• Dr. D

Your Attention Trouble Isn't ADD

Just because you have trouble paying attention doesn't mean you have Attention Deficit Disorder (ADD)


The man was neatly and professionally dressed; shirt open at the collar, loose jacket, trousers, loafers. He walked confidently into the room, had a firm handshake and seemed comfortable meeting me.


He started the conversation with: “I think I have ADD – attention deficit disorder.”


He was an attorney in a large law firm. It looked like he was going to make partner.


But recently he was having trouble paying attention. A couple of years ago he could get through gigantic, fifty-page contracts and make changes to them without any trouble. But now, he was plodding through, had to re-read things a lot and doubted his abilities.


I asked about physical problems, sleep, his family: all the things that might contribute to his work and mood problems.


It turns out his marriage was on the rocks. His wife had filed for divorce and was pursuing primary placement for the kids.


Plus, he didn’t like being an attorney. He’d only gone that route because his father was an attorney and wanted him to follow in his footsteps.


At thirty nine, nothing in his life was where he wanted it to be.


He admitted he had thought seriously about suicide but didn’t want to do that to his children.

In other words, he was depressed.


Not all problem with concentration are ADD


ADD is in the news a lot. A lot of this is marketing. Prescriptions for stimulants like Adderal ®(mixed amphetamine salts), Ritalin® (methylphenidate) and other drugs used to treat ADD, is a huge business. We’re talking billions and billions of dollars.


So these drugs are really promoted by the drug companies.


Sales of ADD drugs are three times higher now than they were in 2006. But the percentage of people who actually have the diagnosis has stayed about the same.


So lots of people are getting these drugs who don’t actually have Attention Deficit Disorder.


I don’t want to sound like I don’t believe the problem exists. It does.


There are some fascinating studies that look at the brains of kids with ADD compared to those who don’t. And there are some real differences.


The brains of kids with ADD show that some of the connections between neurons (nerve cells) work very differently from those of kids who don’t have it.


The problem exists.


It’s just that it doesn’t exist in a lot of the people who are being treated for it.


I’m not going to go into a lot of the symptoms of ADD. You can find a symptom list (and drugs to treat it) in just about any family- or parent- oriented magazine and on line. So I won’t repeat that here.


Instead, I want to look at things people might think are ADD, but aren’t.


Problems That Can Look Like ADD


There are a huge number of actual health conditions that can be mistaken for ADD. I’m covering a few of these here so you can see how people can be given the diagnosis incorrectly.


Depression: the attorney I describe above was depressed. His “ADD” improved greatly after he started antidepressant medication and found a good therapist to work with.


What he thought was a problem with focusing his attention and getting things done were really that he couldn’t stop thinking about his wife and kids. Wondering about the future. Trying to figure out what he had done wrong and whether or not there was something he could do to make it better.


Anxiety: This is a problem that people, including doctors, often miss as causing people to have trouble focusing. These people are also often fidgety, another symptom of ADD when it’s mixed with “hyperactivity.”


They can’t pay attention to even little tasks enough to finish them. Their minds wander. They keep returning to thoughts of things that upset them instead of thinking about things they need to get done.


Sleep apnea: This is a huge problem. Many people, especially if they’re obese, smoke or have other breathing problems have sleep apnea.


This is where you go to sleep and for one reason or another, you stop breathing normally. If you stop long enough, your brain doesn’t get enough oxygen. Your body tells your brain

you have to get air.


So you gasp and jolt awake.


If that happens all night long, in the morning you feel groggy. You can’t focus your attention because your brain is so tired.


Hearing problems: --I think we’ve probably all known somebody who was hard of hearing. There might be a serious conversation going on around them, but since they can’t hear it, their minds wander to something else.


Then if someone tries to get them into a conversation, they have no idea what’s going on because they’ve been thinking of something else. They can’t pay attention because they can’t hear what’s going on around them.


Substance abuse: This is one diagnosis that is often missed as being ADD. If you’re high or in withdrawal from something it’s pretty hard to focus.


If you smoke weed every day or always have alcohol in your body, you’re going to have a lot of trouble getting things done or understanding what you’re being asked to do because your brain isn't working the way it's supposed to.


Other problems: There are other things that can look like ADD but aren’t. Being bored with what’s going on around you, thyroid trouble, other physical illnesses. These are just some of the other types of difficulties that can be mistaken for Attention Deficit Disorder.


So What if the Diagnosis is Wrong?


I get asked this question pretty often. The medications we use to treat ADD, stimulants most often, can make a lot of people feel better. They can give you energy. And even if

you don’t have ADD, you probably can think better when you take a stimulant, at least for a while.


But there are some real problems with taking prescription stimulants even when you have ADD, and more if you don’t.


Kids, especially of college age, are increasingly using stimulants to increase their ability to learn. They even call them “study drugs.”


They say they can pay better attention to what they’re supposed to be learning.


The problem with this line of thought is that, first, while they might spend more time following their studies, it doesn’t seem to stick with them. And second, if they’re not under the influence and are tested on things they “learned” when they were on stimulants, it looks like they never studied at all.


Next is the fact that these drugs can cause physical problems as well, especially the older the person is. High blood pressure often occurs.


Abnormal heart rhythms can occur.


You can take too much which can cause people to hear and see things that aren’t there. And taking too much or too long, in other words, overdosing, can cause death.


Plus, if you’re treated for ADD and don’t have it, you’re less likely to get treated for the problem you actually do have. Your depression might seem better for a little while, but after a few doses of a stimulant you may actually feel worse overall and start feeling suicidal.


If you have sleep apnea, these medications interfere with sleep so that when the effect wears off you’re even more tired and having more problem focusing on important things than you were before.


If You Can’t Pay Attention, Do This:


1. Consider what’s going on in your life: Are relationships going ok? Is work going well?

Could problems in these areas be contributing to your having trouble focusing?

2. Think about how you’re sleeping: Do you wake up often and for what seems to be no

reason? If you wake up worrying about things that aren’t worth your time, could it be

depression? If you are heavier or startle awake often, could it be sleep apnea?

3. Are you drinking alcohol often, smoking weed or using other drugs that can make it

hard to learn and pay attention? Could staying away from these things for a week or

two help you to know whether or not this is the real culprit?

4. Have you noticed that you have to ask people to repeat themselves often? Or do you

feel alone in a crowd because you can’t really hear and understand the conversations

around you? In other words, could hearing difficulties be the real problem?


Don’t assume that the easiest and most popular diagnosis, ADD, is causing you problems. You should try to get to the real problem so that you can be treated with whatever approach is best for you.



Suicidal thoughts by @CanStockPhoto Inc/Vlada13

Sleep apnea by @CanStockPhoto Inc/pixelbrat

Questioning by @CanStockPhoto Inc/ Orla