ADD and ADHD and a new theory, page 1

First of all, I want to say that I am not attempting to diagnose you in any professional manner. I do have some experience reading case studies and making diagnoses for the purposes of training and clinical experience in making clinical diagnostic impressions used by MDs to make diagnoses. I am currently licensed to make diagnoses.

I am going to take your lengthy post at face value and I am going to tell you why I think that AADD may not be the best diagnosis for you and I am going to suggest that you get a second opinion, stop diagnosing yourself, and forget about indigo children until you get some help for your problems in living.

First of all, AADD requires an childhood onset.

A history of childhood attention-deficit/hyperactivity disorder (ADHD) is a mandatory prerequisite for the diagnosis of adult type ADHD, for which no DSM criteria exists. Since the diagnosis must be made retroactively, tentative criteria have been designed to establish the presence of the childhood disorder. www.biopsychiatry.com...

Secondly, You have a history of creative accomplishment.

Other things that I am able to focus on are things which require my imagination, which I have an ease to harness. I am a creative writer, poet,
have classical singing skills, small time actor, and occasional stand up comedian. My mind is very sharp, I do not miss much. I pick up unspoken vibes and changes in peoples manner often before others notice. This has made me a fantastic peace keeper and peer dipolamat. I have exceeded in areas of customer service in jobs where this was required. I have a fantastic knack for saying the thing which soothes an angry individual.

At least elveven of the symptoms listed below must be present for Adult ADHD or AADD:

(Diagnosis requires the presence of at least 11 of the following)
Inability to complete tasks
Difficulty focusing
Distractibility
Stress Intolerance
Frequent forgetfulness
Atypical response to psychoactive drugs
Antisocial personality disorder
Blurting out answers before the question is asked
Difficulty awaiting turn
Interrupting or intruding on others
Inattention Deficit
Driven to Distraction
Sense of Under achievement
Difficulty getting organized
Intolerance of boredom
Often creative and highly intelligent
Increase number of projects going on at the same time
Trouble following "proper procedures"
Tendency to worry needlessly
Sense of insecurity
Problems with self-esteem
Inaccurate self-observation

This criterion fits you, but it does not include the kind of effort and dedication to master the art of classical singing.

Often creative and highly intelligent

But notice this constellation of associated pathologies and behaviors:

Family History of substance abuse, ADHD, or depression
Additionally, symptoms of ADHD can be found in cases of learning disabilities, language disorders and mental retardation. Thus co morbidity raises the questions as to whether the presence of another disorder alters the likelihood of a positive drug response? Family histories of the first degree relatives find increased rates of ADHD, poly-substance dependence, antisocial personality disorder, depression and anxiety disorders. Additionally, there is a 25% concordance rate for ADHD exists among the pro bands' first-degree relatives (Weiss and Hechtman 1986). Children with ADHD are at an increased risk of having antisocial behavior, depression and poly-substance abuse problems occurring when they are adults.

Please note the following quote which addresses creativity in those who suffer from Bipolar Disorder, formerly known as Manic Depressive Disorder:

Though this psychopathology is not for one to wish, one interesting association with bipolar disorder is the creativity of those afflicted. (2, 3, 5, 7) This is not the normal creativity experienced by the above-average people (on the scale of creativity). This creativity is the creative genius, which is so rare, yet an inordinate percentage of the well-known creative people were/are afflicted with manic depression. (2, 3) Among the lengthy list are: (writers) F. Scott Fitzgerald, Ernest Hemingway, Sylvia Plath; (poets) William Blake, Sara Teasdale, Walt Whitman, Ralph Waldo Emerson; (composers) Rachmaninoff, Tchaikovsky. (10) Psychiatrists, realizing a connection greater than coincidence, have performed studies all over the world in an attempt to establish a link between bipolar disorder and creativity. (5) In the 1970s, Nancy C. Andreasen of the University of Iowa examined 30 creative writers and found 80% had experienced at least one episode of major depression, hypomania, or mania. (5) A few years later Kay Redfield Jamison studied 47 British writers, painters, and sculptors from the Royal Academy. She found that 38% had been treated for bipolar disorder. In particular, half of the poets (the largest group with manic depression) had needed medication or hospitalization. (5) Researchers at Harvard University set up a study to assess the degree of original thinking to perform creative tasks. They were going to rate creativity in a sample of manic-depressive patients. Their results showed that manic-depressives have a greater percentage of creativity than the controls. (5) There have been biographical studies of earlier generations of artists and writers which show that they have 18 times the rate of suicide (as compared to the general population), 8-10 times the rate of unipolar depression, and 10-20 times the rate of bipolar depression. (5) The additive results of these studies provide ample evidence that there is a link between bipolar disorder and creative genius. The question now is not whether or not there exists a connection between the two, but why it exists. serendip.brynmawr.edu...

It should be noted that while Adult ADHD or AADD and the manic or hypomanic phases of Bipolar Disorder do have similarities, the drugs used to treat these two disorders are quite different. AADD and ADHD are treated with relatively powerful CNS stimulants, while Bipolar is treated with anti-convulsants, lithium, and SSRIs. (Bipolar medications) (Adult ADHD medications)

This type of mood and behavior would, in my judgement, be consistent with a CNS stimulant:

A few weeks go by, and my ability to focus seems a miracle of modern medicine, and that's when the full blown anxiety attacks started...

I first noticed it in the waiting room at the research facility. It was filled with a group of about 6 very typical ADHD childern, all playing, all loud, all inquisitve of the world around them. I started sweating, their little angelic voices took on a shrill grating sound, they were running around knocking things over banging toys on toys. I could barely contain myself, but at that very moment I yelled SHUT THE HELL UP. Obviously everyone was taken aback, and I later after feeling quite justified at the time, realized what an A$$hole I was.

For people who have ADD, ADHD, AADD and/or Adult ADHD, the effect of a CNS stimulant is quite the opposite.

Well I realized how miserable I was becoming with the obvious side effects of the medicine and thankfully the research study ended within a week of my decision so it was good timing.

Now things are more or less back to "normal" I still can't focus on menial repetitive structured tasks, and I still can't hold down a job. I quit the last one, when I realized just how boring it was. It was that or I wasn't able to do the work anymore, and I was saving myself the embarasment of being fired.

Compare your symptoms with these criteria for Hypomania:

Clinical Symptoms of a Hypomanic Episode

This section describes the clinical symptoms of a hypomanic episode employed by psychiatrists and other mental health professionals as part of the diagnostic criteria for manic depression (Bipolar Disorder) and other mood disorders.

Therapy and the Role of Clinical Diagnostic Criteria

Symptoms of Major Depressive, Manic, Hypomanic and Mixed Episodes

Criteria for Hypomanic Episode

Therapy and the Role of Clinical Diagnostic Criteria

In my own face-to-face and online therapy practice, I do not treat clients as manifestations of mental illnesses in need of medical fixing. No one is merely a case of bipolar disorder, an obsessive-compulsive, or a paranoid schizophrenic. In my view, formal diagnostic categories hold some value in terms of contextual information, but they play a much less important role than the specific personal circumstances of a given client. If you are a client, you are -- first and foremost -- a specific, unique individual.

Nonetheless, in my experience of working with clients who have received formal psychiatric diagnoses from other mental health professionals, I have often found that clients feel they lack adequate information about what these diagnostic labels actually mean. The entries in this section aim to provide the basic facts about each of several diagnostic labels. Please note that the diagnostic information provided here is for educational purposes only and cannot replace the advice of a qualified mental health professional.

More information about diagnostic labels is available on the page on the DSM and ICD.

Symptoms of Major Depressive, Manic, Hypomanic and Mixed Episodes

Because the lists of symptoms for major depressive, manic, hypomanic and mixed episodes play closely interrelated roles in the diagnosis of mood disorders, all are included here separately. The following diagnostic criteria are reproduced verbatim from page 368 of the DSM-IV TR (where 'IV TR' indicates fourth edition, text revision).

Criteria for Hypomanic Episode

A. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.

My mind is very sharp, I do not miss much. I pick up unspoken vibes and changes in peoples manner often before others notice. This has made me a fantastic peace keeper and peer dipolamat. I have exceeded in areas of customer service in jobs where this was required. I have a fantastic knack for saying the thing which soothes an angry individual.

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

inflated self-esteem or grandiosity (see quote above)

decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
more talkative than usual or pressure to keep talking

flight of ideas, or subjective experience that thoughts are racing
distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

had always wondered why I was scatterbrained, whereas others could delve into tedious low stimuli tasks and complete them. My mind would not allow for repetition without changing rapid stimuli. In the face of tedium, regardless of my very determined attempts to focus on the task at hand, my mind would wander. Many times I would only realize this after somone else had pointed this out to me, by ways of either yelling, or getting my attention brought to it.

This has always been the way my mind functioned. On the plus side, stimuli that has been rapid and changeable keeps my interest, television, great conversation with give and take, and video-games.

increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

Other things that I am able to focus on are things which require my imagination, which I have an ease to harness. I am a creative writer, poet,
have classical singing skills, small time actor, and occasional stand up comedian.

excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

D. The disturbance in mood and the change in functioning are observable by others.

E. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

On the Downside on the topic of Jobs, I have lost, or quit every job I have ever had since I started working 8 years ago. Either I would be fired for my lack of focus, or I would be so bored with the Job I would quit.

(This is not entirely consistent with the criteria, but it is worthy of note, that your symptoms are sufficient enough to cause social and occupational impairment. This information should be given to your clinician. GP)

F. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar II Disorder.

It is the tendency of the intelligent to inform themselves about their symptomology prior to seeking help for their problems, unless they are brought to a clinician by law-enforcement or a family member prior to their having become aware of their symptoms.

When a patient uses clinical terminology to express symptoms, clinicians call this "intellectualizing." They don't like it for two reasons. One, malingerers use the same technique. Second, it really doesn't tell the clinician how you feel and that's what they want to know, not how you fit your feelings to a set of definitions. Avoid clinical terminology when discussing your situation with a clinician. "I can't focus" and "My thoughts race and are jumbled," mean more to a clinician that saying "I experience 'flight of ideas'."

Next, based upon my interpretation of your behavior, taking your post at face value, I can make a reasonable argument that you can fit another diagnosis, other than the one's you suspected and you were previously diagnosed as having.

Additionally, your symptoms are causing you significant distress and affecting your social and occupational functioning and the realization of your full potential in life. This is reason enough to seek professional help.

I would suggest that you do what you can to get yourself a complete psychological work-up to include a battery of psycholgical tests, personality inventories, psychosocial assessments, clinical interviews, and if indicated, an evaluation by a psychiatrist.

Frankly, I think you have nothing to lose.

I hope this helps.

(Disclaimer: This exercise is not intended to be a clinical diagnosis nor is it intended to be construed as medical advice. It is intended solely to address issues described in a post to this board and as an argument that the person, who expresses significant distress, should seek further evaluation.)

[edit on 04/9/11 by GradyPhilpott]