When the Wild Child Grows Up
Dr. Timothy Cullinane once had an adult patient who thought he had bipolar disorder. He constantly changed jobs. He abused substances. He engaged in what Cullinane referred to as “impulsive sexual acting out.”
But in reality, he had Attention Deficit Hyperactivity Disorder, or ADHD, also known as Attention Deficit Disorder, or ADD.
“Those symptoms were very much essentially stopped by his ADD treatment,” says Cullinane, chairman of the department of psychiatry at Elmhurst Memorial Hospital.
The focus on ADHD in children has boomed in recent decades, but the fact is the disorder is typically a lifelong one, meaning it affects a bevy of American adults.
“If you’re an ADHD adult, you have to have been an ADHD kid, no matter whether or not you were diagnosed as a child,” says Thomas Phelan, author of All About ADHD: A Family Resource for Helping Your Child Succeed with ADHD (see review on page 22), which includes sections on adult ADHD. “It’s not just something that starts when you’re 25 or 30, if it’s true ADD.”
Phelan, a PhD clinical psychologist with a practice in Glen Ellyn, says about two-thirds of kids with ADHD don’t outgrow it. If three to five percent of all children in America have ADHD, as Phelan says, then it also affects about 1.5 million to 2.5 million adults.
One of those is Mark Pagano of Keeneyville, who always had a reputation as somewhat of a wild child in school.
“I was constantly getting kicked out of class,” he says. “I just knew I was hyper and bonkers, basically.”
In about second or third grade, Pagano was diagnosed with ADHD based on his hyperactivity and lack of focus. With his mom’s reservations, he was given Ritalin, a stimulant, to treat it. That went on for a couple of years, one pill at lunchtime every day.
Throughout junior high and high school, Pagano struggled.
It startled him when other kids would walk out of a class with pages full of notes. He would stare at the teacher during lectures, trying hard to process what was being said, “But my mind was somewhere else.”
His girlfriend at the time and now his wife, Patti Pagano, says she would do what she could to direct his attention.
“It was just very clear that he couldn’t focus all day in school,” she says, “so I would come over after school and sit with him and say, ‘OK, we have to finish this before we go to do this.’”
Pagano once tried a marketing job in an office. He lasted for 30 minutes in a cubicle before walking out.
Now 35, Pagano still deals with such symptoms of his ADHD as hyperactivity. But finding patience and understanding in Patti, as well as discovering the perfect career to help him channel his symptoms, changed his life.
If you’ve never been diagnosed with ADHD, how do you know if you might suffer from it as an adult? How do you know you don’t have depression? Or you’re just extra-stressed? Or extra-tired?
“It’s a lot more complicated than, say, you have five out of nine symptoms, and then you have this diagnosis,” says
Dr. Abdullah Sallaj, a clinician with ABC DuPage, a group of behavioral health providers with offices in Hinsdale and Oakbrook Terrace, and owner of Abby Psychiatry in Chicago.
Dr. Kyle Bonesteel of NeuroHealth Associates in Oak Brook says adults with attention issues can often have trouble “locking in and paying attention for any length of time.”
Corollary symptoms, he adds, include difficulties with self-starting and motivation.
“They simply can’t engage in enough self-directed behavior,” says Bonesteel, “and they don’t have enough drive, enough oomph, enough consistent motivation.”
Other symptoms adults who have ADHD deal with are interfering factors and intrusive thoughts. “It’s sort of the busy brain syndrome,” he says. “Too many simultaneous thoughts going on inside, too much mental chatter.”
Because ADHD can often be confused with such issues as depression, Sallaj says it’s often diagnosed through excluding other possibilities. With adults, Sallaj often starts out with questions.
“I want to know, how long have you had this job? Has the job changed? Are you having interaction issues with people at work? Do you have a bad boss? Do you have difficult peers? Do you have any difficult clients?” he asks.
“Because those issues can really play into your ability to attend to what’s in front of you,” explains Sallaj, “and not be emotionally distracted by other things that are happening on the side.”
Sallaj says he’ll go on to ask how a person’s relationships are going, or if there are difficult situations going on in someone’s family, like an illness.
“Those can really make things worse with regard to attention,” he says. “I want to know, ‘Was this new?’ Because typically, ADHD does not necessarily get worse out of the blue.”
If symptoms do suddenly get worse, without any other life circumstances changing, it could indicate more of a mood problem or anxiety issue rather than ADHD, says Sallaj.
People with classic ADHD, he says, exhibit a mind-body connection that can result in fidgety behavior and a tendency to get bored or distracted easily.
“ADHD, for me at least, as a treating physician, is more a diagnosis of exclusion,” he says. “We exclude everything that can cause inattention and then we move to the idea of medication.”
ADHD can sometimes be present in people with other disorders, or comorbidities, says Phelan. Common comorbidities experienced by people with ADHD include depression, anxiety and bipolar disorder.
Cullinane likened depression to a software issue and ADHD to a hardware problem because it’s more of a brain dysfunction, “as if you had a wiring issue in your computer.”
Often, in adults with ADHD, “It’s usually someone else in their life saying, ‘You have a problem. You need to do something about it,’” says Cullinane. “It’s a lifelong thing. People (with ADHD) don’t know any different.”
Pagano, too, says he viewed some of the hyperactive and restless behavior associated with his ADHD — such as a compelling desire for movement and action — as typical. It wasn’t until other people didn’t mimic his behavior that he realized he was built differently.
In his book, Phelan says diagnosing ADHD in adults requires evaluating developmental and family history, educational and workplace environments, social functioning, medical and psychiatry history, self-reporting, structured interviews, rating scales, questionnaires, observations of office behavior and interviews with close relatives and friends.
Bonesteel has a different take on ADHD diagnosis.
He takes a neuropsychological and neurocognitive approach to testing to see how well a person’s brain can perform on standardized neurological tests. He may also study a brain map to see if brain wave frequency patterns are consistent with those patterns typically present in ADHD.
“Understanding brain performance, understanding symptoms and also looking at what the brain is actually doing physiologically, that three-point approach is typically the most scientific and most comprehensive way of looking at things,” maintains Bonesteel.
The most obvious course of treatment for ADHD is medication. Cullinane says extended-release stimulants, like Adderall, can be “very helpful.” He also says non-stimulant medications like Strattara, can help; Sallaj adds that Strattara is particularly effective with distractibility issues.
Stimulants that increase the amount
of dopamine in the body, Sallaj says, can help people “stick with something for a longer period of time and attend to things in front of them.”
There has to be a certain amount of caution, however, when using medication. If you’re overdosed, Sallaj says, medication can cause mood problems or hyper-focusing. It can also increase anxiety and sleep problems.
“Medication has to be more of a wind at your back,” Sallaj says. “It’s not going to make you focus. It’s just going to sort of gently lead you into it.”
Bonesteel practices another treatment for ADHD called neurofeedback that’s essentially a way of training the brain.
He places sensors on the scalp over areas that aren’t producing enough brain-wave activity. That activity is then monitored in real time by a specialized computer connected to a video screen.
On the screen, there’s a movie playing, but the size and clarity of the picture depend on whether the person’s brain is producing a balanced wave pattern. When the brain-wave pattern becomes more balanced, the screen’s size and clarity also improve.
“It’s a movie that’s under brain control,” Bonesteel says. “The instruction to the person is, ‘Watch the movie, and play it. Let your brain learn how to produce the proper electrical patterns that allow the software to play the movie full screen and clear. So the brain is basically being rewarded for producing the correct electrical pattern.”
There’s also a behavioral and lifestyle component to treatment. It can be as simple, Cullinane says, as having one specific place to always put your keys. Or if you have trouble with interrupting people, practice counting from one to three before speaking.
Unlike kids, adults do not have to be confined to sitting in a classroom for much of the day and can choose a career path that could be commensurate with managing symptoms, such as avoiding sedentary jobs.
Pagano learned he could not handle a job requiring him to sit behind a desk or computer for any length of time. One day in his early 20s, he heard a radio commercial about a training program in heating and air conditioning.
“Being in an office just did not work for me,” he says. “I just knew I had to get into a trade and keep moving.”
The career in heating, ventilation and air conditioning, he has found, suits his hyperactive tendencies, which he has channeled into completing work tasks effectively. He says the speed with which he finishes HVAC jobs has often boggled his bosses.
Even at home, his wife, Patti, says he lines up one project after another to keep from being restless, from gutting bathrooms to refinishing floors to building a new chicken coop.
Pagano now runs his own company, Perfect Temp Heating & Air, and instead of the wild child tendencies of his youth, he has a reputation for promptness and efficient service.
His wife Patti, 36, calls the change she’s seen in Mark from teenager to adulthood “pretty amazing.”
“He just has a dedication that’s bigger than anybody I’ve ever seen,” she says. “It’s just interesting that all his ADHD has been channeled into this and given him an amazing work ethic. He’s definitely still hyper, but he’s hyper in a way that’s doing good for our family.”Edit Module