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Hyperactivity, grown up

ADHD is most often thought of as a childhood disorder, but many adults must learn to cope with its distractions. Prescription drugs and to-do lists can help.

July 10, 2006|Judy Foreman | Special to The Times

LIKE many young mothers, Sophie Currier is a busy woman.

There's all the family stuff at the home she shares with her partner and their 7-month-old son. There's work -- a teaching assistantship for a biochemistry course at Harvard University. And there's school. After majoring in biology at the Massachusetts Institute of Technology, Currier got a doctorate in neuroscience from Harvard and is on track to earn her medical degree a year from now.

The striking thing is that Currier does all this not only with severe dyslexia -- she couldn't read until she was 8 -- but with ADHD, or attention-deficit hyperactivity disorder, as well.

Scientists used to think that ADHD, which is often accompanied by dyslexia, or problems with reading, was primarily a problem for children -- about 8% of American children, roughly 4.5 million, have been diagnosed with ADHD. Scientists also used to think that children would grow out of it.

But it's clear now, as more of those children become adults, that many (perhaps more than half of) children with ADHD do not grow out of it, which explains why so many adults -- currently about 8 million in the United States -- have the condition.

With researchers looking for the genes behind ADHD, it's also clear that it's a biological, inherited disorder. It is not, as had been once thought, "caused by bad parenting or weak character," said Dr. David W. Goodman, a psychiatrist and adult ADHD specialist at Johns Hopkins University School of Medicine, who also consults for companies that make ADHD drugs. "It is a neurological condition validated by medical research whose impairments can be reduced by effective treatment."

The sad part is that, unlike children whose teachers often spot the symptoms, many adults do not acknowledge the symptoms in themselves -- even when spouses, friends and co-workers try to tell them. That means that they often aren't diagnosed until their child is diagnosed, Goodman said.

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Marketing drugs to adults

Dr. Ned Hallowell, a psychiatrist in Sudbury, Mass., said drug companies have been marketing their products aggressively to adults as well as to children, "and there are people who are taking the medications who don't need them, but there are also others who take medication and say it changes their lives for the better."

There's no objective screen such as a blood test for ADHD, but psychiatrists have developed clear-cut criteria for determining when a person may have it.

Adults with ADHD live lives characterized by "unexplained underachievement," said Hallowell, who is the author, with Dr. John J. Ratey, of several books on ADHD, including "Driven to Distraction" and "Delivered From Distraction."

People with ADHD are chronically late, said Hallowell, who has ADHD himself. They're disorganized. They lose things. They can't pay attention. They manage money poorly. They can't understand why everybody's always mad at them.

"These people are a pain in the butt," said Hallowell. "But what I've learned in 25 years of treating them is that when you reframe this in a medical context, a life can turn around. They go on to become the kind of person they are meant to be."

Currier obviously appears to be a high achiever, but her days are punctuated by the things -- both small and big -- that she does to overcome her ADHD. She keeps lists of everything. She sets her clocks ahead so that she has a prayer of making it anywhere on time. She uses her PDA constantly to remind her of where she needs to be and what she needs to be doing.

"I am not a fact holder," the Brookline, Mass., resident said. "The biggest thing is distraction.... I have trouble starting a project, then I have a hard time stopping it."

Like many people with ADHD, Currier has family members with the disorder. Her father, Richard, a Cambridge, Mass., real estate broker, has it. (Family members think his father had it, too) as does her brother, Blake, a construction project manager in Wellesley and Framingham. Richard's wife, Barbara, puts up with it all. "I print out a list of what he has to do every day," she said one afternoon in their kitchen. They both laugh. "Then he loses it."

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A genetic risk

Family studies suggest that about three-quarters of the risk of developing ADHD is genetic, said Susan Smalley, a behavioral geneticist at the Semel Institute for Neuroscience and Human Behavior at UCLA.

Smalley's lab is searching among families with ADHD worldwide for the genes that predispose to ADHD. She has estimated that at least 20 to 30 genes are probably linked to ADHD, some of which are involved in the regulation of dopamine, a natural brain chemical that plays a role in attention.

Many studies suggest that people with ADHD have a wide variety of cognitive and behavioral difficulties. Some have trouble with "working memory," the ability to remember a phone number you were just told or where you just put your glasses.

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