Do people have ADD from birth?

ADD Basics FamilyAs we continue laying out the truth about ADD/ADHD, we turn to some of the most common, burning questions my patients, friends, family, and colleagues most commonly ask me.  The answers to these questions form a critical foundation to understanding the truth about Attention Deficit Disorder.

If people are born with ADD, why don’t problems show up right after birth?

ADD becomes apparent only when the inborn attentional differences interfere with the individual’s ability to meet expectations in the environment. Depending upon the severity of a person’s attentional differences, his temperament, the status of other skills and abilities, and the specific nature of environmental expectations, ADD can crop up at any point along the life span from infancy to old age. Let’s take a look at how this can happen.

Typically, individuals with ADD appear to be normal at birth. As children, they are minimally, if at all, delayed in meeting major milestones of accomplishment such as walking and talking. They generally reach school age with only minor problems in controlling their behavior and interacting with peers. The first grade classroom is often the first place where specific expectations for paying attention occur. As a result, the entry into school is one of the more common times when ADD first shows up. Other key transition points in the individual’s life where expectations for increased efficiency of attention can lead to the emergence of ADD include the following:

  • Movement to the upper elementary grades where time constraints are imposed and increased demands are placed on children to function independently
  • Movement to junior/senior high school where more refined organizational and study skills are required
  • Movement to college where fewer supports are available and the ability to function independently is essential
  • Movement into a new home away from parents where there are no supports and the ability to function independently is even more critical
  • Marrying or cohabiting with a partner where functioning impacts upon the quality of life of another person and demands for efficient problem-solving are high
  • Becoming a parent where responsibilities for keeping it all together, all the time is essential

Individuals with ADD who have strengths in other areas (e.g., strong language skills, a charming personality, intellectual giftedness) can go a long time in life without being identified as having a problem. I have seen many children go through elementary school with A’s and B’s only to have the bottom fall out upon entry to middle school or junior high school. In these circumstances, careful probing of the educational history of these children often reveals evidence of attentional weaknesses that have either been overcome with sheer brain power or been overlooked by parents and teachers because these subtle weaknesses hadn’t really led to failure.

While failure to meet increasing school demands is a very common way for ADD to be uncovered, it can also happen as a result of failure to meet increasing demands for independent functioning, social interaction, or problem-solving at home, in childcare, in the neighborhood, or on the job.

Meet Michael

Michael is a good example of this. He is a 10-year-old boy who has always done very well, academically and socially. He has learned new concepts quickly, has shown a gift for memorizing facts, has been easy to get along with, and has always been a great conversationalist.

Until two months ago, he had also functioned very well at home. At that time, however, his mother got a new job that meant she was no longer able to be with Michael after school. And, despite all of her attempts, she had been unable to find someone who would stay with Michael until her new workday ended. So, for the first time, Michael was on his own everyday from 3:00 p.m. to 6:00 p.m.

The new expectation for him was “keep yourself busy and stay out of trouble for three unsupervised, unstructured hours.” This new demand uncovered Michael’s impulsivity, distractibility, and lack of ability to think through the ramifications of his behavior. He broke a living room lamp by rough housing in “off-limits territory”; he burned a hole in the new family room couch while “fooling around” with a butane lighter; and he soaked the bathroom carpet when he ran to answer the telephone, forgetting to first turn off the faucet.

Without his mom around to help him structure his time, to remind him of the house rules, and to watch over his activities, Michael had become dysfunctional.

Meet Emma

Emma’s story is similar. She is a 22-year first year elementary school teacher who has just married. Emma is gifted, kind, funny, sensitive, and very hardworking. Until now she has done well in almost every sphere of her life, but she has never been asked to establish her own home, to share finances, nights, and laundry with someone else, to complete daily lesson plans for five subjects, to effectively manage thirty fifth-grade children for six hours every day, and to negotiate unclear work politics all at the same time.

Emma is a mess. Despite her intelligence, her hard work, her sense of humor and her likeability, she is not experiencing success anywhere in her life.

Catch up on previous posts in the Pay Attention series.

Patients of all shapes, ages, and sizes come to The Being Well Center and Dr. Craig Liden for diagnoses and treatment plans they can trust. Can we help you too? Visit The Being Well Center for more information about Dr. Liden’s services.

Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

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STRESSES – The Challenge of Taking Medication at College

When students arrive on campus, the demands for efficient attention and self management skills (that is executive functioning) immediately soar . . . challenging academics, consistent study habits, maintenance of healthy daily routines for sleep, eating and exercise, money management, and more complex social decision making.

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Meeting college demands is particularly challenging for students with ADD/ADHD and for the overwhelming majority of them, this means having the aid of a medication regimen that provides benefits throughout the whole day.

We’ve learned from our experience in our Confidence@College program that college is a bad time to try to “fly on my own” and go without medication treatment.  In fact, in our C@C patient population, we have found that acceptance of the need for medication and compliance with an appropriate all-day medication regimen is near the top of the list of factors that contribute our 81% success rate.

For some ADD/ADHD individuals who have been able to get by without medication in the past, entrance into college with its increased demands means having to seriously consider the use of medication for the first time.  For others who have been able to get by with a medication regimen geared to get them through the school day, it means revising their regimen to provide coverage into the evening hours.  And for others, it means committing to taking the medication 7 days a week!

Don’t let an improper use or lack of medication keep you or your student from success at college!

At The Being Well Center, patients who enroll in our Confidence@College program always start with a Discovery Session where we identify the key problem areas and survey the whole person so we can pinpoint the barriers to success and uncover strengths we can mobilize to meet these new challenges.  We then develop an individualized Success Plan.  When medication is a part of the success plan we conduct systematic medication trial testing using objective testing procedures to find the right medication and a treatment regimen that provides efficient attention throughout the waking day.

Before students arrive on campus we brainstorm with them and their parents how they are going to get their medication and how to securely store it.  We go over the logistics of when they will take the medication based upon their weekly schedule.  In addition, we review the dangers of diversion of the medication and make sure we have a mechanism in place to closely track the quantity of medication we provide them.

Once students are on campus, we use innovative technologies and support from our staff through our GuideU video counseling sessions to ensure the student complies with the medication regimen and maintains healthy daily routines, the foundation for a successful medication experience.  We identify signs of sub-therapeutic treatment and possible side effects quickly and our medical staff fine tunes the treatment regimen as needed.

We’re there to ensure success during the whole college experience not just in the classroom, library or study carrel.  We make sure our patients are aware of the importance of taking the medication during evening hours and weekends where social activities provide high risk challenges for un-medicated ADD/ADHD students.  Impulsivity, poor self awareness, weak self monitoring and ineffective problem solving can lead to social decisions that can be disastrous . . . alcohol intoxication, substance abuse, unprotected sex leading to unplanned pregnancy or STD, or illegal activities.  One night of un-medicated “fun” can lead to expulsion from school and life-long consequences.

If you’re at the top of your game, college can be an exciting and enriching experience intellectually, developmentally, and socially, and can provide you with what it takes to independently fulfill your dreams and aspirations through life.  Compliance with the right medication regimen helps this become a reality for students with ADD/ADHD!

Be confident with your child’s success at college . . . call us at the BWC and set up an appointment to participate in our C@C program.  We’ll make sure your child has all the tools, including an optimal medication regimen if needed, to succeed at college.