Consults - New York Times Blog
February 23, 2011, 12:23 pm
The Ups and Downs of A.D.H.D.
By THE NEW YORK TIMES
Cheryl Gerber for The New York Times Karran Harper Royal has two sons with A.D.H.D. Khris, left, and Kendrick, both were given the diagnosis as children. Hear their stories at “Patient Voices: A.D.H.D.”

Is there an upside to A.D.H.D.? Are certain careers more suited to the person with attention deficits than others? How does someone with A.D.H.D. deal with the daily ups and downs of the disorder? These are among the questions recently posed by readers of the Consults blog. Here, Dr. Russell Barkley, clinical professor of psychiatry at the Medical University of South Carolina, responds.

Day-to-Day Variations in A.D.H.D. Symptoms
Q.

Perhaps most frustrating to me is that some days I am completely “on” and “in the zone,” whereas other days, I can’t even buy my own attention, let alone anyone else’s. Are such drastic fluctuations common in A.D.D/A.D.H.D. patients?
TK, Atlanta
A.

Dr. Barkley responds:

A.D.H.D. symptoms do vary in different situations, as well as from day to day. The daily fluctuations may be related to the various activities one is doing on any given day.

If the tasks required on a specific day demand lots of self-control and organization as well as time management and persistence, then those with A.D.H.D. will generally report that their symptoms are worse that day. If, on the other hand, it is a vacation or weekend day and they could do more of the things they enjoyed, they often report that their symptoms were less pronounced that day.

People with A.D.H.D. tend to report less difficulty with their symptoms when they are in novel situations, are engaged in one-on-one interactions, are doing something they enjoy, are able to move about more while doing the activity, and do not have to do a lot of planning and preparation for the situation at hand. Of course, in the opposite circumstances, those with A.D.H.D. tend to report considerable trouble, especially in situations that demand self-restraint, time management, preparation and organization, and controlling their emotions more than usual.

Paddling to Stay Afloat
Q.

One of the things that I find most difficult about A.D.H.D. is the way it always comes back to whammy me. I have strategies that work fairly well, have had great cognitive-behavioral therapy and mindfulness training, and have meds that help a lot. However, it exhausts and frustrates me to know that everything can be going along great and in control for weeks, even months, and if I lower my guard a little bit and unconsciously relax a few protocols about stress management, I’ll suddenly be swimming in unpaid bills and forgotten appointments and lost belongings and fights with loved ones.

What’s the best way to cope with the unending nature of this problem? It’s just so tiresome and frustrating. Staying upbeat was easier in the first few years, when I believed I would just learn better habits and be able to manage life better. It’s harder now that I understand those habits aren’t always directly connected to the problems in ways that make sense, and that sometimes, I STILL just won’t see things or remember things and there’s nothing direct I can do about it. Self-compassion only goes so far. Strategies only go so far. What to do with the knowledge that feeling in control is an illusion that will be broken every few months?
dorcas, boulder
A.

Dr. Barkley responds:

Aside from my comments about using cognitive-behavioral therapy along with medication, coping and exercise (see my post “A.D.H.D.: To Medicate or Not to Medicate?”), the only other short answer I can give you for this frustrating difficulty with the disorder is to own and accept your disorder.

A lot of times, frustration arises because you think you can get rid of the disorder by engaging in lots of treatments and compensatory strategies. But they don’t always work, which can be very discouraging. The same applies to people with other chronic disorders, like diabetes. Try as they might to take insulin, modify their diets, be more health-conscious, exercise, address their hygiene and get routine medical care, they are still going to have days when their insulin is not well regulated and they have mental symptoms associated with that as well. Yes, it is frustrating — but that’s diabetes! Try to learn to accept that sometimes symptoms will re-emerge, and try to take them in stride, with a sense of acceptance and even a bit of humor.

There is a great video by two Canadian comedians, Patrick McKenna and Ava Green, on adult A.D.H.D. and how they cope with it. A lot of it is learning to accept and even laugh about some of the problems it can create. The video, “ADD & Loving It?!” is being aired in March on PBS, and you can see a trailer at their Web site, TotallyADD.com. Acceptance is not easy, but as in all personal foibles and faults, it is a great antidote to frustration and despair over not being perfect all the time.

The Upside of A.D.H.D.?
Q.

Are there any studies of careers in which the A.D.(H.)D. person is more likely to excel? It has been my observation that many very effective salespeople show A.D.H.D. behaviors.
TJ, Washington
A.

Dr. Barkley responds:

There is no evidence that A.D.H.D. is a “gift” or conveys any advantages beyond what other people in the general population might have. People with A.D.H.D. are individuals, like anyone else, and may have been blessed with particular talents that are superior to levels seen in most people. But these talents have nothing to do with having A.D.H.D. — they would have had them anyway.

As for particular careers that may be better for those with A.D.H.D., there is no research to address that question. But based on patients that we have seen in our clinics, we have found that certain careers may be more “A.D.H.D.-friendly.” Such jobs include sales, playing or coaching athletics, many trade professions, being a chef, photography or videography, the military, and acting or other performing arts.

Dr. Barkley is the author, most recently, of “Taking Charge of Adult A.D.H.D.” For more information, see his responses in the Related Posts section, below, and The Times Health Guide: A.D.H.D.

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