ADHD focuses on adults

By Rita Rubin, USA TODAY 12/3/03

If you want to know what's wrong and what's right with Kenneth
Nessing, just look at his résumé.
Education: associate's degree, 1986; bachelor's degree, 2002; law-
school applicant, 2003. Employment: musician, radio reporter, public
relations, human resources.

Nessing, 50, is a bright man of many talents who happens to have
attention-deficit hyperactivity disorder, or ADHD. Although more
successful than many with the disorder, Nessing has long recognized
that he has a problem focusing on tasks.

Researchers believe that as many as 4% or 5% of U.S. adults have
ADHD, but perhaps only 15% to 25% of them know it. Awareness has
increased in the past year as a result of the heavy marketing of
Strattera, the first medication to receive Food and Drug
Administration approval for treating adult ADHD.

The other drugs used to treat ADHD mainly have been tested in
children and teens, but at least two companies are planning to seek
FDA approval to market their products to adults.

Many adults with ADHD never attempt college, let alone graduate.
Nessing didn't enroll until his 30s. Although he has switched
professions several times, he never dug ditches, as one teacher, fed
up with his scatterbrained ways, predicted years ago.

"People don't get it, and they label you as stupid, or they label you
as a troublemaker," says Nessing of Wallingford, Conn.

Getting labeled as an adult with ADHD, widely but wrongly considered
to be only a childhood disorder, was a relief. "A lot of things
started to make sense," Nessing says.

Mental health experts say Nessing is lucky to have a diagnosis. "When
I was a medical student, we were taught it didn't exist in adults,"
says Richard Weisler, an adjunct professor of psychiatry at the
University of North Carolina-Chapel Hill. "We were taught it was
something you outgrew."

Skeptics might wonder which came first, adult ADHD or the drugs for
it.

"Some people these days say, 'Where were all these people before?' "
says psychologist Thomas Brown, associate director of the Yale Clinic
for Attention and Related Disorders. "They were being diagnosed as
unmotivated or lazy."

The same skeptics could run down the list of symptoms on the
Strattera Web site — disorganization, difficulty finishing projects
and losing things, to name a few — and conclude that nine out of 10
adults have ADHD.

"I know to some this is just one more class of victims who don't want
to take responsibility for their behavior," says Russell Barkley, a
psychiatry professor at the Medical University of South Carolina in
Charleston. "That's naive."

The difference between the majority of adults and those with ADHD is
one of degree, Barkley says. "These symptoms occur among these people
far more frequently than they do among the rest of us."

Many highly energetic, creative individuals have ADHD characteristics
such as disorganization, but that doesn't stop them from
accomplishing what they set out to do, says Massachusetts
psychiatrist Edward Hallowell, author of Driven to Distraction, a
1994 best seller about ADHD.

"A disorder is by definition something that gets in your way," he
says. "The intensity and the duration of the symptoms are so severe
that they impede your progress in life."

If symptoms didn't begin until adulthood, they're not due to ADHD. So
an accurate diagnosis often depends on a paper trail decades long.
Report cards noting behavioral problems, bad grades and a poor
driving record provide clues, Barkley says, as does talking with a
patient's parents, siblings or lifelong friends.

Perhaps half of children with ADHD will continue to have symptoms as
adults, researchers say. However, adults usually outgrow the
hyperactivity that's often part of ADHD, especially in boys. "No
adult, no matter how hyperactive, climbs on top of their desk," says
Lenard Adler, director of the Psychiatry and Neurology Adult ADHD
Program at the New York University School of Medicine.

Childhood hyperactivity translates into impulsiveness in adults,
Barkley says.

He began studying the ramifications of ADHD in a group of Milwaukee
school kids in the 1970s. Some had the disorder; others, for
comparison purposes, did not. He continues to evaluate his subjects,
now young adults, every five years.

The differences between the ADHD and the comparison groups are
striking. Only 5% of those with ADHD graduated from college, compared
with 35% of the others. By age 20, 40% of those with ADHD had given
birth to or fathered children; only 4% of the others had. The ADHD
group have worse driving records and are much more likely to have
been fired from a job.

Low score, plus son's diagnosis

Nessing says he was never hyperactive. Disappointingly low scores on
the Law School Aptitude Test, or LSAT, the test required of law-
school applicants, led to his diagnosis three months ago. He has
suspected for seven years that he has ADHD, ever since his son was
diagnosed in first grade.

That's not an unusual chain of events. ADHD tends to run in families,
and parents "will be sitting through the evaluation of their child,
and they'll realize, 'Gee, those are the same symptoms I had as a
child,' " Adler says, adding that not all parents realize they still
have them.

Besides, in the years after his son's diagnosis, Nessing had a good
job and completed his bachelor's degree. He was doing so well he
decided to apply to law school, although he doesn't want to practice
law. "The law degree to me would be a credential that says this guy
can understand complex problems and solve them."

And then he hit the wall called the LSAT. "I took the LSAT in
February of this year and got a score that's totally unrepresentative
of my talent," Nessing says. "I believe that is a direct link to my
not being able to concentrate on certain aspects of the LSAT."

His son's doctor referred him to a psychiatrist and then to Brown.
Nessing says testing by Brown has shown that he's perfectly capable
of achieving a competitive score on the test as long as he's given a
little extra time. He says he just can't read and assimilate
information as quickly as an equally intelligent person without ADHD.

Nessing says he has been able to focus more since the psychiatrist
who originally diagnosed him prescribed Strattera, although, he says,
Brown thinks he might do even better on another drug.

Drugs help to focus

Besides being the only ADHD drug approved for adults, Strattera also
is the only one that is not a stimulant, and, therefore, is not a
controlled substance. That distinction has been a big part of Eli
Lilly's marketing campaign for the drug, although Ritalin has a
decades-long track record.

"I think the stimulants are really safe," says Peter Kramer, a
clinical professor of psychiatry at Brown University and author of
Listening to Prozac. "They've been around for 60 years. The evidence
that they lead to drug addiction in kids has really been reversed."

Still, says Adler, who co-authored the first published clinical trial
of Strattera in adults, "It's nice to be able to have choices to
make" when treating ADHD.

No medication is a cure, says Michael Wendel, 32, of King's Park,
N.Y., a patient of Adler's. "The medication is one part of the
solution."

Wendel takes a cocktail of drugs, including Ritalin, for his ADHD,
diagnosed in the mid-1990s. Ritalin's stimulant effect falls between
that of caffeine and amphetamines. Before Wendel was diagnosed, his
drugs of choice were cigarettes and Diet Coke. Lots of Diet Coke, as
many as 24 cans a day at his peak. The nicotine and the caffeine
helped him function better.

He managed to graduate from college, barely, but he has lost a few
jobs because of his impulsive habit of blurting out inappropriate
comments. "Even if you don't want to say it, it usually comes out,
anyway," says Wendel, a computer consultant laid off from his last
job.

Like Wendel, New Yorker Phyllis Goldman, 59, describes herself as a
lifelong underachiever. She was diagnosed with ADHD a year ago after
her 46-year-old brother and his two daughters were diagnosed with the
disorder.

She wonders what might have been if her ADHD had been detected when
she was in school.

"I would have done a lot better if I'd been diagnosed a long time
ago," says Goldman, manager of a hospital pulmonary lab. "I've been
in and out of therapy years and years for other things, and nobody
ever spotted it."

Goldman says Adler prescribed Strattera because she had had weight-
loss surgery, and he didn't want a stimulant to suppress her appetite
further.

She has noticed a big difference in her life since starting
treatment. "I used to forget everything. I just couldn't stay
focused. For a whole year I have not had a bill late. Everything gets
out on time."