Adult ADD/ADHD — The Diagnosis Persists Beyond Childhood

Are you jittery, distractable or disorganized? Do you lose your keys a lot? Do you get excited or depressed easily? These symptoms, in moderation, may be part of normal life – but they could spell a syndrome not limited to children: Attention Deficit Disorder.

One of the best books on adult ADD is ‘Driven to Distraction’ by Edward Hallowell and John Ratey, MDs. In their opening paragraph they explain, “..some of the symptoms of ADD are so common to us all” the best way to understand it is to see how it affects the lives of people who have it.

Up to 5% of the adult population in the US suffer from Attentional Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD). No single medical treatment has proven consistently effective with ADD adults (or children). Most of us have heard of kids on Ritalin. The number of prescriptions given for ADD has tripled since 1990. (Batoosingh K. Ritalin prescriptions triple over last four years. Family Prac News 4: June, 1995). Many of these kids grow up to become adults with attentional deficits.

It seems that ADD in women is biochemically different from the presentation in men. There are several theories for the differences. According to Gina Nick, PhD, ND (drgina@ltponline.comm, (866) 587-4622), column in Townsend Letter for Doctors & Patients, see Oct 2003 issue Whole Food Nutrition for ADHD) women are much more likely than men to have problems metabolizing carbohydrates, whereas men need nearly three times the volume of daily essential fatty acids required by women to function well. One researcher has demonstrated strikingly divergent responses to glucose loading in ADHD children, compared to normal children.(Giardi N et al. Blunted catcholamine resonses after glucose ingestion in children with ADD. Ped research 38(4):539-543, 1995). His recommendation, summarized by Dr. Nick, is “limiting excessive carbohydrate intake, coupled with maintaining steady glucose levels (eating smaller, high protein meals throught the day)” is a safe and logical way of handling this aspect of ADHD. (Nick G, Whole Food Nutrition for ADHD. Townsend Letter for Doctors & Patients, October 2003, p 62) .

Further, the syndrome may be less visible in women, for several reasons. First, women are expected to be able to ‘multi-task’ and are less likely than men to get flustered when simultaneously putting kids to bed, planning the next day’s meals and balancing the checkbook. Second, attentional deficit in boys and men is more likely to present with hyperactivity. One physician specialist, Dr. Judyth Reichenberg-Ullman (co-author of ‘Ritalin Free Kids’, ‘Rage Free Kids’, website www.healthyhomeopathy.com) points out that boys and men have higher testosterone levels are are more likely to be engaged by risky recreational pursuits (race car driving, extreme snowboarding, etc) and violent video games. Activities such as these run counter to ADD antidotes such as maintaining a slower pace, deep-breathing exercises, memorizing long poems, intricate crafts projects and the like. Women with ADD get missed at the doctor’s office, says Dr. Reichenberg-Ullman, and often are put on chemical anti-depressants.

It is possible that ADD will lead to depression, but is rarely the cause of the problem. There are however, a number of physical problems that can mimic ADD, and these should be considered by your healthcare professional. The list includes hypoglycemia, allergies, learning disabilities such as dyslexia, thyroid problems, hearing or vision problems, and heavy metal poisoning in particular lead or mercury. A helpful website for sorting out the possibilities for your “spacey” behavior is:

One patient, 51 year old Terry U., is struggling to preserve her third marriage, and her relationship with her 9 year old daughter, who also carries the ADD diagnosis. Things are out of order at home, at work, in my mind. I have unfinished projects everywhere. Together we are working on follow-through, and returning all items to their “proper place” when not actively in use. But I’m sure I’ll need the kitchen scissors again soon, she wails. I persuade her to put them away in the drawer after cutting open the frozen veggies. To just try that for right now. She has also begun a supplement regimen (daily essential fatty acids and B vitamins, plus magnesium at bedtime) and dietary modifications (no junk food).

Foods to AVOID:
Dairy (casein) and wheat (gluten) products, food additives, salicylates, refined sugar, yeast. Adults, and children, with ADD/HD tend to be more sensitive to certain proteins found in foods, rendering them more allergic and reactive, both physically and mentally. ADD adults (and children) generally respond favorably to individually determined elimination diets. (Baumgaertel, A (1999). Alternative and controversial treatments for ADHD. Pediatric Clinics of North America, 46 (5), 97-992)

Helpful foods/herbs:
Magnesium. Most ADD/HD subjects are deficient in magnesium, and helped by supplementation (Green, C and Chee, K (1997). Understanding ADHD. Moorebank, NSW, Australia: Doubleday) Chronic magnesium deficiency results in hyperactivity, impaired reaction to external stimulia, irritability, fatigue, difficulty sleeping, and poor mental concentration. Take 500-1000 mg daily at bedtime, preferably in powdered form mixed with water. Whole food sources include dark green veggies, chlorella, nuts, grains, fish, beans and meat.

Essential fatty acids are found in breast milk, game, fish, eggs, raw nuts, raw seeds and green vegetables. EFAs protect the cell’s genetic information (DNA) as well as regulate the central nervous system (brain). To supplement take 375 mg daily of DHA (docosahexaenoic acid) and 500 mg daily of EPA (eicosapentaenoic acid).

Zinc is a co-enzyme in fatty acid metabolism, and many ADD/HD subjects have been proven deficient (Arnold, LE, Pinkham, SM and Votolato, N (2000). Does zinc moderate essential fatty acid and amphetamine treatment of ADHD? J of Child and Adolescent Psychopharmacology, 10(2), 111-117). Take 30-50 mg daily, ideally in the picolinate or ascorbate forms.

Phosphatidylserine (PS). This supplement has been found to improve attention, learning and behavior (in children) (Efalex Product information. www.efamol.com/products/efalix.html) In my clinical practice I also use it to promote sound sleep. Try 100 mg daily at bedtime.

Ginseng and Ginkgo together. Both of these herbs are known to improve cognitive function, and together the results seem to be greater than additive. Memory is sharpened, and the ability to store, hold and retrieve information is improved. (Kennedy D, Scholey A, Wesnes K (2001) Differential, dose dependent changes in cognitive performance following acute administration of a Ginkgo biloba/Panax ginseng combination to healty young volunteers. Nutritional Neuroscience, 4 (5):399-412). Take 360 mg Gingkgo, standardized to contain 24% gingkolisides and 600 mg of Korena ginseng extract, daily in the morning.

OPCs (oligoproanthocyanadins, are powerful anti-oxidants found in grape seeds/skin and berries). Improvements in cognitive function have been reported in animal studies, with confirming anecdotal reports in humans, citing improvement in handwriting, school performance and test scores. (Mann C et al. Quantitative analysis of EEG in boys with ADHD: Controlled study with clinical implications. Pediatric Neurology 8:30-36, 1992.) Take 50-100 mg daily. A favorite formulation (Thorne Research, Nutri-ADD) contains 1000 mcg B12, 50 mcg Chromium picolinate, 100mg Phosphatidylserine, 150 Bacopa monera, 25mg of Lactobacillus and 50mg of OPCs).

Do You Have ADD/HD?
The long list includes most of the following:

  • difficulty sustaining attention in tasks
  • often not listening when spoken to
  • often not following through on instructions and failure to finish tasks
  • difficulty organizing tasks and activities
  • avoiding, disliking or reluctance to engage in tasks that require sustained mental effort
  • often losing things necessary for tasks or activities
  • easily distracted
  • forgetful in everyday activities
  • inaccurate serf-observation
  • chronic problems with self-esteem
  • tendency toward addictive behavior
  • mood swings, restlessness, impulsivity

PLUS childhood history of ADD (may not have been formally diagnosed, but symptom picture was present) AND situation not explained by other medical or psychiatric condition

The short list, sometimes called the Utah Criteria for Adult ADD includes:

  • A childhood history of ADD with at least one of the following characteristics: behavior problems in school, impulsivity, overexcitability, and temper outbursts.
  • An adult history of persistent attentional problems and motor hyperactivity together with two of the following: affective lability, hot temper, stress intolerance, disorganization, impulsivity.

(symptom lists courtesy of “Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood” by Edward M. Hallowell, MD and John J Ratey, MD. Touchstone, New York, NY, 1995)

.