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Honorable William G. Simmons
Lawyer Assistance Committee Chair
Work/Life: The Scope of Attention-Deficit/Hyperactivity Disorder
By: Carol P. Waldhauser
Today, Matthew received a “letter of dismissal” from the managing partner of the mid-size firm where he worked for nearly 3 years. Among the reasons listed were poor working skills. Matthew felt strongly that this was a trumped up charge. After all, he won a number of large-scale, complex cases. Unfortunately for Matthew, this argument was not won successfully.
Emptying his desk, Matthew’s thoughts reflected on other places and distant times when he felt like he did today. Ironically, it seemed for each box packed, a new memory of past difficulties surfaced. Matthew remembers that his difficulties began when he was very young. He is now 35 years old.
As a toddler, Matthew recalls his parents’ stories of his very active and very stubborn ways, as well as their attempts at discipline - that were usually ineffective. In pre-school, Matthew, himself, remembers how he would impulsively disrupt the class. Clearer still, were his memories of elementary school as the nuns reported their concerns about his unacceptable behavior to his parents. By then, Matthew was not only disruptive; he was aggressive and antagonistic toward other children.
Unfortunately, this cycle of behavior continued through grade school, high-school and even undergraduate school. In fact, both Matthew and his parents were amazed that he was able to pull himself, as well as his grades, together long enough to complete law school successfully. Matthew believed that he would realize the same success as a practicing attorney, however, this was not the case. Problems surfaced almost immediately. To make matters worse, Matthew’s personal life was a mess.
Fortunately, the memory of this day stayed with Matthew. Rather than putting his head in the sand; Matthew decided to seek help from a licensed therapist. After a battery of test, Matthew was diagnosed with Adult ADHD. It was not until this psychiatrist diagnosed him with attention deficit hyperactivity disorder that things began to turn around.
THE SCOPE OF THE PROBLEM:
Parents often feel responsible for everything their children do, and may feel especially guilty about admitting that their child has a problem that is serious enough to require professional help. Many problems, however, are easier to treat in children, since their behavior patterns and interaction styles have not yet become firmly established. This seems to be especially true with the diagnosis and treatment for Attention-Deficit/Hyperactivity Disorder.
What is attention deficit hyperactivity disorder (ADHD)?
Attention deficit hyperactivity disorder (ADHD) is the most common behavior disorder diagnosed in children and teens. ADHD refers to a group of symptoms that begin in early childhood and can continue into adulthood, causing difficulties at home, at school, at work, and within the community if not recognized and treated.
What are the symptoms of ADHD?
There are three groups of ADHD symptoms:
· Inattention: This is the most common symptom. In addition to having difficulty paying attention, people with this symptom often are unable to consistently focus, remember, and organize. They may be careless and have a hard time starting and completing tasks that are boring, repetitive, or challenging.
· Impulsiveness: People who frequently act before thinking may not make sound judgments or solve problems well. They may have also trouble developing and maintaining personal relationships. An adult may not keep the same job for long or spend money wisely.
· Hyperactivity. A hyperactive child may squirm, fidget, and climb or run when it is not appropriate. These children often have difficulty playing with others. They may talk a great deal and not be able to sit still for even a short time.
Teenagers and adults who are hyperactive don’t usually have the more obvious physical behaviors seen in children. Rather, they often feel restless and fidgety, and are not able to enjoy reading or other quiet activities. More specifically, many adults with ADHD have not been diagnosed and treated. These people can develop problems such as depression and difficulty maintaining a job. Additionally symptoms of ADHD may vary by individual and range from mild to severe such as:
· Learning disabilities
· Oppositional defiant disorder
· Conduct disorder
· Anxiety disorder
These symptoms are sometimes mistaken for ADHD. They may occur also along with ADHD, which can make diagnosis of the primary problem difficult.
According to the Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association:
The essential feature of Attention-Deficit/Hyperactivity Disorder is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development. (Criterion A). Some hyperactive-impulsive or inattentive symptoms that cause impairment must have been present before age 7 years, although many individuals are diagnosed after the symptoms have been present for a number of years, especially in the case of individuals with the Predominantly Inattentive Type (Criterion B). Some impairment from the symptoms must be present in at least two settings (e.g., at home and at school or work) (Criterion C). There must be a clear evidence of interference with developmentally appropriate social, academic, or occupational functioning (Criterion D). The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, schizophrenia, or other Psychotic Disorder and is not better accounted for by another mental disorder (e.g., a Mood Disorder, Anxiety Disorder, Dissociative Disorder, or Personality Disorder) (Criterion E). P. 86
The diagnostic features include also the following:
Inattention may be manifest in academic, occupational, or social situations. Individuals with this disorder may fail to give close attention to details or may make careless mistakes in schoolwork or other tasks (Criterion A1a). Work is often messy and performed carelessly and without considered thought. Individuals often have difficulty sustaining attention in tasks or play activities and often find it hard to persist with tasks until completion (Criterion A1B). They often appear as if their mind is elsewhere or as if they are not listening or did not hear what has just been said (Criterion Alc). There may be frequent shifts from one uncompleted activity to another. Individuals diagnosed with this disorder may begin a task, move on to another, and then turn to yet something else, prior to completing any one task. They often do not follow through on requests or instructions and fail to complete schoolwork, chores, or other duties (Criterion Ald). Failure to complete tasks should be considered in making this diagnosis only if it is due to inattention as opposed to other possible reasons (e.g., failure to understand instructions defiance). These individuals often have difficulties organizing tasks and activities (Criterion A1e). Tasks that require sustained mental effort are experienced as unpleasant and markedly aversive. P. 86
What causes ADHD?
The exact cause is not clear. However, it is known that chemical balances in the brain affect temperament and behavior. According to the Diagnostic and Statistical Manual of Mental Disorders: Attention-Deficit/Hyperactivity Disorder has been found to be more common in the first degree biological relatives of children with Attention-Deficit/Hyperactivity Disorder than in the general population. Considerable evidence attests to the strong in-order than in the general population. Considerable evidence attests to the strong influence of genetic factors on levels of hyperactivity, impulsivity, and inattention as measured dimensionally. However, family, school and peer influences are also crucial in determining the extent of impairments and co morbidity. Studies also suggest that there is a higher prevalence of Mood and Anxiety Disorders, Learning Disorders, Substance-Related Disorders, and Antisocial Personality Disorder in family members of individuals with Attention-Deficit/Hyperactivity Disorder. P. 90
Is There Treatment for ADHD?
There is treatment for ADHD, however, treatment does not cure ADHD. It can help control the symptoms – inattention, hyperactivity, and impulsiveness and improve:
·Relationships with family, teachers, and peers.
·Behaviors that are disruptive
·School performance, including quality of work and the ability to complete assignments.
·Independence in caring for oneself and completing tasks
· Attention and awareness which helps with everyday safety issues, such riding bicycles or driving
An important first step in treating ADHD is educating parents, teachers and other adults. With training, they can learn what to expect and to recognize the signs. Other treatment includes, but may not be limited to behavior therapy and/or medication. As for our attorney Matthew, he says he feels like a different person since he has been treated for ADHD: “I have a grip”. In fact, Matthew seems to be one of an increasing number of adults who now know that children are not the only individuals that suffer from ADHD – an increasing number of adults do too! For more information call the MSBA's Lawyer Assistance Program at (410) 685-7878 or (800) 492-1964, ext. 3041.
Abnormal Psychology, The Problem of Maladaptive Behavior, Irwin G. Sarason/Barbara R. Sarason, P. 46.
Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-TR, American Psychiatric Association, P. 86, 90