Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood

Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood

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by Edward M. Hallowell, John J. Ratey, John McDonough, Jeff Woodman
     
 

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THE NATIONAL AUDIO BESTSELLER

Procrastination. Disorganization. Distractibility. Millions of adults have long considered these the hallmarks of a lack of self-discipline. But for many, these and other problems in school, at work and in social relationships are actually symptoms of an inborn neurological problem: ADD, or Attention

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Overview

THE NATIONAL AUDIO BESTSELLER

Procrastination. Disorganization. Distractibility. Millions of adults have long considered these the hallmarks of a lack of self-discipline. But for many, these and other problems in school, at work and in social relationships are actually symptoms of an inborn neurological problem: ADD, or Attention Deficit Disorder.

Through vivid stories of the experiences of their patients -- both adults and children -- Dr. Edward R. Hallowell and Dr. John J. Ratey show the varied forms ADD takes -- from the hyperactive search for high stimulation to the floating inattention of daydreaming -- and the transforming impact of precise diagnosis and treatment.

Driven to Distraction is a must listen for everyone intrigued by the workings of the human mind.

Editorial Reviews

Library Journal
Hallowell and Ratey offer a fine addition to literature on ADD (Attention Deficit Disorder). The authors employ a broad, general definition of ADD (``high-energy, action-oriented, bottom-line, gotta-run-type people'') and continually emphasize the special, positive qualities of people with ADD. They describe how ADD affects adults--many Americans mistakenly think of it as a childhood curse--and explain how the American temperament helps create ADD-like symptoms. Best of all are the stories and case studies of myriad folks who have dealt successfully with their diagnosis. A state-by-state list of support groups are included in this excellent approach to an intriguing subject.-- Linda Beck, Indian Valley P.L., Telford, Pa.

Product Details

ISBN-13:
9781402509865
Publisher:
Recorded Books, LLC
Publication date:
06/26/2002

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Chapter 1

What Is Attention Deficit Disorder?

Once you catch on to what this syndrome is all about, you'll see it everywhere. People you used to think of as disorganized or manic or hyper or creative but unpredictable, people who you know could do more if they could just "get it together," people who have bounced around in school or in their professional lives, people who have made it to the top but who still feel driven or disorganized, these may be people who in fact have attention deficit disorder. You may even recognize some of the symptoms in your own behavior. Many of the symptoms of ADD are so common to us all that for the term ADD to have specific meaning, rather than just be a scientific-sounding label for the complex lives we lead, we need to define the syndrome carefully. The best way to understand what ADD is — and what it is not — is to see how it affects the lives of people who have it.

In the cases that follow, and in the many case illustrations that appear in this book, one can wimess the struggles individuals faced to break through inaccurate labels and unfair judgments. As their stories unfold, a definition of ADD emerges.

Case 1: Jim

It was eleven o'clock at night and Jim Finnegan was up pacing in his study. This was where he often found himself at night: alone, pacing, trying to get things together. Now approaching the halfway point of life, Jim was getting desperate. He looked around the room and took in the disorder. The room looked as if the contents of a bag lady's shopping cart had been dumped into it. Books, papers, odd socks, old letters, a few half-smoked packages of Marlboros, and other loose ends lay scattered about, much like the bits and pieces of cognition that were strewn about in his mind.

Jim looked up at the to do list that was tacked to the corkboard above his desk. There were seventeen items, the final one circled several times in black ink and marked with exclamation points: "Reorganization proposal due Tues., 3/19!!!" This was Mon., 3/18. Jim hadn't started on the proposal. He'd been thinking about it for weeks, ever since he told his boss that he had a plan that would increase productivity, as well as morale, in the office. His boss had said fine, come up with a written proposal and we'll see how it looks. His boss had also added a remark about how he hoped Jim would have enough "follow-through" to actually get something done this time.

Jim knew what he wanted to say. He'd known for months what he wanted to say. The office needed a new computer system, and the men and women out front needed more authority so they could make decisions on the spot so everybody's time wouldn't be wasted in unnecessary meetings. Efficiency would go up and morale would definitely improve. It was simple. Obvious. All the ideas were detailed on the various scraps of paper that dotted the floor of his room.

But all Jim could do was pace. Where do I start? he thought to himself. If it doesn't come out right, I'll look stupid, probably get fired. So what else is new? Why should this job be any different? Great ideas, no follow through. That's me, good old Jim. He kicked the trash basket and added to the mess on the floor. OK, breathe in, breathe out, he told himself.

He sat down at his word processor and stared at the screen. Then he went over to his desk and began to straighten things up. The telephone rang and he barked at it, "Can't you see I'm busy?" When the answering machine came on, he heard Pauline's voice: "Jim, I'm going to sleep now. I just wanted to see how your proposal is coming. Good luck with it tomorrow." He didn't have the heart to pick up the phone.

The night went on agonizingly. One minor distraction after another would knock Jim off-line as he tried to clutch onto the task at hand. A cat would meow outside. He'd think of something someone had said three days ago and wonder what they really meant by that. He'd want a new pencil because the one he had felt heavy in his hand. Finally, he got down the words "A Proposal for Office Reorganization at Unger Laboratories." Then nothing. "Just say what you want to say," a friend had told him. OK, say what you want to say. But nothing came. He thought of a new job he wanted to apply for. Maybe I should just bag this and go to bed. Can't do that. No matter how bad it is, I've got to finish this proposal.

By 4 A.M. he was beat. But not beaten. The words began to come. Somehow his extreme fatigue had lifted the censor in his mind and he found himself explaining his ideas simply and efficiently. By six he was in bed, hoping to get a little sleep before his meeting with his boss at nine.

The only trouble was that at nine he was still in bed, having forgotten to set the alarm before he went to sleep. When he arrived in a panic at the office at noon, he knew from the look on his boss's face that no matter how good the proposal was, his days at Unger were over. "Why don't you find a place with a little bit more flexibility?" his boss said, and thanked him for his proposal. "You're an idea man, Jim. Find a place that can accommodate to your style."

"I don't get it," he said to Pauline over drinks several weeks later. "I know I have more to offer than getting myself fired every six months. But it's always the same old story. Great ideas, but can't get it done. Even in high school, can you believe that? The guidance counselor, she was this really nice lady, she told me that I had the highest IQ in the class, and so she just couldn't figure out why I had such a hard time living up to my potential."

"You know what's not fair?" Pauline said, turning the stem of her Manhattan glass between her thumb and forefinger. "They took the ideas in your proposal and used them. Dramatic improvement. Everybody's happier and work is up. Those were your ideas, Jim, and you got fired. It's not fair."

"I don't know what's wrong with me," Jim said. "I don't know what to do."

Jim had attention deficit disorder. When he came to see me at the age of thirty-two, he had been living a life of chronic underachievement, falling short of his goals both at work and in relationships because of an underlying neurological problem that made it difficult for him to pay attention, sustain effort, and complete tasks.

ADD is a neurological syndrome whose classic defining triad of symptoms include impulsivity, distractibility, and hyperactivity or excess energy. About 15 million Americans have it today; most of them do not know that they have it. The condition occurs in children and adults, men and women, boys and gifts, and it cuts across all ethnic groups, socioeconomic strata, levels of education, and degrees of intelligence. It used to be thought that this was a disorder of childhood alone, and that one outgrew it during adolescence. We now know that only about a third of the ADD population outgrows it; two-thirds have it throughout adulthood. ADD is not a learning disability or a language disability or dyslexia, and it is not associated with low intelligence. In fact, many people who have ADD are very smart. It's just that their smartness gets tangled up inside. Undoing the tangle to get a smooth run on the line can take more patience and perseverance than they can consistently bring to bear.

Where does the syndrome begin and normal behavior leave off? What is impulsivity? What is distractibility? How much energy is excess? These are the questions we will explore throughout this book, mainly in the context of individual cases, like Jim's. Considering the symptoms, can't we all recoguize parts of ourselves? Yes. However, one bases the diagnosis of ADD not on the mere presence of these symptoms, but on their severity and duration, and the extent to which they interfere with everyday life.

When Jim came for consultation, he was at wit's end. He came into my office, sat down in one of the easy chairs, and began to run his fingers through his curly hair. He leaned forward, alternately looking at me or staring at the floor. "I don't know where to begin. I don't even know what I'm doing here," he said, shaking his head as if to say no, this won't help either.

"Did you have any trouble finding your way here?" I asked. He was twenty minutes late, so I figured he might have gotten lost.

"Yes, yes, I did," he said. "Your directions were fine, it wasn't your fault. I just turned left where I should have turned right and then I was gonzo, school was out. It's a miracle I got here at all. I ended up at some gas station in Somerville."

"Well, it can be pretty confusing," I said, hoping to let him relax a bit. Of the people who consult with me for problems related to ADD, probably about a half are either late for their first appointment or miss it altogether. I have come to expect it. It comes with the territory. My patients, however, usually feel very bad about it and so begin the session thinking that I am going to reprimand them in some way. "You certainly aren't the first person to get lost coming here," I said.

"Really?" he asked. "That's good to hear." He took a deep breath to say something, but paused, as if the words had crowded in his throat, then let his breath out in a long sigh, the words apparently dispersed. He went through the same cycle a second time before I asked him if maybe he could use a few moments just to collect his thoughts while I wrote down some bits of information about him like his name, address, and telephone number. That seemed to help. "OK," Jim said. "Let's start."

"OK," I responded, leaning back in my chair, folding my hands behind my head. There was another long pause, and another sigh from Jim. "I can see that it's hard for you to get started," I said. "Maybe we could focus on what the problem is that brought you here."

"Yes," he said, "OK." With that little bit of prodding from me, Jim began to fill in most of his history. A normal childhood, or so it seemed to him. But when I pressed for more detail, Jim acknowledged that he was quite rambunctious in grade school and enjoyed getting into mischief. He got good grades even though he never really studied. "I thought school was like playtime," he said. But with high school, things got tougher. His innate intelligence couldn't carry him so easily anymore, and he began to fall behind. He started to get lectures from his teachers and parents on his moral shortcomings, how he was letting himself and everyone else down, how in the long he'd be the worse for it, and so forth. His self-esteem fell, although somehow his inborn temperament was buoyant enough to keep him fairly upbeat. After stumbling through college, he began a long series of jobs in various computer-related fields.

"You like computers?" I asked.

"I could have invented them," he said with great enthusiasm. "I love them. I just have this understanding of them, you know what I mean? I know what makes them tick, and I know how to get the most out of them. If only I could tell people what I know. If only I didn't screw up every time I get a chance —"

"How do you screw up?" I asked.

"How do I screw up?" he asked, then repeated the question again, turning it into a sorrowful statement by his tone of voice. "How do I screw up. I forget. I argue. I postpone. I procrastinate. I get lost. I get mad. I don't follow through. You name it, I do it. I'll get into these discussions with my boss, and I'll see my way is right, and the next thing you know, I'm calling him a stupid jerk for not seeing that I'm right. Tends to get you fired, calling your boss a stupid jerk. Or I'll have this idea, but I won't be able to find it, like it's a jumble lost in the closet or something. It's in there, I know it's in there, but I just can't get it out. I want to get it out, I try to get it out, but I can't. One of my old girlfriends told me before she left me that I should face it, I'm just a loser. Maybe she's right, I don't know."

"You cared about her?" I asked.

"For a while. But then she got fed up, like all the rest have. I mean, I'm pretty intense to be with."

"Where do you think that intensity comes from?" I asked.

"I don't know," he said. "It's always been there, though."

The longer we talked, the dearer it became how right Jim was, how the intensity had always been there, seldom harnessed, but always burning. That intensity may in part explain why ADD is common among people in high-energy fields, from sales to advertising to commodities to any high-pressure, high-stimulus kind of work. "Have you ever consulted a psychiatrist before?" I asked.

"A couple of times," Jim said. "They were nice guys, but nothing really changed. One of them told me not to drink so much."

"How much do you drink?"

"I binge. When I really want to let loose, I go out and tie one on. It's an old family tradition. My dad drank a lot. I guess you could say he was an alcoholic. I don't think I'm an alcoholic, but that's what they all say, huh? Anyway, I get these terrible hangovers the next day, so I don't go back to it for a while."

Often people with ADD self-medicate with alcohol or marijuana or cocaine. Cocaine, particularly, is similar to one of the medications used in the pharmacological treatment of ADD.

Jim began to cross and uncross his legs a lot as we talked. "If you're feeling restless, feel free to pace a bit while we talk," I said.

"Really? You don't mind? Thanks a lot." He stood up and began to walk around, conducting his conversation with his arms as he spoke. "This is great. Most people would get unnerved if I did this, but I really think better when I walk. Is that weird? No wonder I had trouble in school. You know, that's half my problem. I'm always so tied up inside. And you can imagine it doesn't go over big at work if I want to pace half the time."

"I don't know," I said. "Maybe you just haven't found the right job."

"You sound like all my bosses. Is there a right job for me?"

ADD comes in many shapes and sizes. In many people, particularly adults, the symptoms of ADD are masked by more obvious problems, such as depression or gambling or drinking, and the underlying ADD is never detected. In other people the symptoms take on a particular cast, congruent with the person's personality as it evolves over time, so that the symptoms are never really noticed the way symptoms of a cold or flu might be but rather are dismissed as being part of "just the way he is," not warranting medical or psychiatric intervention. And within the domain of properly diagnosed ADD there is also much variability. Jim's ADD, I was discovering, was the high-energy, hyperactive type. But there is another kind of ADD that shows no hyperactivity whatsoever. Indeed, these people can be underactive. This is the child, often a girl, who sits at the back of the classroom daydreaming, or the adult who moves serenely within a cloud, never quite present anywhere.

"I don't know if there is a right job for you," I said, coming back to Jim's question. "For now I'd just like to hear more of your story. Have you ever really told it before?"

"No. Nobody can follow me. I go off on too many tangents, they all say."

"Well, you just keep talking, and let me do the organizing. That's what I'm paid for."

Jim talked for a long while, over weeks. He told many stories of misunderstanding, miscommunication, self-reproach, underachievement, missed chances, angry people, and risky behavior. It often seemed, as his mother had told him when he was twelve, that he simply didn't know enough to come in out of the rain. He'd do foolish things, forget, and dillydally all the time. But he also told stories of adventure, and kindness, of intuition and charm and energy and enthusiasm. He told stories of big dreams and high hopes and big disappointments as well. Baffled and frustrated, he never blamed anyone but himself. He was a very likable guy, even though he didn't like himself very much.

And this is the case with so many people who have ADD. They are very likable, although they get into the most difficult of patches. They can be exasperating in the extreme — one mother called me about her son, who had ADD and had just inadvertently almost set fire to his school, and asked me if she could run over him in her truck — but they can also be unusually empathic, intuitive, and compassionate, as if in that tangled brain circuitry there is a special capacity to see into people and situations.

Jim's story took us through many twists and turns. There was the time he had a job as a bus driver: one dreamy afternoon doing his regular run he made what he thought was his last stop and headed home for the bus yard only to pull into the lot with a bus half-full of confused and angry customers. He had forgotten to make the actual final stop on the line. "Where are we?" the passengers demanded. "Where have you taken us?" It was Jim's last ride for that bus company. Or there was the time in conversation with a female colleague when he referred to his boss as a "pinhead," only to realize almost as he was saying it that the female colleague was his boss's wife. "I don't do it on purpose,". he said. "I just put my foot in my mouth. I don't think about who I'm talking to or where I am. Is it my unconscious wish to fail?"

"It could be," I said. "That sort of thing has been known to happen. On the other hand, it could be something completely different." I began to tell Jim about ADD. "You see, it might be that you're not a screw-up or a loser at all, and that you do not have an unconscious wish to sabotage yourself. It might be, and it is beginning to sound to me as if this is very much the case, that you have a neurological condition called attention deficit disorder. It's no more a thing to be ashamed of than being nearsighted is. In fact, it's sort of like being nearsighted. You don't focus very well. You have to strain to see clearly. People with ADD have trouble attending to one task at a time. You've probably heard of hyperactive children, and that was how this syndrome was originally described — hyperactivity in kids. We now know that the symptoms include more than just hyperactivity and that it affects adults as well as children. The hallmark symptoms of ADD are easy distractibility, impulsivity, and sometimes, but not always, hyperactivity or excess energy. These people are on the go. Type A personalities. Thrill seekers. High-energy-, action-oriented-, bottom-line-, gotta-nm-type people. They have lots of projects going simultaneously. They're always scrambling. They procrastinate a lot and they have trouble finishing things. Their moods can be quite unstable, going from high to low in the bat of an eye for no apparent reason. They can be irritable, even rageful, especially when interrupted or when making transitions. Their memories are porous. They daydream a lot. They love high-stimulus situations. They love action and novelty. Just as this kind of problem can get in the way at work, it can also interfere with close relationships. Your girlfriend can get the wrong impression if you're constantly tuning out or going for fast action."

As I explained to Jim what attention deficit disorder was, I watched him. He leaned forward in his chair and looked right at me. He began to nod his head at the mention of each new symptom. An excited look came over the face that had been so harried when we first met. "When. I was a kid," he broke in, "it was always 'Earth to Jim!' or 'Where's Jim?' or 'Jim, why don't you just shape up?' My parents and my teachers just thought I was lazy. So I would get punished or yelled at. For a while I yelled back, but then I just sort of began to agree with them. I mean, what can you do? My dad had a way of smacking me across the side of my head if I talked back. It was kind of brutal, come to think of it. So I don't think of it much. I have to wonder, though, what kept me going. I mean, I never lost my spunk. I remember a teacher in the sixth grade making me copy pages out of a geography textbook because I had lost my homework. She said if I would admit I just hadn't done the homework instead of lying and saying I'd lost it, she wouldn't make me copy the pages. Well, I had done the damn homework, so I was not about to say I hadn't. Well, she got ticked off and really lost it. She got into this thing where she kept upping the ante, assuming I would back down. She kept adding on pages for me to copy. When she reached a hundred pages, she stopped. I stayed up all night copying those pages, and I would have reached the hundred pages if my mother hadn't found me in the middle of the night. She made me stop. Plus she went into school the next day and raised a big stink. Old Miss Willmott had to apologize to me. To me! It was the most satisfying moment of my entire educational career, bar none, and I'll always love my mother for it."

"But I wish they had known then what you are telling me now," Jim went on. "There were so many stories. My whole ninth-grade year was like one long war with my parents. They got into the same thing Miss Willmott did, always upping the ante. Their basic idea was that I wasn't trying hard enough, so they kept coming up with more and more punishments, none of which worked. It makes me kind of sick to think back on it. It wasn't my parents' fault. They didn't know what was going on. Why didn't anybody tell me about this before?" Jim finally asked me in exasperation.

"People haven't really known about it very much until fairly recently," I answered.

It can't be said when ADD came into existence. The fidgety, overactive child has been around, one may presume, for as long as children have been around. And they have not been treated well.

The treatment of children has been terrible throughout history, one of the consistent but little-mentioned black marks in almost every epoch of human civilization; people have seldom differentiated much when it comes to children who behaved "badly." Too often, it was simply recommended that these children be beaten, or in some cases, killed. There is something in the most inhumane part of human nature that enjoys hurting smaller and weaker beings, particularly if they annoy us or make demands on us. It is beyond the scope of this book to document the abuse of children that mars human history; I bring it up in connection with ADD because it has often been the overactive children, the ADD kids, who have been subjected to the worst abuse. It is only recently that we have conferred upon children rights beyond those of animals and decided to look upon their "misbehavior" as possibly signifying something other than satanic possession or a moral infirmity deserving punishment.

So it is not surprising that although the syndrome we now call ADD has been around for centuries, it was simply lumped together with all other "bad behaviors." It was not until this century that it began to be recognized as a medical condition. Although it is hard to say who first defined the syndrome, credit usually goes to British pediatrician George Frederic Still, who, in a series of lectures to the Royal College of Physicians in 1902, described some children in his medical practice who were difficult to control, showing signs of "lawlessness," lacking "inhibitory volition," and in general being obstreperous, dishonest, and willful. He hypothesized that the condition was not the result of bad parenting or moral turpitude, but rather was biologically inherited or due to injury at birth.

The theme of injury at birth and brain damage continued in the thirties and forties in the idea of the "brain-injured child." Even When no actual evidence of neurological impairment could be found, "brain damage" was invoked to explain uncontrollable behavior. It was during these decades that stimulant medication (amphetamine) was first tried, successfully, to help contain the behavior of some of these children.

Other terms began to appear, some quite descriptive, such as "organic drivenness," others rather amorphous and bleak, like "minimal brain dysfunction." One had to wonder whether the brain itself was minimal or the dysfunction was minimal or perhaps whether the understanding of what was happening in the first place was minimal.

Separating the symptom of hyperactivity from any notion of brain damage, Stella Chess in 1960 and others around the same time began to write about the "hyperactive child syndrome." Chess saw the symptoms as part of a "physiologic hyperactivity," whose causes were rooted in biology rather than the environment.

By the 1970s many major researchers were investigating the syndrome of hyperactivity. Virginia Douglas, in Canada, began to look broadly at the symptoms associated with hyperactivity and found four major traits to account for the clinical picture: (1) deficits in attention and effort, (2) impulsivity, (3) problems in regulating one's level of arousal, and (4) the need for immediate reinforcement. In large part due to her work, in 1980 the syndrome was renamed attention deficit disorder.

In the decade since that time, research has ballooned. Probably the most up-to-date and definitive account of the history and current state of the field is to be found in a book written by one of the great researchers in the area, Russell Barkley; his book is entitled, simply, Attention Deficit Hyperactivity Disorder.

"So what does it mean, exactly?" Jim asked me. "Does it mean I'm stupid?"

"Not at all. But don't let me tell you. You tell me. Are you stupid?" I asked.

"No, I'm not. I know I'm not," he said emphatically. "I've just had this trouble all my life of getting out what's inside."

"Exactly," I said. ''That can be due to a lot of different things in different people, but in your case I think it's due to ADD."

"Is it common?" he asked.

"Probably fifteen million people in this country have it, both children and adults. It affects males more than females, probably in a ratio of about three to one. We don't know what causes it exactly, but the best evidence is genetic. Other factors may contribute, like problems at birth, but genetics is the main cause. Environmental factors can make it a lot worse, but they don't cause it."

"You mean my mother didn't screw me up?" he asked ironically.

"Not in this case. Maybe in other ways, who knows. Do you want to blame her?"

"No, no. But I want to blame someone. Not blame someone, I just want to get mad. It really pisses me off that no one told me about this before. If this is just the way I'm wired —"

"Then," I interrupted, "you don't have to blame yourself."

"Who is, of course, the person I've been blaming all along. But it is my fault, isn't it? I mean it doesn't matter whether I've got ADD or XYZ — if I've messed up, I've messed up and at my age there's no one but me to take the heat. Right?"

"In a way, I guess," I said, rubbing my shoulder as if his words had activated an old ache. "But what's to gain in all the blame? I want to give you a framework to understand yourself in such a way you can forgive yourself and move on."

"OK," Jim said, "I get what you're saying. What's the bottom line, though? Is there anything you can do for this?"

"ADD people love bottom lines," I answered, laughing. "It's always, 'Get to the point'; 'What's the next show?'; 'Where's the beef?'"

"Yeah, you're right," he said. 'Tm not big on scenery. I want to get there. Is that bad?"

"I didn't mean to put you on the defensive. I have ADD myself. I know how it feels."

"You have ADD?" Jim asked, apparently taken aback. "You seem so calm."

"Practice," I said, smiling. "Actually, I'm sure for you there are times when you can be quite focused and relaxed. For me, doing this kind of work is one of those times. But the practice part is true also, and we'll get into that."

From this point Jim's treatment began. Actually, it had begun already. Just finding out about the syndrome, finding at last that there is a name for it, constitutes a large part of the treatment for most people.

"What is it with me?" he asked in one session. "I don't mean to be rude. But this guy calls me up and he starts to tell me the materials I sent him were the wrong ones, when I knew perfectly well they were the right ones, he just didn't know why they were the right ones, and so he thought they were the wrong ones, and so immediately that started to annoy me, but it wasn't even that that got to me, it was his tone of voice. Can you believe it? I knew from the first second he started on the phone that I wanted to hang up on him or punch him."

"You had like a rage reaction," I offered.

"Damn straight. And when I think about it now, I get mad all over again. So I tried to do what you said. Pause. Think of the consequences. This was a good customer. I didn't want to lose him and I didn't want him bad-mouthing me to his friends. So I paused. But the more I paused, the more he talked on, in this really slow, dumb voice, on and on, and! wahted to scream at him, 'Get to the point!' So instead, I just cleared my throat. But then he said to me, 'Don't interrupt me, I'm not finished.' Well, I lost it. I told him I thought we could be on the phone until next Christmas and he still wouldn't be finished and I had better things to do and I hung up. Can you believe that?"

I laughed. "I think you did very well. At least up until you lost it. The guy was pushing your buttons. And let's face it, there are going to be times where you're going to get annoyed and you're going to lose it. Treatment for ADD won't take that away completely, and you wouldn't want it to, would you?"

"I guess not. But is this part of ADD, this rage reaction, as you call it?"

"Yes," I said. "It's part of the impulsivity. If you think of ADD as a basic problem with inhibition, it helps explain how ADD people get angry quicker. They don't inhibit their impulses as well as other people. They lack the little pause between impulse and action that allows most people to be able to stop and think. Treatment helps with that but it doesn't cure it completely."

"You know what the funny thing was?" he asked. "The guy called me back the next day and said he was sorry we had developed a communication problem between us the day before and maybe we could start over. A communication problem, can you believe that? I said sure, only let me start this time. I explained to him in ten seconds why what I had sent him was what he needed, he said he understood and said thank you, I said, 'No, it is me who should thank you, I'm sorry for our communication problem yesterday,' and we said goodbye, best of friends." Jim slapped his knee.

"How do you like that?" I said. "Your guardian angel must have been on duty."

"But where does it come from, this anger?"

"Can you tell me?" I asked.

"I think it's built up over the years. When I was a little kid, I was all over the place, but I wasn't angry. I think it built up, in school. All the failures. All the frustration." Jim clenched his fists without knowing it as he talked about his feelings. "It got so I knew before I started something it wasn't going to work out. So all I had left was tenacity. I wouldn't give up. But, damn, why didn't I, with all the screw-ups I had to show for my efforts?"

Jim was beginning to get into what is a large and very important part of ADD, although, strictly speaking, it is not part of the neurological syndrome itself. He was starting to talk about the secondary psychological problems that typically develop in the wake of the primary neurological problem of ADD.

Due to repeated failures, misunderstandings, mislabelings, and all manner of other emotional mishaps, childr

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