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Women and ADD: Part 1

Already ten minutes late for her first appointment, Claire phoned from her car that she’d be in the office in five minutes. Fifteen minutes later, she arrived flustered and embarrassed, and “Oh, my gosh, I left all the forms on my kitchen table, but I did fill them out,” and “My insurance card? I’m sure I had it, I can call my husband, he has one, I think,” and “Could you please put money in the meter for me, I just realized I forgot and I have s-o-o-o many tickets…”

Claire wanted to see me about fatigue, but she also wanted to mention her concern about a possible yeast infection, and then there were her hormones, and could she see the nutritionist too on this visit? She jiggled her knee constantly as she spoke, answered my questions mid-sentence, and changed the subject frequently.

I asked her — slowly, carefully — if she’d ever been diagnosed with attention deficit disorder (ADD). “Funny that you should mention ADD,” she replied.

“My best friend, Sarah, she makes jewelry, sells it at art fairs, she’s got a website with pictures. What did you ask me again?” Sarah, I learned, thought Claire had ADD, but no, Claire had never been tested for it, and yes, she’d finished college, “so my ADD can’t be that bad, though it did take me eight years to get my degree.”

I asked if she’d take an ADD test with me. We took this one. “Well,” she laughed, “That’s the first time I’ve ever gotten a 100 on any test.”

Doctors can diagnose ADD with a combination of observing the patient and asking some pertinent questions. When the situation calls for it, I refer patients to WholeHealth Chicago’s Dr. Janet Chandler, a psychologist who can do more extensive testing.

What doctors are learning is that there are far more adults, especially women, with ADD than anyone ever suspected. Until relatively recently, physicians were taught that ADD was pretty much confined to boys, and fairly easy to identify because of hyperactivity, inattentiveness, and easy distractibility. I remember being taught that the condition was rare in girls.

In addition, for many years doctors believed that children with ADD simply “outgrew” it – that medication could be discontinued during adolescence. This too turned out to be wrong. Children do become less hyperactive over time, but the inattention and distractibility continue unabated. As adults, they struggle because their medication was (inappropriately) discontinued. Untreated men with ADD have a real problem controlling impulsive behavior. It’s estimated that half the men in jail have some degree of ADD.

Today we know that young girls can have the same ADD symptoms as boys … except for the hyperactivity. The girls are sitting quietly in class but their brains are like TV sets with a dozen channels going at once. Until relatively recently, girls with ADD went undiagnosed, but they eventually grew up and we now have an immense population of undiagnosed and untreated adult women with ADD. How many? Experts believe 7 to 10% of the population (both sexes) probably has ADD.

The result of this oversight: millions of women 25 and older have been struggling through their lives impaired by their undiagnosed ADD, and they’ve experienced incredible challenges with learning. People with ADD endlessly hear, “You’re not living up to your potential.” They may fail to advance in their jobs (and may make frequent job changes), experience difficulties with relationships (“I always interrupted him”), and even with sex (“he could tell my mind was somewhere else”).

Most people with ADD compensate by living in a veritable snowstorm of Post-It notes, memo books, and Blackberries. Generally, their workspaces are chaotic (piles instead of files), and they go through life missing deadlines and appointments, procrastinating, and losing things.

Some women are finally diagnosed when one of their children is found to have ADD. Others struggle through life not knowing why.

The sad irony is that when treated, women with ADD are quite often fiercely intelligent, frequently surprised by how easy learning actually is and how powerful memory can be. Many feel sad when they realize how different their lives might have been had someone recognized their ADD when they were, say, seven years old.

Next week: What’s behind ADD and how we treated Claire’s condition.

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