Paying Close Attention to Hyperactive Adults : Newly Discovered Disorder May Cause Emotional Problems, Psychiatrists Say

A man walks down the street

He says why am I short of attention

Got a short little span of attention

And wo my nights are so long

--Paul Simon, “You Can Call Me Al”

Carol Padgett felt as if she were caught in one of those nightmares where you work as fast as you can but you never catch up.

She’d soap the dishes, and strip the sheets off the bed, then jump to the next task, leaving the bed unmade, the dishes still soapy. As soon as she began one chore, another called to her.

The avalanche of unfinished housework, along with sleepless nights, weighed on the 51-year-old Jasonville, Ind., mother of seven, until one day she said to her husband: “I don’t want to die, but I don’t want to live like this anymore.”

If Padgett had been a child and her restlessness had been observed in regard to schoolwork, a school nurse might have suggested she be checked by a pediatrician for hyperactivity. As many as 5% to 10% of all children are hyperactive, a condition referred to by doctors as attention deficit disorder. Hyperactive children have trouble completing tasks; their grades drop as a result. Their frustration at being unable to concentrate often results in behavior problems.

The wisdom passed along by pediatricians to parents traditionally has been that the hyperactivity will vanish of its own accord sometime around puberty.

It’s only since the mid-’70s that psychiatrists have begun to suspect that anywhere from one-third to two-thirds of those children labeled hyperactive grow up to be hyperactive adults, with a set of problems only slightly different from those they had as youngsters.

“They’re no longer throwing spitballs, but they may get irritable at traffic lights,” said Dr. Paul Wender, a professor of psychiatry at the University of Utah Medical Center who has studied adult hyperactivity for seven years.

He has observed that hyperactive adults may appear no more physically active than other adults. But, like hyperactive children, they are unable to pay attention for long, and that leads to all sorts of personal troubles.

“I think there are many adults out there who are having difficulties with relationships, with work, and with themselves, and the diagnosis (adult hyperactivity) has not been applied yet,” said Dr. Walid Shekim, associate professor of psychiatry and biobehavioral science at the UCLA Neuropsychiatric Institute, and one of the nation’s few specialists in adult hyperactivity.

Carol Padgett was one who went undiagnosed for many years. Before she finally discovered what was plaguing her, she spent 15 years casting about for answers to her emotional problems.

Padgett said she was hospitalized numerous times with various psychiatric diagnoses. She was treated with anti-depressants and other drugs.

Eventually, she found relief when a doctor prescribed Dexedrine. Dexedrine and similar drugs act as stimulants in most people, but they have the reverse effect on hyperactive adults and children, allowing them to concentrate.

Those who suffer from hyperactivity, a disorder caused by a disturbance of two neurotransmitters in the brain, do not develop a tolerance for the drug as nonhyperactive people do, and so they are not at risk for addiction. Neither do they get a stimulant or euphoric effect.

The adult form of attention deficit disorder was discovered in the ‘70s by child psychiatrists who made a point of following their juvenile patients into adulthood. They found that, contrary to the accepted theory, some of their patients did not get better as they aged. “Some of them, in fact, got worse,” Shekim said.

But because adult hyperactivity is a newly discovered disorder (included in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Assn.), clinicians are not yet in the habit of diagnosing the problem in adults. And an adult who was originally diagnosed as a hyperactive child has a better chance of being correctly treated for the disorder than one who slid through childhood without detection.

That’s because “the diagnosis of attention deficit disorder, residual type (adult hyperactivity) requires that the patient had attention deficit disorder as a child,” Shekim said. “If the symptoms occur in adulthood and the patient was not like that (hyperactive) as a child, then the diagnosis is something else.”

Shekim said that hyperactive adults usually seek professional help not for overactivity, but for unhappiness over poor relationships with spouses, bosses and friends.

Hyperactive adults tend to have a “short fuse,” Shekim said. Sometimes this irritability leads to problems with the law or with drugs. Shekim said some adult hyperactives drink too much or use cocaine or other drugs in an attempt to self-medicate themselves. They may not know that they are hyperactive, only that certain drugs help them to function.

If a doctor suspects hyperactivity, he or she must make a retroactive diagnosis of childhood attention deficit disorder by reviewing the patient’s behavior in elementary school--usually with the help of the patient’s parents.

The doctor will be looking for these things: a lifelong pattern of restlessness and impulsivity; and shifting moods, ranging from excitable to depressed in a brief span.

If the patient fits this pattern, the doctor may administer tests to gauge attention span.

While hyperactivity occurs anywhere from 4 to 10 times more often in boys than girls, adult men and women seem to have the disorder in equal numbers, Shekim said. (This may mean simply that more childhood cases go undiagnosed in girls.)

Until adult hyperactivity is a more widely recognized syndrome, Shekim advised that adults who suspect they may suffer from this disorder consult a professional who has the most experience treating hyperactivity--a child psychiatrist.

In many cases, Shekim said, adults are first alerted to the possibility that they may be hyperactive when one of their children is diagnosed as such. (Attention deficit disorder is believed to run in families).