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An Elusive Disorder

Shlomo Dovid Freedman, MA, MBA

Most medical conditions are easy to spot. But attention deficit disorder (ADD) falls into a category of its own — not only is it similar to hundreds of other conditions, but the symptoms look like regular character flaws (think impulsivity and absentmindedness). The result: Millions of people remain undiagnosed — and untreated.

Wednesday, September 14, 2011


Since ADD has been so publicized over the years, most of us assume we have the basic facts straight. But that’s not actually the case. For instance, many people associate ADD with hyperactivity. But in truth, 40 percent of children with ADD aren’t hyperactive, and among those who are, the hyperactivity decreases with age. According to the American Psychiatric Association, there are three subtypes of ADD.

The least common is “primarily hyperactive.” In children this shows up simply as hyperactivity, while in adults it’s usually expressed by restlessness, impulsivity, or emotional outbursts. There’s also “primarily inattentive,” which describes someone who has difficulty sustaining attention over time, as well as resisting internal and external distractions. People with this type are also prone to over-thinking or daydreaming. Most commonly, ADDers fall into the third category, which is a combination of both types.

Although these subtypes are well established, there’s actually no simple profile for someone with ADD. For instance, while many ADDers find reading difficult and unrewarding, others become avid readers, writers, and academics. Many ADDers drop out of school or yeshivah, while others become talmidei chachamim and
PhDs. The ADDers of the hyperactive type are often highly emotional and excitable, while inattentive ones tend to be detached daydreamers.
While the cause of ADD is not completely known, genetics play a big role. In fact, your parents’ genes play a greater role in whether or not you have ADD than in
how intelligent you are. Few personal attributes are more “heritable” — i.e., determined by genetics — than ADD.
The genetic link is so strong that Dr. Umesh Jain — ADD authority and child and adolescent psychiatrist at Toronto’s Centre for Addiction and Mental Health (CAMH) — will question an ADD diagnosis of anyone lacking relatives with strong ADD symptoms. Research has also shown that a person with ADD has a 50 percent chance of having at least one parent with the condition.
Other factors have also been linked to the disorder, such as birth trauma. If a woman smokes during pregnancy, it can also increase the risk of her child developing ADD.
It’s equally important to know what does not cause ADD. The condition cannot be brought on by bad middos, such as laziness or a lack of discipline. And despite popular notions, parents cannot cause their children to develop ADD through insufficient discipline, sugar, video games, or food additives. Although these things can aggravate the symptoms of ADD, they in no way give rise to the disorder. (For more ADD myths, see sidebar.) Furthermore, addressing these factors cannot alleviate the underlying condition.
ADD is a developmental disorder, meaning that it appears approximately by the age of seven. Although there’s no “adult onset” of ADD, it’s possible that a person’s ADD might not cause significant impairments until later in life. This was the case with me; I only discovered that I had ADD when I was middle-aged.

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