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Suggested Diagnostic Criteria for Attention Deficit Disorder in Adults
by Edward M. Hallowell, M.D. and John J. Ratey, M.D.


This section is probably of interest to those adults diagnosed with ADD.It maybe be useful for parents of ADD children who may not be aware thatmaybe they have ADD,

Dr. Hallowell is a child psychiatrist at Harvard Medical School who hasADD himself. Attached is a transposed handout from one of his lectures.The handout isn't copyrighted.

These criteria are based on extensive clinical experience but havenot yet been statistically validated by field trials. Consider a criterion met only if the behavior is considerably morefrequent than that of most people of the same mental age.

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 yoursuspicion may be raised, but an evaluation by a physician to rule out otherconditions is essential.

Suggested Diagnostic Criteria

1. A chronic disturbance in which at least twelve of the following are present:

a) a sense of under achievement, of not meeting one's goals (regardlessof how much one has accomplished).

We put this symptom first because it is the most common reason an adultseeks help. "I just can't get my act together," is the frequentrefrain. The person may be highly accomplished by objective standards, ormay be floundering, stuck with a sense of being lost in a maze, unable tocapitalize on innate potential.

b) 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 adultmay stagger under the organizational
demands of everyday life. The supposed "little things" may mountup to create huge obstacles. For the want of a proverbial nail--a missedappointment, a lost check, a forgotten deadline
--their kingdom may be lost.

c) chronic procrastination or trouble getting started.

Adults with ADD associate so much anxiety with beginning a task, due totheir 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.

d) many projects going simultaneously; trouble with follow-through.

A corollary of "c". 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.

e) tendency to say what comes to mind without necessarily considering thetiming or appropriateness of the remark.

Like the child with ADD in the classroom, the adult with ADD gets carriesaway in enthusiasm. An idea comes and it must be spoken, tact or guile yieldingto child-like exuberance.

f) an ongoing search for high stimulation.

The adult with ADD is always on the lookout for something novel, somethingin the outside world that can catch up with the whirlwind that's rushinginside.

g) a tendency to be easily bored.

A corollary of Boredom surrounds the adult with ADD like a sinkhole, everready to drain off energy and leave the individual hungry for more stimulation.This can easily be misinterpreted as a lack of interest; actually it isa relative inability to sustain interest over time. As much as the personcares, his battery pack runs low quickly.

h) easy distractibility, trouble focusing attention, tendency to tune outor drift away in the middle of a page or a conversation, often coupled withan ability to hyper focus 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 thingyou know, he or she isn't there. The often extraordinary ability to hyperfocus is also usually present, emphasizing the fact that this is a syndromenot of attention deficit but of attention inconsistency.

i) often creative, intuitive, highly intelligent.

Not a symptom, but a trait deserving of mention. Adults with ADD often haveunusually 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.

j) trouble going through established channels, following proper procedure.

Contrary to what one might think, this is not due to some unresolved problemwith 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 supposedto be done.

k) impatient; low tolerance for frustration.

Frustration of any sort reminds the adult with ADD of all the failures inthe past. "Oh no," he thinks, "here we go again." Sohe gets angry or withdraws. The impatience has to do with the need for stimulationand can lead others to think of the individual as immature or insatiable.

l) impulsive, either verbally or in action, as in impulsive spending ofmoney, changing plans, enacting new schemes or career plans, and the like.

This is one of the more dangerous of the adult symptoms, or, depending onthe impulse, one of the more advantageous.

m) tendency to worry needlessly, endlessly; tendency to scan the horizonlooking for something to worry about alternating with inattention to ordisregard for actual dangers.

Worry becomes what attention turns into when it isn't focused on some task.

n) sense of impending doom, insecurity, alternating with high-risk-taking.

This symptom is related to both the tendency to worry needlessly and thetendency to be impulsive.

o) mood swings, depression, especially when disengaged from a person ora project.

Adults with ADD, more than children, are given to unstable moods. Much ofthis is due to their experience of frustration and/or failure, while someof it is due to the biology of the disorder.

p restlessness

One usually does not see, in an adult, the full-blown hyperactivity onemay see in a child. Instead one sees what looks like "nervous energy":pacing, drumming of fingers, shifting position while sitting, leaving atable or room frequently, feeling edgy while at rest.

q) tendency toward addictive behavior.

The addiction may be to a substance such as alcohol or cocaine, or to anactivity, such as gambling, or shopping, or eating, or overwork.

r) chronic problems with self-esteem.

These are the direct and unhappy result of years of conditioning: yearsof being told one is a klutz, a spaceshot, an underachiever, lazy, weird,different, out of it, and the like. Years of frustration, failure, or ofjust not getting it right do lead to problems with self-esteem. What isimpressive is how resilient most adults are, despite all the setbacks.

s) inaccurate self-observation.

People with ADD are poor self-observers. They do not accurately gauge theimpact they have on other people. This can often lead to big misunderstandingsand deeply hurt feelings.

t) Family history of ADD or manic-depressive illness or depression or substanceabuse or other disorders of impulse control or mood.

Since ADD is genetically transmitted and related to the other considerationsmentioned, it is not uncommon (but not necessary) to find such a familyhistory.

2. Childhood history of ADD (It may have been formally diagnosed, but inreviewing the history the signs and symptoms were there.

3. Situation not explained by other medical or psychiatric condition.


This article is copyrighted to and written by Edward M. Hallowell,MD and John J. Ratey, MD. It has been reposted by Steven Ledingham. Note:as the person posting this information on the World Wide Web, I do not thenot warrant (the accuracy or content) of the information contained herein.This document is provided for informational purposes only and should notbe used in the treatment of this disease. See a licensed medical practitionerfor actual diagnoses and treatment.

Visit The Hallowell Center website at: http://www.drhallowell.com/

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