Some of the most frequently asked questions about adult ADD:
1. Is ADD different from ADHD?
No, they are the same. ADD is the common name given to attention-deficit disorder and it is how most people refer to the disorder. ADHD (attention-deficit/hyperactivity disorder) is the formal official name used in the Diagnostic and Statistical Manual, DSM IV, for the diagnosis. When I put a diagnosis on an insurance company form or for a report for accommodations for workplace or school, I have to use the formal official diagnosis ADHD inattentive type DSM-IV 314.00 or ADHD combined type, which means inattention plus hyperactivity and/or impulsivity.
2. Do most adults prefer short-acting or long-acting stimulants?
In my 16 years of experience treating adult ADD, most adults, approximately 70%, seem to prefer short-acting rather than long-acting stimulants because of the flexibility of dosing. They can get up at different times on different days and still take their morning dose. They can take two or three doses a day depending on their preference. All three stimulants, Ritalin, Dexedrine and Adderall, have short-acting and long-acting forms. The short-acting generally last approximately four hours and the long-acting last between 8 to 12 hours in general.
3. Which is the best stimulant for ADD: Ritalin, Dexedrine or Adderall?
There is no best stimulant, only the best one for you. Prior positive response and blood relative with a positive response can help simplify which drug to use. If you have a blood relative doing well on a drug, it is very likely you will do well on the same medication. The three stimulants are all good drugs and they all differ subtly in the ways they work on the brain. You have to try them one at a time and see which is best.
4. If you have ADD and another diagnosis, can you treat them at the same time?
Yes. 80% of adults with ADD have a second diagnosis, 50% of adults with ADD have two other diagnoses. ADD, bipolar and social anxiety are three disorders that often occur at the same time. As discussed in my article, you usually treat the more severe diagnosis first, the second and the less severe diagnosis second and third, but the medication for ADD, bipolar (a mood disorder) and social anxiety (an anxiety disorder) are not mutually exclusive. They do not conflict.
5. Can you be smart, have graduated from college and still have ADD?
Yes. It is a mistaken belief that someone who graduates from college cannot have ADD. In fact, many people with ADD are quite gifted, talented and intelligent, but due to the problems of inattention, they do not achieve their fullest potential. I treat doctors and lawyers for ADD.
6. Why do some people drop out of high school due to ADD and others can make it through college and even grad school?
There is mild, moderate and severe ADD in terms of symptoms of inattention. Some people are more disabled than others in terms of ability to focus, distractibility, procrastination, finishing things and executive functions.
7. Is ADD the same as OCD?
No. OCD is obsessive-compulsive disorder. It may coexist with ADD, but OCD is an anxiety disorder and treated with different medications.
8. What are the most common disorders that occur with ADD?
A. Mood disorders (20% of adults with ADD have depression and 20% have bipolar disorder)
B. Anxiety disorder (49% of patients with adult ADD have anxiety disorders; social anxiety, generalized anxiety disorder, PTSD, OCD, panic disorder)
C. Substance abuse disorder (16% of patients)
D. Learning disabilities (10% of adult ADD patients)
9. Why does good evaluation take an-hour-and-a-half?
Refer to my opening statement on the website and the attached article. You have to make the diagnosis of ADD by testing. You have to get the six to nine target symptoms on which inattention symptoms and executive functions are most disturbed. You need to rule out secondary diagnoses. Remember, 80% of adults with ADD have a second diagnosis and 50% of adults with ADD have two other diagnoses, etc.
10. When stimulants work, do they usually work to give benefits across the seven to eight major symptoms, that is, the four inattention symptoms and the four executive functions listed in my article?
Yes. They usually do approximately 80% of the time, but approximately 20% of the time in my experience, distractibility and focus improve, but nothing else improves. There is no improvement in executive functions, procrastination, organization or finishing things. This is a fairly common pattern. In these patients, I will add a second drug from the antidepressant side: Wellbutrin, desipramine, Strattera, Provigil, etc., and oftentimes, I am able to get executive function benefits and benefits for procrastination, finishing things with the combination of two drugs. So, in summary, about 20% of patients I see eventually need a trial of a second drug in addition to a stimulant. So, I have a number of people who are on Adderall, Ritalin, Dexedrine plus a low-dose amount of desipramine, Strattera, Wellbutrin and guanfacine. Refer to the article in the website for the medications used to treat ADD.
11. How do you start a trial of a stimulant?
You start low and go slow. I start with a very low dose in the morning 45 minutes before eating and a second dose four hours later. We gradually increase the dose in weekly intervals until benefits or side effects start happening.
12. People with ADD often say, In school and at work, I do really well on tasks and courses I am interested in, but on the ones I am not interested in, I cannot get anything done. Is this common?
Yes, it is very common. Russell Barkley, one of the most important writers on ADD in this country, makes the statement, People with ADD cannot persist in things they are not interested in whereas normal people will persist in subjects or activities they are not interested in and complete them. Adults with ADD often avoid uninteresting or difficult subjects. They put them off, procrastinate or often find ways of distracting themselves by using the Internet or going to other easier or more interesting activities.