Dr. Christopher Quarto highlights the signs of Attention Deficit Disorder (ADD) in adults with thoughts on treatment and symptom management.
Rosemary Cope: Welcome to this edition of the Vanderbilt Health and Wellness wellcast. I am Rosemary Cope with Work/Life Connections. I am here today with Dr. Christopher Quarto, who is on the faculty at Middle Tennessee State University and has a private practice in Murfreesboro. Dr. Quarto is a graduate of Central Michigan University and University of Illinois. Many people incorrectly assume that attention deficit hyperactivity disorder, often referred to as ADD or ADHD, is a childhood condition only. The symptoms also continue into adulthood for many people. Left untreated, these symptoms can impact daily activities and wreak havoc on relationships and work situations. Chris, thank you for being with us today.
Dr. Christopher Quarto: Thank you. Thank you.
Rosemary Cope: You know, some people assume that adults can't have ADD or they just grow out of it as children. Would you give our listeners a brief overview of what ADD looks like in adults?
Dr. Christopher Quarto: Well, first of all, thank you for having me. Yeah, it's interesting, because when most people think of attention deficit disorder, they think of kids and they think of the "wild child," and you see that a lot in boys, and that is just not really the case with adults. Adults do not have that overt restlessness. It's more of an internal restlessness that they feel. I'll give you an example. I have a lot of people who come into my practice for psychological evaluations. I had a guy come in the other day for this and he was telling me that he will be at work, and of course, with him, there's a lot of distractibility and all that kind of stuff, but he just can't seem to sit still. So, every 10, 15 minutes, he has to get up and just kind of walk around the office or walk around the building, and once he does that, he kind of feels a little settled down, like he can get back to work, but it's still, it's kind of a constant thing for him, that internal restlessness. So, although it's not kind of running around and all that kind of stuff, for adults, you see it more that way. Other adults will kind of describe it as more of an internal restlessness as well. But we also see a distractibility and for some people, the impulsivity, not thinking before they act, and of course, that can present itself a little bit differently in adults as well. But those are the ... Barkley refers to this as the "holy trinity" of ADHD symptoms of inattention, impulsivity, and hyperactivity, but more so, restlessness for adults.
Rosemary Cope: Okay. How would that present in an adult besides, "I need to get up and move sometimes," or, "I make impulsive choices?" Anything else that people would look for?
Dr. Christopher Quarto: Uh-huh, yeah. I think that when they come in for these evaluations, when they describe these, they have done a lot of searching on Google, and so they kind of look at this and say, "Yeah, that's me, yeah, that's me." I think the other things that you'll oftentimes see are problems with what we call executive functions, so things such as, not only with attention span, focusing issues ... oftentimes, they will say, "I just can't stay focused on my work, and I try everything I can, but my mind is just wandering and I'm always distracted by things," but also even things like prioritizing - what do I do first? Like, if it's on the job, "I know that I should be doing this, but yet, my body or my brain is telling me - no, this would be more interesting to do." Some people describe this, people with ADHD, as having an interest-based nervous system, that they do things that are of interest to them. That's the thing that they are really focusing on or looking to do because that's what stimulates them. But the things that aren't as interesting, or that are boring, those are the thing that's really tough for them. So, that's the internal struggle that they experience.
Rosemary Cope: So, they wind up saying, "I know what I'm supposed to do, but I just can't seem to do it."
Dr. Christopher Quarto: That's right.
Rosemary Cope: "And I would like to, but I don't know how."
Dr. Christopher Quarto: That's right. And so, there's a motivation issue here at play with adults with attention deficit.
Rosemary Cope: So, Chris, is there like a cure for ADD and what can be done to treat this?
Dr. Christopher Quarto: Well, there are a lot of different things that can be done and it's interesting. If you look at the research now, researchers are looking at a lot of different things. Of course, we have had medication as the primary way of treating this for many years. Your listeners may know the medication Ritalin. That's been around for about 80 years now. It is a stimulant. And of course, the primary way of treating this is with stimulant medication. So, in addition to Ritalin, we have things like Vyvanse, Focalin, Concerta, and the list goes on. There are tons of them. But they all do the same thing. They help people focus, concentrate. This issue that I was just talking about with the motivation and distractibility, those aren't as big of an issue when treated with medication. So, that's the primary way, but there are other things that they can do as well. There are some techniques, little tricks that they can use. Oftentimes, it's getting people who they know to kind of help them, to remind them of things, whether it is a spouse, partner, people that they work with ... can do that kind of stuff. And it's also ... it's interesting nowadays, too, is that there are a lot of apps that can be used on phones to help them with organization, prioritizing, remembering things, just all this kind of stuff, so lots of different things that can be done.
Rosemary Cope: If I was going to look for an app, because we are all walking around with a phone in our hand, are there any that you are familiar with?
Dr. Christopher Quarto: I don't use those apps myself, but the ones that I would recommend are ones that, if they go searching for these types of apps, searching for ones that have good ratings, good reviews, and preferably ones that have good research behind it, because there are lots of apps that are out there but haven't proven to be effective. So, if they are going to do a search for apps, make sure and look for the research-based apps.
Rosemary Cope: Makes sense.
Dr. Christopher Quarto: Yeah.
Rosemary Cope: And Chris, if I think that I might be affected by ADD as an adult, where can I go for help?
Dr. Christopher Quarto: There are lots of different ways of doing that. A lot of the referrals I get for testing come from the primary care physician. So, that's usually the first stop, and that's a good thing to do, because oftentimes, when people have symptoms of attention deficit disorder or what they think is attention deficit disorder, it could actually be a physical problem. It might be a problem with the thyroid. It could be a lot of different things. It could be a substance issue that they are having, and that doesn't have anything to do with attention deficit, but that's kind of how it presents. So, I think ruling those out by going to the physician first is a really good idea. If the physician rules those out, then I think the next stop would be to get evaluated for this. Do they really have attention deficit disorder, or is it something that is masking as this? Anxiety and depression can be very similar in symptom presentation. So, it's good to get an evaluation to make sure that it's not one of those and it really is attention deficit, and then once they get that proper diagnosis, then they can look at treatment. There are a lot of people who do treatment for this, looking at things that they can do to alter a lifestyle, helping them at work. So, a lot of the therapeutic procedures that we have heard of in the past, like cognitive behavioral therapy and different types of therapies, can certainly help these folks.
Rosemary Cope: Thank you so much for giving us a little overview on this and giving us places to go for help and some better understanding about something that affects more people than we are aware of.
Dr. Christopher Quarto: Not a problem at all. It's been nice talking to you, Rosemary.