ADD Is No Deficit At All

ADD Is No Deficit At All

In the early 2000s, there was an article published about an extraordinarily successful and innovative new airline, JetBlue.  Initially under the name, “NewAir,” it was founded in 1999 by David Neeleman, a Brazilian-American entrepreneur who had forged a career in the developing the “low-cost” sector of the airline industry.  As part of the piece, the writer interviewed Neeleman’s wife who stated that Neeleman has ADD (attention deficit disorder).  The beginning of her husband’s career was exciting offering him many opportunities to try out new ideas.  But then his career took a turn wherein his responsibilities were more in managing and not in creating.  According to his wife, he became down, uninspired and found it difficult to keep focus.  But when he became involved with the planning and then launching of NewAir, or JetBlue, he again was the energetic, vibrant workaholic his wife always knew him to be.

Neeleman is the classic example of individuals with ADD.  These individuals are among the most successful people in nearly every field.  And yet this fact seems utterly contradictory to having a DEFICIT of attention.  If indeed people with ADD lack the ability to focus and maintain attention, how is it possible that these same individuals, when engaged in projects and activities, have the capacity for endless focus, attention and persistence?

Moreover, how is it possible that so many of the most successful people have ADD when the reputation of ADDers is that they are “all over the place,” “can’t get anything done,” “get into trouble” and thus are not successful in life?

The answer is very clear.  Pure ADD (Attention Deficit Disorder) or ADHD (Attention Deficit Hyperactivity Disorder), the more common form in children and adolescents, does not involve any deficit of attention whatsoever, and its designation as a “disorder” is misleading.

Individuals with what is called “ADD” are people whose brains crave and starve for stimulation.  When their environment – relationships, work, study, activities – “feed” their brains with sufficient stimulation, they thrive.  They can pay attention for longer and harder than the average person.  And they can maintain their attention for very long periods of time, even years and a lifetime.

However, when their environment is not sufficiently stimulating, they become very, VERY uncomfortable: anxious, irritable, depressed  Their own energy level drops precipitously and in that low energy state, they cannot focus on anything at all.  If that state goes on for too long, even in the presence of a potentially stimulating opportunity, they find it exceedingly difficult to muster up the necessary excitement to convince others, and themselves, that they are up for the task.  It is a vicious cycle.

It is not uncommon, as they turn downward, that they seek out ways to escape the discomfort through impulsivity, provocation, and unfortunately for not a few of them, through recreational drugs.  Barring drug abuse, the endpoint of this downward spiral is always an uncomfortable, or agitated depression.

I began to see many more cases of ADD beginning in the 1990s, for two important reasons.  First, with the advent of the internet, entire industries were being turned on their heads.  Computer geeks between the ages of 18-25 were in high demand while older and more experienced individuals in rapidly changing industries were becoming less valuable and some even obsolete.  If they weren’t being passed over or even worse losing their jobs, their treasured careers were evaporating.  Those who had previously undiagnosed and asymptomatic ADD  because their stable careers had previously been adequately stimulating, were increasingly agitated and depressed.

The second reason for the increased prevalence of ADD was the sudden boom in the “new” anti-depressant medications (like Prozac, Zoloft, Paxil, etc.), eighty percent of them being prescribed not by psychiatrists but by primary care physicians.  Keep in mind that many individuals with “ADD” don’t even know they have it because their lives provide sufficient stimulation.  But because life is not constant, nor is that stimulation constant, these people have transient dysphoria or depression.  In the  age of the “Prozac Nation,” these transient or lasting periods of feeling down triggered an immediate prescription.  The number of anti-depressants prescribed during this decade skyrocketed.

What you need to know about these antidepressants is that they are also weak mood stabilizers.  What that means is that they narrow the range of emotional experience.  This is helpful at the low end, preventing someone from dropping deeper into depression.  But they also put a rigid ceiling on how good you can feel.  People with ADD must be able to fly.  Their mood must be able to take flight and soar.  If you raise the floor and lower the ceiling, they will feel trapped and ultimately, numb.

So during these years, countless individuals coming for consultations repeated the same story.  Their lives became less stimulating and they began to feel down.  Their primary care physician prescribed an antidepressant.  Initially they felt less depressed.  But then they began to feel completely numb.  The classic line was, “I don’t feel like myself.  This is not me.”  That was the tip off.

When the antidepressant was stopped and they were placed on medication to address ADD, they nearly all returned to themselves in short order and were then in a position to make the life changes necessary to again feel connected to their work, family and environment.

Essentially, what the ADD medications do is supply a constant, baseline “chemical” stimulation to the brain that doesn’t allow the individual to become uncomfortable even when his/her environment is not adequately stimulating.  Once the individual makes life changes such that his/her life is sufficiently stimulating, there is no longer the need to take the medication.

One of the most common questions encountered in relation to ADD is, “Isn’t there a checklist to diagnose that I have it?”  In fact, frequently people take these online self-assessments that purport to diagnose ADD.

Let’s clear this up.  There is NO valid test or questionnaire that diagnoses ADD.  None.

The best diagnosis is made from a patient’s history to a mental health professional.  A definitive diagnosis is made by taking an ADD medication.  If the individual has ADD, there will be an unmistakable and predictable improvement in a very short period of time.  In essence, the treatment is the definitive diagnostic tool.