SUGGESTED DIAGNOSTIC CRITERIA FOR ATTENTION DEFICIT DISORDER IN ADULTS
Copyright 1992 by Edward M. Hallowell, M.D. and John J. Ratey, M.D.
     The following criteria are SUGGESTED ONLY.  They are based upon our
clinical experience and constitute what we consider to be the most commonly
encountered symptoms in adults with Attention Deficit Disorder.  These
criteria have not been validated by field trials, and should be regarded
only as a clinical guide.
NOTE: Consider a criterion met only if the behavior is considerably more
frequent than that of most people of the same mental age.
A. A chronic disturbance in which at least twelve of the following are
present:
      1. a sense of underachievement, of not meeting one's goals
(regardless of how much one has actually accomplished).
      We put this symptom first because it is the most common reason an
adult seeks help.  "I just can't get my act together," is the frequent
refrain.  The person may be highly accomplished by objective standards, or
may be floundering, stuck with a sense of being lost in a maze, unable to
capitalize on innate potential.
      2. 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
adult may stagger under the organizational demand of everyday life.  The
supposed "little things" may mount up to create huge obstacles.  For the
want of a proverbial nail--a missed appointment, a lost check, a forgotten
deadline--their kingdom may be lost.
      3. chronic procrastination or trouble getting started beginning a
task, due to their 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.
      4. many projects going simultaneously; trouble with follow through.
      A corrollary of #3.  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.
      5. tendency to say what comes to mind without necessarily considering
the timing or appropriateness of the remark.
      Like the child with ADD in the classroom, the adult with ADD gets
carried away in enthusiasm.  An idea comes and it must be spoken, tact or
guile yielding to child-like exuberance.
      6. a restive search for high stimulation.
      The adult with ADD is always on the lookout for something novel,
something engaging, something in the outside world that can catch up with
the whirlwind that's rushing inside.
      7. a tendency to be easily bored.
      A corollary of #6.  Boredom surrounds the adult with ADD like a
sink-hole, ever ready to drain off energy and leave the individual hungry
for more stimulation.  This can easily be misinterpreted as a lack of
interest; actually it is a relative inability to sustain interest over
time.  As much as the person cares, his battery pack runs low quickly.
      8. easy distractibility, trouble focusing attention, tendency to tune
out or drift away in the middle of a page or a conversation, often coupled
with an ability to hyperfocus 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 thing
you know, he or she isn't there.  The often extraordinary ability to
hyperfocus is also ususally present, emphasizing the fact that this is a
syndrome not of attention deficit but of attention inconsistency.
      9. often creative, intuitive, highly intelligent.
      Not a symptom, but a trait deserving of mention. Adults with ADD
often have unusually 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.
     10. trouble in going through established channels, following proper
procedure.
     Contrary to what one might think, this is not due to some unresolved
problem with 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 supposed to be done.
     11. impatient; low tolerance for frustration.
     Frustration of any sort reminds the adult with ADD of all the failures
in the past.  "Oh no," he thinks, "here we go again."  So he gets angry or
withdraws.  The impatience has to do with the need for stimulation and can
lead others to think of the individual as immature or insatiable.
     12. impulsive, either verbally or in action, as in impulsive spending
of money, changing plans, enacting new schemes or career plans, and the
like.
     This is one of the more dangerous of the adult symptoms, or, depending
on the impulse, one of the more advantageous.
     13. tendency to worry needlessly, endlessly; tendency to scan the
horizon looking for something to worry about alternating with inattention
to or disregard for actual dangers.
     Worry is what attention turns into when it isn't focused on some task.
     14. sense of impending doom, insecurity, alternating with
high-risk-taking.
     This symptom is related to both the tendency to worry needlessly and
the tendency to be impulsive.
     15. mood swings, depression, especially when disengaged from a person
or a project.
     Adults with ADD, more than children, are given to unstable moods. Much
of this is due to their experience of frustration and/or failure, while
some of it is due to the biology of the disorder.
     16. restlessness.
     One usually does not see, in an adult, the full-blown hyperactivity
one may see in a child.  Instead one sees what looks like "nervous energy":
pacing, drumming of fingers, shifting position while sitting, leaving a
table or room frequently, feeling edgy while at rest.
     17. tendency toward addictive behavior.
     The addiction may be to a substance such as alcohol or cocaine, or to
an activity, such as gambling, or shopping, or eating, or overwork.
     18. chronic problems with self-esteem.
     These are the direct and unhappy result of years of conditioning:
years of being told one is a klutz, a spaceshot, an underachiever, lazy,
weird, different, out of it, and the like.  Years of frustration, failure,
or of just not getting it right do lead to problems with self-esteem.  What
is impressive is how resilient most adults are, despite all setbacks.
     19. inaccurate self-observation.
     People with ADD are poor self-observers.  They do not accurately gauge
the impact they have on other people.  This can often lead to big
misunderstandings and deeply hurt feelings.
     20. family history of ADD or manic-depressive illness or depression or
substance abuse or other disorders of impulse control or mood.
     Since ADD is genetically transmitted and related to the other
conditions mentioned, it is not uncommon (but not necessary) to find such a
family history.
B. Childhood history of ADD (It may not have been formally diagnosed, but
in reviewing the history the signs and symptoms were there).
C. Situation not explained by other medical or psychiatric condition.
 * SLMR 2.1a * "Ya know something? I think we're all Bozos on this bus."
--- I killed my WildCAT!
---------------