As you correctly noted in your question, there’s much, much more to ADD (I call it ADD, but the technically correct designation is ADHD with a subtype that does not include the H for hyperactivity) than just not being able to sit still, follow directions, and pay attention.
In fact, what we call ADD (a terrible term, as it is not a deficit of attention but rather a wandering of attention, and it is not a disorder in my opinion but rather a trait; if you manage it properly it can turn you into a phenomenal success, but if you don’t it can ruin your life, which makes it unique and fascinating) is really a type of mind, genetically transmitted, and composed of a wide array of complex and often contradictory tendencies.
For example, the signature symptom, attention, may either occur in abundance or wander off. People with ADD can super-focus when they are really interested, as in playing video games, an instrument, a sport, or studying a subject they love; or they can wander off, when they lose interest, when the book is boring, the teacher is boring, Grandma is boring, or the car ride is too long. This inconsistency of attention can lead to inconsistent performance and underachievement in school (or, for adults, at work). Too often, teachers and parents (and bosses) jump to what I call “the moral diagnosis,” and ascribe the underachievement to lack of effort or laziness, which leads to lectures, punishments, and a gradual infection of the spirit with the viruses of shame and diminished sense of self. In fact, the correct diagnosis is of a brain difference, not a brain deficit, and certainly not a moral failing.
Other common symptoms include: impulsivity, restlessness, poor organizational skills, tendency to procrastinate, tendency to be willful and stubborn, low tolerance of frustration, tendency to have many projects going on at once with trouble with follow-through, tendency to multi-task, trouble following sequential directions, trouble with authority, strong desire to be free and independent, love of excitement and danger, poor tolerance of boredom, trouble in showing one’s work, heavy reliance on intuition, and a desire to strike out in new directions, regardless of what is the order of the day.
On the positive side, which people rarely discuss, people with ADD are the people who founded this country. They tend to be visionaries, dreamers, explorers, inventors (Edison was a classic), path-finders, discoverers, entrepreneurs (almost all entrepreneurs have ADD), creative types, original thinkers, paradigm breakers, trend-setters, free thinkers, as well as being big-hearted, trusting, generous, and fun.
Paradoxes abound. They are hard to rein in, but they love to lead. They can’t be counted on, but they are there in a crisis. They don’t read the directions, but they are the first to put the toy together. They drive you crazy with their inability to follow through, but they charm the pants off you.
Diagnosis rests on taking a history both from parents and child as well as from school teachers. The diagnosis shines through in the history. Then you can get neuropsychological testing to supplement the history. There is no definitive test for ADD. The combination of history, as taken from multiple sources, with neuropsych testing is the best approach.
Treatment includes, first of all, education. MAKE SURE the child and parent understand this is not a “deficit disorder,” but rather a condition that can be associated with tremendous success. I have millionaires and billionaires in my practice. There are numerous Academy Award winners who have ADD, Pulitzer Prize winners, CEO’s, Nobel Prize winners, Generals, Admirals, world class chefs, and leaders in every field who have ADD. The real disabilities are shame, fear, and believing you are a loser.
The next components of treatment should include some form of coaching or tutoring to improve organizational skills and so-called executive functions; lifestyle modifications, as proper exercise, sleep, and nutrition are key; an introduction to meditation or mindfulness training, as this has been proven to significantly improve the problematic symptoms of ADD; positive human connections, or what I call “the other Vitamin C, Vitamin Connect,” as these kids often get nothing but corrections, tutoring, and reprimands all day; and finally medication, which when used properly is safe and dramatically effective in 70-80% of cases. Be sure you see an experienced doctor so as to get proper education and delivery of medication.
ADD tends to persist throughout life, although many people learn to compensate so well it seems they no longer have it as adults.
People argue as to whether ADD is a learning disability or not, but it is more a semantic argument than a substantive one. ADD — involuntarily inconsistent attention — can certainly make learning in areas where one is not interested more difficult. If that defines it as a learning disability, then it is. However, the advantages it so often confers — intuition, creativity, outside-the-box-thinking — would cast it as a learning advantage. As do so many questions in the world of ADD, this question can have contradictory, equally correct answers.
To be clear: undiagnosed and untreated, ADD can ruin a life. It can ruin school, ruin childhood, ruin a career, ruin a marriage, ruin everything. The prisons, the halls of the addicted and unemployed, the multiply divorced, the depressed, and the people who attempt and complete suicide, all are over-represented by ADD.
But, so are the people who change the world for the better: the entrepreneurs, the entertainers, the innovators, the visionaries, and the creatively gifted in all fields.
All of this combines to make this condition fascinating but also of great import. The stakes are high. Early diagnosis — around age 5 or 6 — enhances the chances of the best outcomes. Embracing a strength-based model enhanced the chances of best outcomes. A life rich in positive human connections enhances the chances of best outcomes.
For a condition as common as ADD is — at least 5% of the population, and, depending upon how it is defined, much higher — we would do well to take it seriously, and do all we can to ensure proper diagnosis and treatment for people of all ages.