 1997 to 2006. The researchers found no significant change in the percentage of children aged 6 to 11 diagnosed with ADHD over the same period.

... The researchers did not say why older children were being diagnosed at a higher rate than younger children, but suggested it may be that older children had more chances of being evaluated and diagnosed than younger children.

Oh, please - older children are also more likely to be taking standardized tests, such as the SATs, where a kid with a diagnosed disability gets special accommodations such as extra time.

This is complicated?  In the high pressure world of college admissions, every little bit helps.  And I personally know some "ADD" kids that a laymen would not have been able to single out as having a problem.  Sometimes these ADD diagnoses can be very subtle.  And very helpful.

Comments

[Jane]

Sometimes these ADD diagnoses can be very subtle. And very helpful.

And extremely expensive. Around here the schools get extra cash for every bad diagnosis of anything they come up with. Every 2 year old boy gets diagnosed with something, so the schools can expect that extra cash for years and years and years.

[Crunchy Frog]

And the libs complain about the ever increasing rise in the cost of health care...

[Phelps]

Not only do they get more time, they get Ritalin, which is considered to be an intellectually performance enhancing drug.

http://articles.latimes.com/2007/dec/20/science/sci-braindoping20

[clarice]

"CYNIC!!" She screamed with all the fury of Carol whatshername screaming "HUMPERDICK!" in Princess Bride.

[Porchlight]

Many college kids take Ritalin as a recreational drug. I tried it once back in school and let me just say, it was absolutely flabbergasting to me that these same pills were given to small children. And I only took half a pill!

[bad]

I'd respond but I forget about what...

[Jim Rhoads aka vnjagvet]

In our day, Clarice, we didn't have ADD or ADHD to hide behind. We got labeled class clowns, or some such.

And some of us managed to "grow up" despite a certain, shall we say, somewhat disorganized and unorthodox approach to student life.

[Neo]

They say that Ritalin can boost your SATs by at least 60 points .. some report over 150 points.

[kim]

I've maintained for years that ADD in a chaotic, dangerous, environment, such as combat, may confer a survival advantage. I'm not the least bit sure of this bit of supposition.
================================

[Jane]

My sister was dyslexic, which was the precursor to ADD. Probably in an attempt to help, my mother became a diagnostic psychologist for the school system and was accredited with a lot of the initial work in that field. So you can probably blame me for a lot of this current bull which all seems to stem from that.

[clarice]

Jim, I even know someone--not mentioning her name--who was called into the principal's office at graduation and told she was getting into national honor society with the worst conduct grades in the hisotry of the school..Just saying..

[Neo]

Warning: On average, knowledge workers change activities every three minutes, usually because they're distracted by email or a phone call. It then takes almost half an hour to get back to the task once attention is lost. So if you're trying to read this column at the office or within range of your mobile device, what should be a few minutes can take much longer. Consider the rest of this article an 800-word test of your ability to maintain attention.

[Jim Rhoads aka vnjagvet]

Character, Scholarship, Leadership and Service, Clarice.

No one said anything about comportment.

Thankfully for that unidentified young lady and me.

[clarice]

Smooches...

[hrtshpdbox]

"I tried it once back in school and let me just say, it was absolutely flabbergasting to me that these same pills were given to small children. And I only took half a pill!"
If you "need" the med (and it's just speed) then supposedly you won't have that reaction, but I don't buy that. My son was diagnosed as having ADD and I eventually, reluctantly allowed him to try out the drug he'd been prescribed (not Ritalin, but they're all just amphetamines wearing different-colored lipstick), and he hated it and stopped taking it on his own within a few days. Now he just studies harder.

[Darby Shaw]

When they mean "older children" I believe they are referring to most of the people I work with. No of them can ADD or subtract either.

[Barney Frank]

Warning: On average, knowledge workers change activities every three minutes, usually because they're distracted by email or a phone call. It then takes almost half an hour to get back to the task once attention is lost.

That would seem to indicate 'knowledge workers' never actually do any work.
In fact if I'm adding this up right for every eight hour work day they are distracted a total of eighty hours.

[cathyf]

Well, the person calculating the half-hour distraction per three minutes of work was going to go back and double-check the math, but then got an email, followed by a phone call, followed by two more emails, followed by a chat, ...

[clarice]

Heh--In real life it's not that funny. Often when I had a brief or motion to write, I didn't even try to do it at work--I just did it in the evening at home in a fraction of the time it would have taken to do it in the very chatty and collegial office.

[Soylent Red]

All of these comments remind me of the funniest ADD joke I've ever heard...

How many comedians with ADD does it take to tell a joke?

[Jim Rhoads aka vnjagvet]

Rhoads' rule:

Concentration increases geometrically the closer to an absolute deadline you get.

Corollary:

It is impossible to concentrate on any task more than one week before a deadline.

Problem:

Some tasks take more than one week.

[Patrick R. Sullivan]

On average, knowledge workers change activities every three minutes, usually because they're distracted...

Maybe that explains Obama's speech today. He switched to a completely new platitude every sentence or two.

[kim]

It only makes sense if you accomplish useful work during the half hour it takes to get back on task, and that is commonly the case. Nonetheless, the multi-taskers shall inherit the earth; they already do most of the work.
============================

[Jane]

How many comedians with ADD does it take to tell a joke?

Waiting....

[Soylent Red]

For what Jane?

Oh and good morning.

[clarice]

Soylent,"THWACK

[Soylent Red]

Clarice:

The world is my straight man.

[Joe Y]

I rarely disagree with the prevailing opinions of thie site, but you people don't know what in the hell you're talking about.

Sure, like every other disease, especially one that is newly understood, there are misdiagnoses, prescription abuse, and fraud. However, I lost the first 45 years of my life--that's 45 years--to this wretched condition. By my early 20's, I was near suicide, and if it hadn't been for the intervention of a loving, if by then thoroughly exasperated ex-girlfriend, I probably would have done it. As it was, I wandered through a succession of ill-fitting jobs, poor choices--and I'm going to stop right there.

Two years ago, I couldn't take it anymore. My wife agreed to take out a large line of credit that we couldn't afford, and I went to see a very, very expensive psychiatrist. Halfway through the first session, he closed his notebook, wrote me a prescription, and said to call him if there was a problem, but that I was "right out of a textbook."

The next morning I took the pill. Ten minutes later...well, if you have it, you know what I mean, and if you don't, well, the feeling joins sunsets and orgasms as one of those things that words cannot describe. To put in its simplest form, for the first time in my life, I wasn't scared.

My life will only be a shadow of what it could have been, but I'm so grateful for Ritalin. It doesn't change one's personality or make life any easier than what other people face; rather, it allows a person to make decent use of what he has.

I said a few paragraphs ago that the feeling of release cannot be described, but I thought of a story, well-known in libertarian and conservative circles, that comes closest, Vonnegut's short story called something like "Harrison Bergeson." I'm sure most readers know the one I mean. Taking Ritalin, if you genuinely have ADHD, is what the character in the story must feel like when he rips off all his handicaps.

My greatest satisfaction is that my own children will be able to live decent lives. My consolation for my own late discovery of the drug is that at least I don't have to go through a lifetime of fear and dispair, and may make some contribution after all, but there are so many strange ways of behaving that an adult ADHD sufferer develops to cope with the world, that only now am I accomplishing much of anything. Finally, the tragic and bizarre history of one branch of my family makes complete sense now, and we have been able to put a stop to it.

Again, I'm not saying there aren't abuses, but there is a lot of suffering too, and a lot of people who can be productive, happy members of society thanks to the discovery and successful treatment of this disease. Yes, people with it can cope and accomplish a certain amount, sometimes even great things, but far more cannot. If you know any people who were diagnosed in adulthood--and you probably do, but don't know it, because people are mocked for it in ways that are written here--sit down and listen sympathetically for awhile.

I'm the only adult I know who admits publicly to taking this drug, but others have told me confidentially that they are on it, and they all have stories similar to mine, and some worse.

[Jane]

I sense the joke is on me.

I can take it!

[Jane]

Joe,

I know some people on ritalin who really need it. But the over-diagnosis rate is unbelievable. I personally think the incentive for the over diagnosis is the rate of return for the schools -

That being said, I don't think anyone is arguing that it's not valuable and perhaps life-saving for some.

[bad]

But the over-diagnosis rate is unbelievable.

Sometimes getting a medical diagnosis is easier than taking responsibility for poor parenting.

[Joe Y]

Jane: I appreciate your comments, but I have to respectively disagree with your statement that "the over-diagnosis rate is unbelievable," though, again let me emphasize that I do not disagree that overdiagnosis is a problem, and in certain locales, a serious problem.

For example, hrtshpdbox's story: "If you 'need' the med (and it's just speed) then supposedly you won't have that reaction, but I don't buy that. My son was diagnosed as having ADD and I eventually, reluctantly allowed him to try out the drug he'd been prescribed (not Ritalin, but they're all just amphetamines wearing different-colored lipstick), and he hated it and stopped taking it on his own within a few days. Now he just studies harder."

If his son really could "just study harder," then he didn't have it, or not a severe enough case that couldn't be worked with through other means. Then again, one talent that ADHDer's of a certain kind--the dreamy, quiet variety (mine, though its most common in females), not the better known jump-around like a flea type--tend to develop is that we are terrific liars. We have to be, since we lose so many parts of the day. Also, ADHD children are extremely sensitive to their parents' moods. Since they can't keep track of reality for more than short periods of time, they depend on those close to them for instructions in how to act.

I believe the phrase "unbelievable," however, implies a unbiquity of over-diagnosis that is not justified. Furthermore, I fear--agonize, really--for those who do not get it, but really need it.

I'm thinking of Jim Rhoads, who said, "...we didn't have ADD or ADHD to hide behind. We got labeled class clowns, or some such." Or as head cases, failures, losers, drunks, sluts, psychotics...ah, the good old days.

He goes on, "And some of us managed to "grow up" despite a certain, shall we say, somewhat disorganized and unorthodox approach to student life." Well we all grew up--most of us--but what is the point of all that suffering and underachievement?
Will one of you people please tell me that?

I've never understood it. However, I'm willing to be proven wrong. The next time that one of you breaks your leg, has a heart attack, gets cancer, etc. I'll make you a deal: If you refuse your treatment for your disease, I'll refuse treatment for mine, and stop taking my pill. I read this site almost every day. Just leave a post.

[bad]

Joe

Wish I could provide a link (I can't remember where to go)but cancer, and HIV have both been diagnosed by mistake in people who did not have the disease.

[Porchlight]

Joe,

I'm very glad that Ritalin helps those like you who truly need it. It's the rate of overdiagnosis that concerns me, as it does others here.

My chief worry is that what was once understood to be classic "boy" behavior - difficulty in sitting still and concentrating - is now interpreted as a disorder in need of medication. Of course some boys may really have that disorder and need that medication. But others need something else that they are not getting enough of - physical activity. This is related (in my view) to the feminization of the culture and the expectation that boys ought to behave like girls, quietly and compliantly. Boys are failing at greater rates in schools than they ever have before, and I suspect this is a big part of the problem.

I could go on and on, that's just the tip of the iceberg. But I do appreciate your input. Your comparison to Harrison Bergeron was really eye-opening.

[Bob]

Ditto what Joe said. A likely reason that teenagers are diagnosed is that they have the innattentive form of ADD. They never caused problem when they were younger so nobody thought there was a problem. I never would have thought I was ADD until some fluke article I read described me to a tee. The reaction of people in this comment thread is fairly typical. Only about 1 out of 4 people were supportive, the rest were hostile to the diagnosis to a varying degree.

[Jane]

Joe,

No one is asking you to stop taking your medication so I'm not sure why you are saying that. My nephew has ADHD, and he has been prescribed Ritalin. He hated it, so when in college he would only take it to study for a test. He has no focus, is distracted constantly and sort of stumbles thru life. He knows the alternative and prefers it like that. His sister has even a worse case, has never taken medication, but is obsessive as hell. She moved in with me at age 20, unable to actually form a sentence. For 2 years I did everything I knew to help her grow up, and interact with people. (Her ADHD was not the worst of her problems.) What I discovered was that she was motivated by incentives. At age 20 if I offered her a dollar to clean the entire house she would jump at the opportunity. (In kindergarten she would raise the roof for a gold star.) So she had hyper-focus as well as an inability to focus. She is now a top telephone salesperson for a big company. For her it is all about the prize and she discovered that money was for her the best prize of all.

Different people have different needs. What I object to, is the desire for school employees to diagnose nearly every 2-year-old boy (that is the current magic age around here) with some iteration of the condition so they can demand special ed funds from the state. (I think the reality is that 2 year old boys don't act like 2 year old girls.) Give em a drug and then we don't have to do anything.

While drugs work for some, they don't work for all, and some don't need them, and some need a lot more than drugs. While I think you are incredibly lucky that you discovered what works for you, I dislike the excuse that the diagnosis gives to prescribe and ignore because it doesn't work as well for everyone else.

[Jane]

Porchlight,

I agree with everything you said - including the feminization part.

And BTW I finished the book today. By the end I wished Thomas could find an escape from his morosity (is that a word?), because I truly believe success is the best revenge.

[Porchlight]

Jane,

Thomas is a bit gloomy - I think he was built that way, to some extent. I like to think of him and his wife out RVing around in the summer, shaking hands in Wal-Mart parking lots with evident enjoyment (or so I am told).

I have about a zillion theories on the feminization of the culture. Don't even get me started on helicopter parents, a phenomenon I've been ranting about for ten years or more.

[Jane]

helicopter parents

Never heard of it.

[Joe Y]

I appreciate this discussion, and wish I could continue, but I'm on Eastern time and its sack time. I want to say, though, that I agree even with the those who differed from me, including the infuriating criminalization of masculintiy that Porchlight brought up. My fear is that those who need help will be deterred from getting it. I'm glad you weren't, Bob.

Jane, I didn't know your story. You are clearly an extraordinary person to have given so much. I wish I would have had an aunt like you back in the day! Obviously, you're quite right about the many treatments and personality types. I guess one more blessing of being an American is that we can usually find a place for everyone, as your niece did.

I hope you'll forgive my stridency on this topic; I would tone down my posts somewhat, but it's too late now. I'll check tomorrow morning to see if we're still going.

Good night and God bless.

[Porchlight]

Jane,

Helicopter parents are the hovering types who obsess over germs and choking hazards, put their kids in the baby swings until age seven, and are generally afraid to let little Aidan or Olivia out of their sight for one minute lest something awful happen, even if it's just to take the garbage out. Remember that kid with the overprotective mom who you felt sorry for in grade school? He's the norm now.

I'm exaggerating here, but not much. And if you're a parent, good luck bucking the trend without getting CPS called on you.

[Porchlight]

Joe (and Bob),

Thanks again for your input. I definitely learned something. Hope you'll delurk again on other topics!

[Rick Ballard]

For those who would rather argue about the actual study, rather than the somewhat oversimplified news report, it's available here. I would suggest that the findings support more of a Munchausen's By Proxy impetus on the part of parents than a search for an edge on the SAT for young Festus or Marigold. "Reversion to mean" is a simply unsatisfactory explanation (to some) for the fact that one has produced a child who will be among the 70% who will never pick up that all important degree.

The decision to bear a single Golden Prince or Princess rather than burden Gaia with another mouth or four has some rather peculiar consequences.

[JM Hanes]

There is certainly plenty of wrongful overdiagnosis, and I don't think schools or teachers should have a hand in it at all. There is also abuse, especially among teens who will swap almost any sort of drugs. That said, however, the dismissive attitude that pervades so many discussions is mostly full of misinformation, misdirection and condescending platitudes about child rearing.

Attention Deficit Disorder is something of misnomer, it's more like Attention Control Disorder -- with nothing in between being completely scatterbrained or wearing blinders. It's not surprising that Jane's niece could hyperfocus with sufficient incentive -- incentive is a stimulant. She's one of the lucky ones for whom that proved sufficient. Porchlight, the drug you tried wouldn't actually do the same thing to anyone who does, in fact, have ADD. When your brain chemistry is already in balance, you end up over stimulated. That's why ADD meds are such popular recreational drugs, and why students take them to put themselves into overdrive in demanding situations, where the ADD student needs the drug just to get up to speed.

While not technically correct, it helps to picture ADD as a problem with firing and receiving neurons efficiently because of deficiencies in the chemical medium for that transaction in your brain. A lot of ADD adults are real danger junkies, because as excitement rachets up, your body begins pumping more chemicals into your brain, not just your muscles. Normal people get "fired up," ADD people actually begin to feel normal. They make great emergency responders. Unfortunately, lot of ADD folks also end up as addicts, because in similar fashion, stimulants which give other folks highs, make them feel normal too. Ironically, when ADD adults do coke, it's more likely to calm them down than the reverse.

ADD was first noticed and studied in boys at school, because it's so often accompanied by hyperactivity, ADHD, which tended to be most obvious in (dull/unstimulating) classroom settings. For a long time, nobody noticed the girls with ADD, because they weren't hyperactive and disruptive, they just sat in corners daydreaming. For a long time, doctors thought that ADD/ADHD was a childhood problem which was outgrown by the onset of puberty. It turned out that the hyperactivity often dissipated, while the ADD itself was likely to persist. The last people to be noticed were adult women -- most of whom were generally misdiagnosed with other disorders or treated for depression (which typically accompanies ADD) without success.

Accurate diagnosis is not a simple matter, in any case, because you can't do much testing on the brain. It's also not so much a discreet condition, but a continuum that goes from normal to the kind of affliction which limits your ability to function normally in society at all. In some cases, things like intelligence and parental organization can mitigate sufficiently without medication. Jane paid attention, and provided an incentive to her niece. So many others end up succumbing to a terrible triad of ADD/depression/addiction. ADD/ADHD people constitute a disproportionate share of prison populations. On the flip side, they can also be enormously creative, because they spend their lives thinking outside the box. And if they are fortunate enough to be able to alter their own environments and follow their own drummers, they can be enormously successful in many cases too.

As you might suspect from this long comment, I was diagnosed with ADD, myself. Not till age 47, alas. I fought both the diagnosis & the very idea of medication, till my doctor finally said, take this medication for a month and then we'll talk. It righted the world on its axis. My ex and I led a logistically complicated life, and for a lot of that time, I felt like I was literally starting to go insane. I spent a lot of time struggling to make it look like all the things that seemed so easy for everyone else to accomplish -- like just packing a suitcase -- were easy for me too. I still wake up with no idea how I can possibly accomplish all the things I need to do, or even figure out what order to do them in. Every single day used to start with panic, anxiety and the frightening feeling that everything around me was on the verge of spinning out of control. Trying to provide some sort of organized framework for my ADD son was like my nightmare job description. The only reason I don't panic now, is because I know that an hour after I take that pill, I'll just sort everything out and get it done.

I understand the concern about overdiagnosis and abuse. I share it, but make no mistake, ADD is a genuine affliction. For every careless or self-serving diagnosis, there is a struggling child whose parents believe ADD is just pop-psyche fad and an adult losing a desperate battle because he doesn't know enough to realize that the problem is his brain chemistry, not his character. If I, too, feel compelled to comment at length here, it's not because hostility aimed at abusers, whether institutional or individual bothers me in any way. Widespread hostility toward the idea that ADD really merits serious treatment, however, bothers me a lot.

[Jane]

Holy cow JMH. Do you know anything about cause?

Porchlight, re: helicopter parents - Amy tells stories of people like that all the time. I never knew it had a name.

[Rick Ballard]

Jane,

Table 2 within the study indicates that diagnosis of the condition is slightly higher among low birth weight children and 50% higher among children with no father at home. Causation is not addressed but the over diagnosis situation is recognized.

The study is really very good and supports the 'reality' of the situation as reported here by Joe, Bob and JMH.

[Jane]

Interesting Rick,

I've certainly lost focus in my old age, altho I attribute a lot of it to practice. I can still muster up hyper-focus when necessary for short periods of time, but absent the urgency, my eyes and mind glaze over. For example, I cannot imagine ever having the focus to familiarize myself with "table 2". (I'm serious)

[Joe Y]

There are different ideas about what causes it, but I think that there are actually different causes that present themselves similarly. In my family, it is clearly hereditary, and it primarily manifests itself as the “inattentive” type. As Ritalin is effective in treating it for us, I believe it must be the along the lines of increasing blood flow to the “working memory” areas of the brain, and decreasing it to the competing regions. I’m not going to make a fool of myself by trying to talk with any more sophistication than that, but this is a quick summary of a study that observed the brain activity changes in adult ADHD subjects before and after taking Ritalin. http://news.bio-medicine.org/medicine-news-2/How-Ritalin-Enhances-Memory-3A-Clues-Provided-By-Brain-Scans-of-ADHD-Patients-Using-The-Drug-11368-1/ .

A good metaphor is that of a computer chip. The Ritalin expands the chip’s capacity to a size large enough to manage normal tasks; without the computer keeps crashing. When a computer crashes, it either stops freezes or functions erratically; to compare to human beings, think of the inattentive or hyperactive respectively. This is also what makes ADHD sufferers easy to manipulate and control and/or withdrawn.

I want to very much thank JM Haynes for his long letter, and I’d like to recommend you seek out a support group. I’m pretty sure you’ll have the same (extremely negative) reaction to the phrase “support group” that I had, but you know what? After a lifetime of being told I was lazy, spoiled, self-indulgent, an underachiever, etc—you probably heard it all too—and told to tough it out, I go with what works. There are a lot of practical ways to lighten your burden. In my own case, I have realized that I had developed so many defensive behaviors that I mistook as part of my personality, that even when I’m not on the drug I am a much more effective and happier person. A support group accelerated this process.

[bad]

RE: Helicopter parents

The practice isn't confined to K thru 12. Family and friends who teach at universities tell of ever increasing phone calls and e-mails from parents of college kids asking for grade changes, homework updates and "please be nicer to Johnny."

[clarice]

Well, whatever you have or take, JMH--you are one of the sharpest tacks in the drawer.

I don't have it--or at least I don't think I do--but for the few months I was on Chantix and taking a (too)high prescription for statins, I was as flippy as you describe your pre-prescription days. Brain chemistry sure is complicated.

[Porchlight]

bad, I work with faculty at a university and I hear the same thing. You would think the students would be embarrassed by their parents doing that - certainly I would have been mortified - but apparently now many of them expect it. The kids themselves harass the instructors via email - complaining about assignments, demanding better grades, etc. It's really appalling.

[Jane]

8 years ago I was diagnosed with a brain tumor. What was worse than the tumor, was the way the diagnosis came about. It's too long a story too relate as it went on for months, but ultimately some big hot-shot doctor handed me a piece of paper and told me to look up what it meant on the internet.

I was so pissed off with doctors (I have very bad luck with doctors) that I refused to see one for a few years and then was referred to a guy who took 2 years to tell me he was the wrong doctor for the job. Three years ago, I found out I don't have a brain tumor.

In the beginning I just started dying. Unfortunately this all happened at a time when the normal vicissitudes of aging were setting in so when I started losing my previously steel trap memory, I attributed it to my death sentence and not aging. My vision also changed, I could no longer see the words on the page making it nearly impossible to read. This again I attributed to the diagnosis instead of a natural progression in life. (Last summer I figured out it was an issue of having enough light.) My focus also went to hell, but I suspect from lack of use as opposed to anything clinical. I'm still sorting out what I gave up too easily.

I'm not sure what my point is, and since you all know me very well you know it is not to evoke sympathy, except maybe that we have to work this stuff out at some point, and kudos to Joe and JMH for doing so.

On a happier note, I got my confirmation for the NRO cruise this morning!

[bad]

Randy Pausch:

You just have to decide if you're a Tigger or an Eeyore.

[bad]

Jane

What an experience!! Its beyond imagining.

[Jane]

Oh bad, I suspect you can imagine it just fine, I'm very sorry to say.

[bad]

JMH, Joe, Bob

Thanks for sharing your experiences. The brain is a fascinating organ that produces extraordinary individuals.

[Pofarmer]

That would seem to indicate 'knowledge workers' never actually do any work.
In fact if I'm adding this up right for every eight hour work day they are distracted a total of eighty hours.

Where do I sign up?

[cathyf]

Table 2 within the study indicates that diagnosis of the condition is slightly higher among low birth weight children

My mother-in-law's older brother was very premature. He weighed about 3 pounds. The doctor came to the house and said to call the undertaker. His parents put him in a shoebox in the warming oven of the woodburning stove as an incubator. Miraculously, he was one of the 1% who survived in 1926... My mother-in-law says that decades later, as a children's librarian she realized that he showed all of the classic symptoms of ADHD. At 82, he still does...

[Porchlight]

Jane, what a story. I remember you once mentioning something about distrusting doctors. Now I understand why.

But that is great news that you're going on the cruise! I'm delighted that you and JMH will be meeting each other (and Mark Steyn!). Looking forward to hearing all about it.

[Lesley]

Dear JMH - my sympathies/empathies.

An eighty-eight year-old friend, concerned about me, gave me this book: "Driven to Distraction, Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood" by Hallowell, M.D. & Ratey, M.D.

Suggested Diagnostic Criteria for Attention Deficit Disorder in Adults (Note: Consider a criterion met only if the behavior is considerably more frequent than that of most people of the same mental age.)

1. A sense of underachievement of not meeting one's goals (regardless of how much one has actually accomplished).
2. Difficulty getting organized.
3. Chronic procrastination or trouble getting started.
4. Many projects going simultaneously; trouble with follow-through.
5. Tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark.
6. A frequent search for high stimulation.
7. An intolerance of boredom.
8. 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.
9. Often creative, intuitive, highly intelligent.
10. Trouble in going through established channels, following "proper" procedure.
11. Impatient; low tolerance for frustration.
12. Impulsive, either verbally or in action as in impulsive spending of money, changing plans, enacting new schemes or career plans and the like.
13. 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.
14. Sense of insecurity.
15. Mood swings, mood lability, especially when disengaged from a person or project.
16. Restlessness.
17. Tendency toward addictive behavior.
18. Chronic problems with self-esteem.
19. Inaccurate self-observation.
20. Family history of ADD or manic-depressive illness or depression or substance abuse or other disorders of impulse control or mood.

FWIW

[JM Hanes]

Joe Y:

"In my own case, I have realized that I had developed so many defensive behaviors that I mistook as part of my personality, that even when I’m not on the drug I am a much more effective and happier person."

I'm still no good a packing suitcases, I just don't agonize over how to get it done or dread having to travel any more! I was fortunate in my circumstances and not as acutely afflicted as many; I got so good a coping, and hiding just how hard it was, that most of the folks around me were pretty stunned when I crashed.

Fortunately, when I finally asked for help, I got a lot of support, and it made a huge difference. That's why I hate to see people throwing the baby out with the bath water, just because so many teachers seem to be perfectly happy with the idea of medicating their students into proper little zombies, or because so many parents are perfectly willing to pump up their kids up with drugs to give them an advantage if they can find a socially acceptable way to do it.

[Lesley]

Dear JMH:

I hated packing, too, until a friend turned me on to a great solution. Using those clear plastic zipper bags in which blankets, sheets, etc. usually come, I designate one for lingerie, one for nightgowns and a robe, one for sportswear, one large one for shoes (which are then individually wrapped in bags), one for makeup and toiletries, one for books, pens, travel clock, one for laundry.....I think you catch my drift. Obviously one garmet bag for hanging items.

The wonderful thing about it is that these clear blanket bags fit right in a drawer, keep one organized, and prevent your lovely clothes from getting ruined should there be a leak. Moreover, because of the organizational aspects of these silly bags, I've learned to pack for long trips in less than an hour and unpack when I get home in less than twenty minutes.

(And, if you need help deciding what to wear for all your different events, which is entirely a horse of a different color, call me. ::wink::)

PS My kids tease the heck out of me, but after years of hauling kids and large hunting dogs up to the lake for the summer (9 1/2 hours from home), we've settled on clear plastic bins with lids. Everyone has several bins, loads of blanket bags to organize everyone's carp within, and its a snap! Ofcourse, you do need a large pickup truck and several SUV's to facilitate the trek....but damn, are we organized.

(After rereading what I've written, I've got to wonder where my ADD ends and my obsessive compulsiveness begins. Heh.)

[clarice]

Well,jmh, in Jane you have the PERFECT travel companion, don't you? (I'm not happy she'll have a jump so to speak on Steyn , but there you go.)

[Jane]

I'm not packing for her Clarice, if that's what you are saying!

(Actually I would if she asked, but she might not be thrilled with the result. I'm a great starter but I absolutely hate finishing things.)

And I will be jumping on Steyn if I get the chance!

[centralcal]

JMH and Jane, I am so jealous. I hope you guys will be able to post comments about all the fun you'll be having on the cruise.

[clarice]

rrrrrrrrrrrrrrrrrrrrrhi I knew you would,Jane--I just KNEW it.

[JM Hanes]

Lesley:

LOL! We're definitely kindred spirits. I too have known haulin' kids, dogs, cats, rabbits, gear and food for multitudes. When Supersized Xtra Jumbo Ziploc bags hit grocery store shelves, it was a life changing event, and I think I've got clear plastic containers in almost every size that's legally allowed in a domestic residence. I quit unpacking my dop kit altogether too.

I jotted down some thoughts before I checked back to find that the spirit of the thread had evolved in my absence, but I'll go ahead and paste it into a separate comment anyway, for what it's worth.

[JM Hanes]

With continuing advances in technologies for non-invasive study of the brain, I believe we'll ultimately end up with more reliable chemical/neurological and/or genetic markers. Till then, the struggle to establish a definitive set of behavioural criteria for diagnoisis will continue. Human behavior is so variable that distinguishing between symptoms and causes on the basis of observation will always be an inexact and controversial science, and interpreting the kind of checklists we're reduced to using will remain, in no small part, a matter of art, training and experience. That's why the judgment call that diagnosis represents at this point in time should be made by a professional. As the body of observation grows, the accuracy of diagnosis does improve, as do the opportunities and options for amelioration.

As a layman/patient coming to terms with my own diagnosis, I found two books particularly helpful. "Women with Attention Deficit Disorder" by Sari Solden was one of the first books on the popular market front that really addressed ADD in women and recognized gender related differences in how it manifests itself. On the purely speculative front, I loved Thom Hartmann's book called "Attention Defifict Disorder: A Different Perspective." He set out to approach ADD as a positive feature, rather than a disorder, and came up with a theory that fans of evolutionary psychology (where the only standard seems to be plausibility!) might enjoy. Whether it will ever be sustained scientifically, I have no idea, but he offered what for me a very helpful way to think about ADD.

Hartmann suggests that folks with ADD are genetically related to the hunter gatherers who were largely wiped out by expanding populations of farmers. He began by observing that the problem with ADD children is not that they are incapable of paying attention, but that they are paying too much attention. They are either noticing absolutely everything that's going on their environment from the teacher at the blackboard to the sound of a pencil rolling off a desk and the sight of wind in the trees out the window. When something excites them they take action in ways that seem overtly impulsive, but they are, in fact, responding to things or connecting dots that others simply don't notice. Once involved, they focus so intently, that they don't notice anything else at all and find it very difficult to switch channels till they've finished whatever it is they are doing. Hartmann suggests that particular feature set would be a real advantage, if you depended on hunting for survival. In agricultural societies consistency, preparation and predictability are much more important. You're tied the land, you need to find and develop reliable sources of water, you have to protect and tend your livestock every day without fail, and put up food for the winter.

Obviously, it's hard to do justice to a book in a paragraph, but at the decided risk of sounding like the inestimable Rev. Wright, it sometimes really is helpful to think in terms of skill sets, not deficiencies. ADD people are square pegs adapting to life in a round holed world. They process information in very different ways, and I, personally, believe that a lot of the attributes that make them a difficult fit in traditional education and 9-5 (daylight!) jobs may ultimately be much in demand again going forward. I'd bet a lot of them are techno geeks right now.:)

[JM Hanes]

Jane:

I suddenly find myself wondering where on earth I put my own confirmation and whether it included forms that I was supposed to fill in and return.... Maybe I'd better go "hunt" it down instead of penning posts!

[JM Hanes]

Then again, it is Friday night.

[Jane]

I got the forms today. I'm told I need trip insurance and it should cost 5% of the trip and not to buy it from the cruise line.

I'm also told that until I accept or reject the cruise line's insurance I can not be fully registered.

I just hate minutia. I haven't had a secretary in 7 years, and boy there are times when I think that was a very bad idea. This is one of those times.

But I will say, I am looking forward to this trip as much as I've looked forward to anything in a long time. So I will persevere.