SUBJECT: Attention Deficit Disorder
ASPECT/PERSPECTIVE: ADD diagnostic criteria
Suggested Diagnostic Criteria For Attention Deficit Disorder In Adults
by Edward M. Hallowell, MD and John J. Ratey, MD
Note: These criteria are based on extensive clinical experience but have not yet been statistically
validated by field trials. Consider a criterion met only if the behavior is considerably more frequent
than that of most people of the same mental age.
A. A chronic disturbance in which at least twelve of the following are present:
1. a sense of underachievement, of not meeting one's goals (regardless of how
much one has accomplished)
We put this symptom first because it is the most common reason an adult seeks help. "I just
can't get my act together," is the frequent refrain. The person may be highly accomplished
by objective standards, or may be floundering, stuck with a sense of being lost in a maze,
unable to capitalize on innate potential.
2. difficulty getting organized
A major problem for most adults with ADD. Without the structure of school, without
parents around to get things organized for him or her, the adult may stagger under the
organizational demands of everyday life. The supposed "little things" may mount up tp
create huge obstacles. For the want of a proverbial nail--a missed appointment, a lost
check, a forgotten deadline --their kingdom may be lost.
3. chronic procrastination or trouble getting started
Adults with ADD associate so much anxiety with beginning a task, due to their fears that
they won't do it right, that they put it off, and off, which, of course, only adds to the
anxiety around the task.
4. many projects going simultaneously; trouble with follow-through
A corollary of #3. As one task is put off, another is taken up. By the end of the day, or
week, or year, countless projects have been undertaken, while few have found completion.
5. tendency to say what comes to mind without necessarily considering the timing
or appropriateness of the remark.
Like the child with ADD in the classroom, the adult with ADD gets carries away in
enthusiasm. An idea comes and it must be spoken, tact or guile yielding to child-like
exuberance.
6. an ongoing search for high stimulation
The adult with ADD is always on the lookout for something novel, something in the
outside world that can catch up with the whirlwind that's rushing inside.
7. a tendency to be easily bored
A corollary of #6. Boredom surrounds the adult with ADD like a sinkhole, ever ready to
drain off energy and leave the individual hungry for more stimulation. This can easily be
misinterpreted as a lack of interest; actually it is a relative inability to sustain interest over
time. As much as the person cares, his battery pack runs low quickly.
8. easy distractibility, trouble focusing attention, tendency to tune out or drift
away in the middle of a page or a conversation, often coupled with an ability to
hyperfocus at times
The hallmark symptom of ADD. The "tuning out" is quite involuntary. It happens when the
person isn't looking, so to speak, and the next thing you know, he or she isn't there. The
often extraordinary ability to hyperfocus is also usually present, emphasizing the fact that
this is a syndrome not of attention deficit but of attention inconsistency.
9. often creative, intuitive, highly intelligent
Not a symptom, but a trait deserving of mention. Adults with ADD often have unusually
creative minds. In the midst of their disorganization and distractibility, they show flashes of
brilliance. Capturing this "special something" is one of the goals of treatment.
10. trouble going through established channels, following proper procedure
Contrary to what one might think, this is not due to some unresolved problem with
authority figures. Rather it is a manifestation of boredom and frustration: boredom with
routine ways of doing things and excitement around novel approaches, and frustration with
being unable to do things the way they're supposed to be done.
11. impatient; low tolerance for frustration
Frustration of any sort reminds the adult with ADD of all the failures in the past. "Oh no,"
he thinks, "here we go again." So he gets angry or withdraws. The impatience has to do
with the need for stimulation and can lead others to think of the individual as immature or
insatiable.
12. impulsive, either verbally or in action, as in impulsive spending of money,
changing plans, enacting new schemes or career plans, and the like
This is one of the more dangerous of the adult symptoms, or, depending on the impulse,
one of the more advantageous.
13. tendency to worry needlessly, endlessly; tendency to scan the horizon looking
for something to worry about alternating with inattention to or disregard for actual
dangers
Worry becomes what attention turns into when it isn't focused on some task.
14. sense of impending doom, insecurity, alternating with high-risk-taking
This symptom is related to both the tendency to worry needlessly and the tendency to be
impulsive.
15. mood swings, depression, especially when disengaged from a person or a
project
Adults with ADD, more than children, are given to unstable moods. Much of this is due to
their experience of frustration and/or failure, while some of it is due to the biology of the
disorder.
16. restlessness
One usually does not see, in an adult, the full-blown hyperactivity one may see in a child.
Instead one sees what looks like "nervous energy": pacing, drumming of fingers, shifting
position while sitting, leaving a table or room frequently, feeling edgy while at rest.
17. tendency toward addicitive behavior
The addiction may be to a substance such as alcohol or cocaine, or to an activity, such as
gambling, or shopping, or eating, or overwork.
18. chronic problems with self-esteem
These are the direct and unhappy result of years of conditioning: years of being told one is
a klutz, a spaceshot, an underachiever, lazy, weird, different, out of it, and the like. Years
of frustration, failure, or of just not getting it right to do lead to problems with self-esteem.
What is impressive is how resilient most adults are, despite all the setbacks.
19. inaccurate self-observation
People with ADD are poor self-observers. They do not accurately gauge the impact they
have on other people. This can often lead to big misunderstandings and deeply hurt
feelings.
20. Family history of ADD or manic-depressive illness or depression or substance
abuse or other disorders of impulse control or mood
Since ADD is genetically transmitted and related to the other considerations mentioned, it is
not uncommon (but not necessary) to find such a family history.
B. Childhood history of ADD (It may not have been formally diagnosed, but in reviewing the
history the signs and symptoms were there.
C. Situation not explained by other medical or psychiatric condition.
It cannot be stressed too firmly how important it is not to diagnose oneself. From the information
and examples presented here it is hoped that your suspicion may be raised, but an evaluation by a
physician to rule out other conditions is essential.
SUBMITTED BY: Edward M. Hallowell, MD and John J. Ratey, MD
REFERENCES & LINKS: http://www.seas.upenn.edu/~mengwong/add/20q.html
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