Brook Ochoa, 42, doesn’t fidget or squirm or bounce off walls like an 8-year-old child with ADHD. That’s primarily because she’s an adult, and adults tend to lack the hyperactivity part. The single mother of two has plenty of other symptoms, however. “I read seven books at a time, have never finished a project in my life, and when I get bored with a job I just walk away. I never knew until recently that that wasn’t normal. If it’s boring, I’m done.”

“Boring” is the kiss of death to adults with ADHD (attention deficit hyperactivity disorder or just ADD if they lack the hyperactivity component). And her inability to stay interested in any one subject for long may explain why Brook quit several jobs as manager and assistant manager of stores like Target and Wal-Mart. Brook is certainly competent enough to handle a heavy workload. She did well in school and earned a master’s degree in human resources; she can focus and finish assignments when they interest her. But around the house, she struggles with such simple tasks as washing dishes after meals. “Every dish in the house has to be dirty before I notice,” says Brook with a sigh. (See also “Symptoms of ADHD.”)

But at least she knows where her demons lie. For adults who were not diagnosed as children—and anyone who was already an adult when ADHD became widely recognized in children in the 1990s is unlikely to have been—having a label affixed to their struggles allows them to finally seek help. Perhaps even more important, it lets them make sense of a lifetime of bewildering experiences, of feeling hopeless or helpless in the face of their mental dysfunction, and, in many cases, wondering why they never achieved what they felt they could have.

“The more she described ADD the more the light bulb lit up for me,” recalls Robin Bellantone, 61, a mental health counselor in Portsmouth, New Hampshire. She had no idea adult ADD existed when she had the life-altering conversation during her graduate-school internship at the Massachusetts College of Art and Design in 1999. It was there that she heard a fellow staffer who specialized in working with artists with ADHD talking about the disorder: “It explained so much about my own history”—her inability to focus, her difficulty paying attention, her constant search for new stimulation.

Stories of adults who finally learn they have ADHD are as unique as the people themselves, but they have at least one thing in common: a sense that what was once shrouded in mystery is now lit with understanding, that a weight has been lifted and a puzzle solved. The National Institute of Mental Health estimates that 4.1 percent of adults have ADHD in any given 12-month period (compared to 9 percent of children). In the young, three times as many boys as girls have ADHD, but by adulthood the prevalence is the same in both sexes.

If it sometimes seems that everyone has some form of ADHD in today’s disjointed world of smartphones, tablets, and the like, the formal diagnosis is indeed on the verge of becoming more common. The newest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, scheduled for release in May 2013, is expected to loosen the diagnostic criteria for the disorder substantially, lowering the number of symptoms required. (See chart, “Symptoms of ADHD,” next page.) But, even so, there are misconceptions about what it takes to qualify. For example, inability to focus and being easily distracted—with no other symptoms—wouldn’t be enough. You do not have ADHD if you simply like to flit from task to task at work. You do not have ADHD if you get bored doing housework. You do not have it if your mind wanders when reading dense, boring prose on a topic you have no interest in; if you get fidgety during boring sermons or hours-long presentations from a financial planner; or if you start reading another book or magazine before you finish the previous one you’ve started.

Moreover, the symptoms must appear in at least two settings: If you only show these behaviors at work, then you do not have ADHD. You probably just don’t like your job.

Still, the condition is underdiagnosed. Today, for every adult whose ADHD has been identified, there are at least three adults whose ADHD has not, according to Dr. Mary Solanto of Mount Sinai Medical Center in New York. Underdiagnosis reflects that adults can compensate for ADHD by choosing jobs that fit their brains—for instance jobs that present constant new challenges rather than jobs where one does the same task over and over.

That probably explains why Ruth didn’t receive her diagnosis until age 74. As a young woman she had few friends, felt isolated, and often blurted out what she felt without much thought for the consequences. Then, after marrying and raising a family, Ruth—who did not want her full name used—went to nursing school at age 46. She adored her new career. “I was busy all of the time. It’s never boring,” she says.

Understanding Adult ADHD The Saturday Evening Post

Inattention Symptoms
• You fail to pay close attention to details or make careless mistakes.
• You often have trouble remaining focused during lectures, conversations, or while reading.
• When spoken to directly, your mind seems elsewhere even in the absence of any apparent distraction.
• You often do not follow through on instructions and fail to finish work or chores.
• You often have difficulty organizing tasks and activities, so you fail to meet deadlines.
• You often avoid, dislike, or are reluctant to undertake tasks that require sustained mental effort, such as preparing reports or completing forms.
• You often lose things you need for tasks, such as books, wallet, paperwork, or cell phone.
• You are often easily distracted by extraneous stimuli.
• You are often forgetful in daily activities such as running errands, returning calls, paying bills, and keeping appointments.

Hyperactivity-Impulsivity Symptoms
• You often fidget with or tap your hands or feet, or squirm while seated.
• You often get up when remaining seated is expected, such as at work.
• You often run around where it is inappropriate.
• You are often unable to quietly engage in leisure activities, such as reading or gardening.
• You are often unable or uncomfortable sitting still for an extended time, as in restaurants or meetings.
• You often talk excessively.
• You often blurt out an answer before a question has been completed, finish other people’s sentences, or cannot wait your turn in conversation.
• You often have trouble waiting your turn, such as in line at a bank or store.
• You often interrupt others by butting into conversations or activities.

Symptoms of ADHD The Saturday Evening Post

Our brains routinely sort and store information along billions of nerve cells connected in trillions of ways. As we learn more about how the brain works, research shows a digital gaming system called the Interactive Metronome or IM may circumvent timing glitches that can occur in the brain’s basic wiring. The treatment (often guided by an occupational therapist) combines movement and sound to boost cognitive, language, and motor skills in people with ADHD, autism, stroke, and Parkinson’s disease.

How IM Works
Interactive Metronome therapy challenges users to precisely match a computer generated rhythm by clapping and tapping. The series of progressively challenging movements are designed to improve timing, focus, and concentration. Training typically consists of 15 one-hour sessions over a three to five week period.

The Theory
Auditory training is based on the theory that timing in the brain is disrupted by conditions such as ADHD, autism, stroke and Parkinson’s, and that improving neural timing helps kids and adults improve behavioral, social, cognitive, and motor skills.

The Evidence 
American Journal of Occupational Therapy:

IM training for ADHD improved attention, concentration, motor coordination, language processing, and reading and math skills in pre-teen boys with the condition.

IM training for chronic stroke resulted in significant functional gains for two patients with arm weakness—even though their strokes occurred years earlier.

For more about the science, patient stories, and to find a provider, go to the Interactive Metronome website.

Brain Fitness The Saturday Evening Post

The Post profiles several well-known individuals—Ty Pennington, Shane Victorino, Karina Smirnoff, and Andrés Torres—who share their struggles and triumphs in coping with ADHD, a condition that afflicts millions of American adults, largely underdiagnosed.

But as these celebrities clearly demonstrate, once diagnosed and treated, adults with ADHD can truly thrive.

ABC/BOB D'AMICO

Ty Pennington

America knows Ty as the hyper-energetic man on the megaphone, juggling 18 projects simultaneously to transform homes for deserving families on the former TV program Extreme Makeover: Home Edition. More recently, the same energy surfaced on the daytime show The Revolution. Today, Ty is busy working on a home décor and fabric line.

But the 47-year-old is equally enthusiastic and candid when talking about success in coping with his lifelong battle with ADHD.

“I was diagnosed before they really knew what to call it,” says Ty. “My mom was studying to be a child psychologist. I was lucky because she went to my elementary school to evaluate kids and study the ‘worst’ ones. Everybody was saying that ‘I don’t think you really want to know who that one is.’ Watching through the classroom window, she saw me distract everyone—from hitting Johnny in the back of the head to climbing out the window. I was a constant distraction. It seems comical when you are young. I was an out-of-control kid.”

Ty’s mother tried several different interventions but none worked, and she worried as she watched her young son struggle academically and emotionally.

“The telling thing about ADHD as a kid is that feeling you get when people are saying that there is something wrong with you,” the TV host says. “It’s tough to communicate why (you) are doing something in school and why you are not digesting studies as much as other kids are. However in some categories, you excel. For example, in geometry where graphic shapes are at play I stood out. Today, I promote the arts because it offers kids who might not be academically inclined a chance to find what they are good at. While I was the odd man out, I could focus on my projects until I was pretty well known, then I turned back into Mr. Excitement.”

As with many individuals now and especially then, Ty remained undiagnosed until his late teens.

“It wasn’t until I was out of high school and in my first year of college that my art instructor asked to get in touch with my mom. I was making drawings that were a little dark,” he recalls. “During the early days, doctors put me on antihistamines to calm me down.”

The antihistamines made him drowsy. But nothing seemed to really work. Fortunately, Ty discovered another outlet for his boundless energy—sports.

“I have always been the Energizer Bunny, way before I was medicated,” Ty says. “Sports, for many, is an area where you can gain confidence. You are not going to gain confidence from bringing home a book report with a B on it. With sports, you can define yourself as a certain player in a certain sport. With some kids, it is the only arena where they can find their confidence, as part of a team. Any time you can take a kid and get them out of the isolated ‘odd kid out’ mentality and make them part of something, that’s good.”

At 17, he was finally diagnosed with ADHD and offered effective treatment to manage his symptoms. The diagnosis was literally a true game changer.

“I played soccer my entire life beginning at age 8 and was good,” he admits. “But when finally diagnosed and medicated, I played like I never could. Finally, I could read the field, thinking ahead of the play before I got there. I had no idea how.”

Off the field, he began to notice other changes as well helping him focus and achieve goals that he never thought possible.

“ADHD affects your communication skills as well as your confidence. I no longer spoke in fragments for one thing,” he says. “People began to see a change in me, on the soccer field and in academics as well. Reading has always been a challenge. You get lost after several paragraphs. You realize that your eyes are still reading but you are not soaking in the information. I have always been very visual, so I would draw pictures for a history class so that looking at the picture would help me visualize the information I was reading.”

It was in the visual arts where Ty discovered a place to focus his considerable energy and talents.

“ADHD affects so many aspects of life, including your confidence level,” Ty says. “You have to believe in yourself. When people are challenged with ADD, especially ADHD, they really have to find an outlet where they can shine. For me, that was in art. I put myself through art school and people began praising me for the talent. I had not had that experience before—people praising me for something.”

A familiar face to almost everyone in America, Ty now meets many families who face a situation all to familiar to the artist.

“Families see that I can complete a task, which is a big accomplishment,” explains Ty. “And some of those tasks have been pretty monumental. I can lead a team and build a house in less than four days while keeping my fingers and digits at the same time. ADD and working with power tools is not the smartest choice.”

The challenges of ADHD overshadow personal relationships as well, but medication can help.

“ADHD affects your family life and any relationships because communication is the biggest drawback to ADD,” he says. “Because you can’t get out what you want to say. Sometimes another medium like writing or art can help, you can communicate better. One of the reasons you can get into trouble in relationships is the belief that you are not as good as someone else; you cannot live up to their expectations. Everyone would love not to be on medication, but people do not realize that (it) is so easy to go off your routine. But medication provides an extra helping hand to keep you on your routine.”

ADHD: Living in Overdrive The Saturday Evening Post

Post: How does Intuniv work?

Dr. Jain: First, let me explain there is a very important chemical in our brains called norepinephine. It has many jobs to do, but one of them is helping us—whether or not we have ADHD—to pay better attention as well as to control our impulsivity and activity. It seems that people develop symptoms that we call ADHD when there are abnormalities in the norepinephrine system.

To answer your question, Intuniv is a selective alpha-2A receptor agonist. In other words, this drug selectively attaches itself to certain “docking stations” on nerve cells, making the brain’s norepiniphrine system work better. Subsequently, this leads to an improvement in the symptoms of ADHD.

Post: Who are the best candidates for Intuniv?

Dr. Jain: Kids from the ages of 6 to 17 who have been diagnosed with ADHD and have impairing symptoms of attentional difficulties, hyperactivity difficulties, and impulsivity difficulties. It appears to be an all-comers-are-welcome kind of drug. In addition, the Intuniv is FDA approved for use with current stimulant therapy—to make the stimulant act even better. This is a uniquely interesting medicine in that it is approved as monotherapy, or as add-on therapy.

Post: What do parents need to know about this medicine?

Dr. Jain: It’s important to know several things, including: 1) Intuniv is an FDA-approved medication. 2) It is not a stimulant. 3) It does not appear to cause weight loss or sleep difficulties such as insomnia.

In addition, parents ought to discuss with their pediatrician, family doctor, or psychiatrist whether Intuniv can be added the child’s current medication that may not be working appropriately or not entirely so.

Post: Might doctors prescribe Intuniv as first line therapy—prior to trying stimulant drugs?

Dr. Jain: In my opinion, it would be appropriate to use Intuniv as first line therapy for a child who already has little appetite, sleeping difficulties perhaps, and some troubles with irritability, impulsivity, hyperactivity, and inattentiveness. In other cases, however, using the stimulants as first line is more appropriate. It’s wonderful to have multiple medications with different mechanisms of action.

We have broadened our ability to help children with ADHD by having a medication that is FDA approved to be added to a stimulant medication that may be partially working but not quite as well as desired.

Post: Are scientists closing in on the cause of ADHD?

Dr. Jain: Absolutely not. We really don’t even have a clue. The most consistent finding in people who have ADHD is norepinephrine and dopamine difficulties in the brain. We know it is highly genetic, it starts early In life, and its ability to impair a person’s life is enormous.

Post: So, people are born with it?

Dr. Jain: It does appear so. Most would say that. The first symptoms may not appear immediately but they do appear before the age of 7, about the time kids start school.

Post: Are you currently involved in any research projects related to ADHD?

Dr. Jain: Yes, in a number of them. We continue to look at the specific roles of Intuniv: should it be taken in the morning, the evening, or does it depend on the particular child? We’re also evaluating other medications to see if we can continue improving treatment options. In addition, we want to see if improving sleep further helps ADHD symptoms.

The field of ADHD is very active. And that’s perhaps something your readers want to know: the medical community is not walking away from ADHD. We are very aggressively continuing to look for ways to help our kids and their parents.

A list of ADHD research trials in the U.S. and around the world is available at ClinicalTrials.gov. The registry also provides information about the study’s purpose, who may participate, locations, and phone numbers for more details.

Does ADHD disrupt your child’s life—and yours? Share with other MU readers the treatments that help, and those that don’t.

Breakthroughs in ADHD: An Interview with Dr. Rakesh Jain The Saturday Evening Post

“I understand why a parent may initially question whether ADHD is a medical condition,” says Rakesh Jain, MD, MPH, Director of Psychiatric Drug Research for R/D Clinical Research at Lake Jackson, Texas. “They have a right—in fact an obligation—to do so. But the scientific evidence that ADHD is real and impairing is very strong. By all means question, but also educate yourself in detail so that if your child does have ADHD, you don’t ignore it. Left untreated, long term consequences of ADHD are very often disastrous for the children, and their families.

ADHD affects about three to seven percent of American school-aged children, according to the Centers for Disease Control and Prevention. There’s no known cause, and no cure yet on the horizon for the disorder that experts define as a mix of persistent inattention and/or hyperactivity and impulsivity that is more frequent and severe than typical among peers.

Treatments include educational, behavioral, and pharmaceutical approaches, including a new prescription drug option for children and adolescents from Shire biopharmaceutical company. In February, the FDA approved Intuniv (guanfacine) extended release tablets for use as adjunctive therapy to stimulants, making Intuniv the first once-daily nonstimulant to be approved for use alone or in combination with stimulants for treatment of ADHD.

The medicine has no known potential for abuse or dependence.

“This approval of INTUNIV for treating ADHD as adjunctive therapy to a stimulant offers physicians a new treatment option for children and adolescents with ADHD who are having a suboptimal response to their current stimulant therapy,” said Robert Findling, MD, Director of Child & Adolescent Psychiatry at University Hospitals Case Medical Center and a lead investigator for a 9-week placebo-controlled study of INTUNIV when given in combination with a stimulant in children ages 6 to 17 with ADHD. “In this study, the once-daily dosing of INTUNIV was effective when taken in the morning or the evening, giving physicians flexibility when it comes to treating their patients with ADHD.”

Coming in Part 2: Post editors interview Dr. Rakesh Jain to learn more about the new drug and catch up on latest ADHD research.

Identifying ADHD The Saturday Evening Post