Volume 18, Number 5
Other Bumps in the Road
ADULT ATTENTION DEFICIT DISORDER
By Alan C. Bail
How do you explain to the court that you were late because you couldn't choose which shoes to wear? And that after you had chosen your shoes, polished them, and put on your suit and tie, you decided that you didn't like the way the tie looked with that suit, requiring a change of suit and, of course, different shoes? There was a time when a simple activity such as getting dressed made my life extremely complicated.
I had come to accept the fact that I was always running late, and had to agree with those who were left to wait: I must be lazy and inconsiderate. Others organized their days, their lives; why couldn't I? I obviously wasn't stupid: I graduated cum laude from a good law school, loved to try cases-the more difficult the better-and got excellent results. So why was it so difficult to get those status reports and bills out?
As my frustrations mounted over the years, I found a solution to the increasingly uncomfortable emotions: marijuana! It worked quite well in relieving some of my anxiety, and, remarkably, it seemed to help me focus on one thing at a time. I opened my own firm and reveled in the excitement of it all. As long as things were interesting, I was on top of it. I hired others to handle the less interesting aspects of the practice. When things slowed in the mid-nineties, I took more of the responsibilities upon myself. Sometimes, they just didn't get done. I was working 60 to 70 hours a week; what more could people expect of me?
Nine years after opening my practice, I had to move my office into my home. There, I would stare at the computer for hours, my fingers refusing to cooperate with my brain. A routine declaration that should have taken 30 minutes to complete would take days instead. What in the world had happened to me?
At last, a psychiatrist sat me down and asked me to answer a few simple questions, then a few more. "Oh, you're ADD," he said. "Read Driven to Distraction, and we'll start some medications." At last, I had a name for my condition, a medical explanation for many of my difficulties. I could now start to understand what made me tick. Unfortunately, even with the correct diagnosis, my life continued to spiral downward. I eventually lost my car and home, and somehow ended up living on a sofa in some guy's living room. Looking back today, I understand that I probably needed to go through that journey in order to make a complete recovery.
People have asked me how I did so well in law school with undiagnosed and untreated ADD. The simple answer is that the rigid structure of law school kept me on track. Interestingly, it turns out that litigation ranks high on the list of professions to which we ADDers are drawn. While ADD is generally marked by a lack of focus, it is often coupled with an intense "hyperfocus" that can be quite useful in a deposition or trial.
How can an adult determine if he or she has Attention Deficit Disorder? The official diagnostic reference, the DSM-IV, presents criteria applicable only to children. While ADD behavior has to have been present since childhood for a finding of ADD in an adult, behaviors can morph over time as we attempt to cope with what Thom Hartmann calls "a hunter's mind in a farmer's world." Edward M. Hallowell, M.D., and John J. Ratey, M.D., authors of the ADD "bible," Driven to Distraction, have come up with a list of 20 diagnostic criteria, most of which must be present in the patient "considerably more frequently than [in] most people of the same mental age" to be considered significant. Among those criteria:
- Difficulty getting organized; tendency toward procrastination (or trouble getting started).
- Many projects going at once; trouble with follow-through.
- Tendency toward impulsiveness, verbally or in action, regardless of consequences or appropriateness.
- Tendency to be easily bored; great effort expended to avoid boredom; searching for stimulation; restlessness.
- Difficulty focusing attention; tendency to tune out; easily distracted, but often an ability to selectively hyperfocus.
- Low tolerance for frustration; trouble going through established channels or following proper procedure.
- Tendency to worry needlessly and endlessly, coupled with inattention to actual dangers; a sense of impending doom or insecurity, coupled with high risk taking.
- Chronic problems with self-esteem; inaccurate self-observation; mood swings; depression, especially when "disengaged."
- Tendency toward addictive behavior (whether related to drugs, alcohol, shopping, eating, gambling, or work).
- A sense of underachievement, regardless of what one has actually accomplished.
- Often highly creative and intelligent (usually nonlinear thinkers, with flashes of brilliance).
More details about the diagnostic criteria can be found at www.netacc.net/ ~gradda/sp94addu.html, or by using any search engine on the phrase "Adult Attention Deficit Disorder."
I have found that the hardest issue for me in dealing with ADD is my sense of time. Dr. Hallowell describes an ADDer's perception of time as a feeling that "everything is happening all at once," causing a loss of perspective, difficulty prioritizing, and often a sense of inner turmoil or panic. I have found structure to be the critical factor for getting things done within the ADD world. Throughout my formal education, that structure was imposed by school, study groups, and classmates. Of course, in the "real" world, structure often must be self-imposed. Such self-regulation and structure obviously run against the grain of many ADD traits. Many ADDers turn, either formally or informally, to ADD "coaches"-people who understand how the ADD mind works-to help keep them on track with their lives.
Perhaps ADD is much like an addiction: before people become willing to give up a way of life to which they have become accustomed (and which used to work), they must often hit bottom. This was certainly the case with me. I am now willing to accept structure in my life because the alternative is far less pleasant.
After some three years away from the practice of law, I have been able to return, slowly but steadily, with a greater confidence than ever before. I have come to accept myself as I am. I take medication to help alleviate some of the more problematic aspects of the condition, and I have discontinued my prior self-medication. I am finally able to stop wasting my time uselessly beating myself up, and instead I am continuing the process of moving my life forward. Now if only I could only get this article in on time.
Alan C. Bail is a lawyer in Los Angeles. His practice focuses on complex tort, contract, and land use litigation. He may be contacted at firstname.lastname@example.org
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