Driven to Distraction

 Edward M. Hallowell and John J. Ratey's book, Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder From Childhood to Adulthood, is a classic text on ADD. Although not an especially recent text, published in 2011, it offers good insights into the disorder, especially as it relates to adults. The beginning of the book is dedicated to diagnosis and vignettes about personal impact on the lives of people affected with ADD. Since this area has been quite formalized, it is not particularly important to discuss at this moment. He cautions that ADD is often comorbid with other conditions, such as anxiety, depression and OCD, and those conditions should be treated as well. Individuals often choose to try and self-medicate or are driven to high risk behaviors resulting in substance abuse as well.

Form my personal warehouse of knowledge. When people use mamajuana they damage the amygdala in the brain. This damage is permanent. One of the roles of the amygdala is to regulate what the brain should pay attention to. Since people with ADD struggle with focus to begin with, adding this chemical to the mix is particularly harmful.

 One comment that struck me as pertinent was, " the ADD therapist must offer concrete suggestions concerning ways of getting organized, staying focused, making plans, keeping schedules, prioritizing tasks to be done, and, in general, dealing with the chaos of everyday life" (p. 112-3). From there he goes on to talk about some of these concrete suggestions to manage the disorder. He notes that people with ADD are often poor self-reporters of their behavior and the impact it has on others. He strongly suggests finding an ally to provide reports and supports as the individual with ADD seeks treatment.

Of Hallowell and Ratey's top suggestions is medication. He comments that it should not be forced on people but they should be convinced by facts that it is the path to go on. Convincing people can be challenging, but worth the risk. He comments that not all medications work for all people and that standardized dosing may not be the most appropriate. As a result he suggests being prepared for a potentially long period of trials to establish a therapeutic dosage. Further, he does admit that not all people with ADD benefit from medication. Getting client buy in is critical in this time period. Since many recommended drugs are fast acting, success at a particular dosage can fairly quickly be assessed. 

The biggest suggestion he offers is the establishment of routines and structures. Patterns as he often refers to them. Structures must be reinforced for extensive periods of time, since the ADD person will have difficulty recalling the structures. Once, however, the item becomes a pattern of behavior, it helps to organize the person's life. Current phone capabilities provide many methods for developing reminders. Alarms can be set to remind an individual about events. Phone based agendas and planners and calendars can help establish reminder lists.

The next thing the authors strongly recommend is a coach. People with ADD have a high need for feedback and reinforcement. Video games provide this and so are often sought after by people with ADD. A coach, be it a friend, teacher, parent, or spouse, can provide outside evaluation of success and frequent reinforcement of appropriate behavior. Although medication can make it easier to implement interventions, even without them, behavioral interventions are essential. The coach can provide daily support for how the individual is progressing.

Although not a new tome, the text, has many useful suggestions for helping people with ADD to manage their disorder so that they can be more productive members of our community.