Maybe just a little ADHD, but probably not, but maybe?

September 30, 2010 11:15 AM

Is it possible to have "just a little" ADD/ADHD?

For a few years I've wondered if I have ADHD, and I've never really come to a solid conclusion either way. (Neither have my therapists or doctors; yep, I've talked to them, but I've usually been tentative and wishy-washy about it.) I have some of the symptoms, but I don't feel like it affects my quality of life that much. It's more like "I could be doing better" than "I am having trouble functioning."

I've always sort of assumed that, for me, it's a combination of human nature - boring work is boring, new interesting stuff is fun - and my never having developed good habits or the ability to focus. (I don't want to start a debate on whether ADHD is "real." I believe it is a very real condition for a lot of people, I'm just wondering whether it applies to me.)

A few reasons I've suspected ADHD: I regularly have great ideas but rarely get beyond starting them; I have a lot of trouble paying attention for more than five minutes in meetings; unless I'm absorbed in what I'm reading, I don't stick with it (I've caught myself "reading" books by staring blankly at a page for a while and then turning it, and I've "read" a lot of books and been completely unable to summarize the plot); I often start to do something at work, open another email or something, and then completely forget that I was doing anything before; I make small, careless errors despite checking my work several times.

On the other hand, I have productive days when I can plop myself down, get to work, and allow myself few distractions, and it feels great. I don't have trouble forgetting appointments or losing important things.

I tried Concerta once, at the suggestion of a doctor. It did nothing and I didn't pursue further treatment. I read either Driven to Distraction or Delivered from Distraction a few months ago, after reading the ADHD thread (and thinking "That sounds like me - okay, that doesn't - but wait"); I don't remember which one I read, but I definitely actually read it instead of looking at the pages, and it felt very not-like-me for reasons I don't remember now.

YANMD; if doctors haven't confidently diagnosed me, I don't expect the internet to. However, I do want to hear other people's experiences. Is it possible to have a mild/subclinical version of ADHD? Or, if you went from "maybe I have ADHD" to a definite yes or no, how did you figure it out? Where did you go from there, and what worked?

posted by Metroid Baby to Health & Fitness (22 answers total)

Your level of focus--five minutes in meetings, not starting stuff, etc.--sounds like me. My therapist and I discussed the possibility of me having ADHD and she said, "Well, I can't make a clear diagnosis without testing, and I'd refer you to a psychiatrist for that, but my sense is that you might have mild ADHD, but not necessarily to the point where you need medication."

Which is to say, yes, I think you can sort of have ADHD.
posted by hought20 at 11:29 AM on September 30, 2010

Best answer: I have ADD, no H. I didn't think Concerta did much of anything, but I'm happy with Adderall. I wasn't diagnosed until I was in my early 30s, and I'd gotten along okay--good coping skills, not so great sense of direction, and poor impulse control. You don't have to have a constant monkey brain nor be buzzing around all the time to benefit from medication, nor do you have to take it everyday for the rest of your life.

I strongly suggest seeing a neurologist, not a psychologist or therapist. I think the biggest difference for me is that I can complete rather routine boring tasks (excel spreadsheets) without tears and screaming fits and mistakes. I was good at making lists, and checking things off, had a strong visual and aural memory, but could have trouble getting started on less-than-engrossing projects.

I was diagnosed by a UCLA genetics research project, but in general, the test is pretty much cognitive exercises.
posted by Ideefixe at 11:33 AM on September 30, 2010 [2 favorites]

I feel very similar to you. When my son started having attention issues, I suspected that I did too. I overfocus sometimes, often get bored with things, and don't finish what I start. I read a bunch of books in a very short period of time about ADHD with the idea that I could diagnose him and me. What I remember was this:

1) If you can read a book, you probably don't have ADHD
2) It has to severely disrupt your life
3) It has to show up by the time you are 7 years old

Disappointed that I didn't have a prescriptable reason for my scatterbrain, I looked at some other books, like The Renaissance Soul, that try to frame lack of focus in a positive light (which may be the right approach for all I know.) I also talked with a career counselor about it. My shrink doesn't think I do either. I never found a fulfilling explanation for it.
posted by acheekymonkey at 11:37 AM on September 30, 2010 [1 favorite]

Best answer: If you really want to know definitively, ask your doctor for a neuropsychology referral. A licensed clinical neuropsychologist will be able to give you a battery of tests to determine if your issues are related to ADD, another learning disorder or subclinical attentional deficits (there is a lot of variation in individual attentional abilities, therefore it is very possible to suck at focusing, but not meet the threshold for ADD/ADHD). Neuropsych tests are better for this kind of yes/no quetion, because they rely on quantitative standardized scores, not your therapist subjective assessment of your symptoms.
posted by Mrs.Spiffy at 11:39 AM on September 30, 2010 [3 favorites]

Best answer: Standard "IANAD, IANYD" disclaimer applies, but... As someone who struggled with educational therapy and medication for years before I learned to manage it without medication (also the result of years of therapy and meditative techniques): to me, it doesn't really sound like you have ADHD, especially if medication didn't work. And as far as I know, adult ADHD doesn't tend to present as mildly as yours does, but I could also be wrong.

Speaking as someone who's still dealing with the long-term effects of ADHD medication: I wouldn't bother with any further medication, especially if Concerta didn't help. It sounds more to me that you just need to develop better focus and motivational habits, which is something you can definitely discuss with your therapist. You can be easily distracted, excitable, and have poor focus without having ADHD -- and working on developing those good habits can help with it. It seems to me that the diagnostic criteria for adult ADHD is not very well organized, and if your therapist can't even decide if you have it, I'd say not to worry about it anymore. You obviously already know what you need to work on, so maybe it'd be better to focus on the actual issues rather than wondering whether it's caused by a disorder you might not have.

I can tell you from experience, even as someone who does have ADHD, that I've found it more effective to just work on my bad habits and turn them into good ones. I was diagnosed with ADHD as a child in the 90s and was medicated for years. The medication only helped so much, and it had nasty side effects as I got older (blood pressure changes, unhealthy weight loss, messing with my alertness patterns). I decided to go off it on my own when I was about 17, and working without it was HARD, but after a couple of years of really wanting to be able to function without it, and some additional therapy where I was also being treated for anxiety, I'm finally able to sit down and work, although I have my own coping methods. I'm fidgety and easily distractible, so I took up knitting to keep my hands occupied while I do reading for classes. I also do some vipassana meditation, which although I originally started doing for my anxiety, also helps me retain my focus for longer, as I've found. I've been able to learn to focus and function even with diagnosed ADHD, but I think the methods for you, whether or not you actually have it, could be similar. I find that it's all about balancing my fidgety and distracted tendencies and developing methods to cope with the urge to change what you're doing immediately to someone else.

Apologies if this response is a little disorganized. But I hope it helps at all!
posted by runaway ballista at 11:41 AM on September 30, 2010 [1 favorite]

Every case is different. Suggesting that you can be "a little" ADHD implies that there is some kind of big ruler that measures everyone on the same scale. Not really.

It's worth getting tested, if only to understand what your symptoms are so that you can devise strategies with and without medication to deal with them.

And though IANYD, I am certified ADD and you sound at least "a little" ADD to me. The reqason you may only feel "a little" ADD is that you have probably done well at compensating and finding things to do in life where ADD is not as much of a problem (or may even be an asset.)

That was my case. I was doing quite well for decades and went on medicine only when I switched to a job that had me working alone on long projects from home. ADD hell for me.

Arm yourself with data and respond accordingly.
posted by cross_impact at 11:44 AM on September 30, 2010

This is going to sound like I'm in a cult, but I used to work for this kinda crazy life-coaching company. They pushed this personality test called the Kolbe test. The online test costs $50 - just to warn you. It measures how you use your instincts to problem solve. One of the areas you can rank high in is called "quickstart". So basically, if someone puts a bunch of wood and some nails in front of you and tells you to build a birdhouse, you just go for it and start building it (where as some people would ask questions, organize materials, draw a picture, etc.). Knowing this about myself has really helped me learn how to help how I already am. Example: I'm really adaptable, I'm great under pressure, I'm great at doing things really fast, then refining it when I have more patience. I don't know if this sounds familiar, but you may want to check it out.
posted by ashtabula to opelika at 11:47 AM on September 30, 2010 [1 favorite]

For a more definitive answer, don't bother with a therapist or a regular GP. In fact, I would be kind of suspicious of any general therapist or GP who felt comfortable diagnosing ADHD in an adult. Find yourself a neurologist who specializes in ADHD and get yourself a consult. (This will probably end up being a pediatric neurologist.) Be prepared for this appointment to take up to 2 hours, and don't be worried if you feel like you'll have trouble describing your symptoms/issues - they're used to waffling.
posted by elizardbits at 12:02 PM on September 30, 2010 [1 favorite]

FWIW- The DSM IV TR (The book used to diagnose disorders) does not recognize ADD. One can have ADHD or ADHD with the subtype of predominantly inattentive (ADHD-PI).

You need 6 or more of the following behaviors:

1) Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.

2) Often has trouble keeping attention on tasks or play activities.

3) Often does not seem to listen when spoken to directly.

4) Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).

5) Often has trouble organizing activities.

6) Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period (such as schoolwork or homework).

7) Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).

8) Is often easily distracted.

9) Is often forgetful in daily activities.

In addtion to these, you also need to have these behaviors disrupt or impair you life in some way. You must also have these behaviors in at least 2 settings (i.e. work and home).

Hope this helps.
posted by WhiteWhale at 12:03 PM on September 30, 2010

Best answer: Some people have talked about Attention Deficit Trait (ADT).

This means a person has ADD-like issues, but the problem is not biologically based, but more a function of learned behaviors, the work environment they're in etc. The distinguishing feature would be that you don't *always* have these problems, and have not had them your whole life. For example, maybe you don't have any problems when you're on vacation.

In any case, the non-pharma options for people seem to be exactly the same for everyone regardless of whether the label is ADD, ADT or just some work habit label like "procrastination problems".

So maybe the diagnosis is not so important as finding what works for you.
posted by philipy at 12:43 PM on September 30, 2010

There is certainly a continuum between mild ADHD and severe ADHD, so it makes sense to me that there would be people whose symptoms are mild enough that they don't meet the threshhold of being diagnosed. My ADHD is fairly mild, and there are definitely things in the ADHD thread and in books I've read that don't sound like me, either because I don't have the symptom at all or because it isn't as severe as it is for other people. But on the other hand there's usually lots that does.

By the way, I wouldn't read too much into Concerta not working-- plenty of people with ADHD at all levels of severity need to try several different medications to find one that works for them. So it's really not much evidence of anything.
posted by EmilyClimbs at 1:06 PM on September 30, 2010

I'd also recommend neuro-psych testing as others have suggested. The criteria do seem loose, but they rely on a preponderance of evidence. Having testing done would give you a sturdier handle on what's going on.
posted by canine epigram at 1:41 PM on September 30, 2010

Best answer: I have been thoroughly evaluated by neurologists, psychologists, psychiatrists, and a psychiatric nurse-practitioner. I've been diagnosed ADHD-combined type from clinical interview and history by all of the mental health providers, and confirmed by neuropsychological batteries administered by separate licensed professionals.

If you seek evaluation, you don't usually start off by seeing a neurologist. Neurologists rarely--I won't say 'never,' because lord knows in academia you will find a handful who have an extra license--administer neuropsychological batteries specifically for ADHD. Nor would you see a pediatric neurologist as an adult. And although clinical interview and history is one way to diagnose, for a thorough evaluation, I too suggest seeing a clinical psychologist with a strong background in neuropsychological assessment. If you have ADHD, the test results are worth every penny, should you need accommodations.

I just finished my....I don't know...'n'th work-up (for purposes of renewing documentation) this week. The current thorough neuropsych work-up for ADHD includes a clinical interview and history, neuropsychological battery (I got the full WAIS-IV, a few extra executive functioning tests, as well as at least one on response inhibition), the MMPI, the long-form ADHD self-report and two third-party reports based on my childhood. It took over six hours of pure, wall-climbing frustration. I even took it medicated, and flunked. Or passed, depending on your definition, I suppose.

Also, some people with ADHD can read entire books cover-to-cover. Individuals are...individual.
posted by Uniformitarianism Now! at 1:54 PM on September 30, 2010 [4 favorites]

There's a pervasive misunderstanding of ADHD that, if you can ever concentrate on anything, that, of itself, is contraindicative of ADHD. It's not.

I have ADHD. You sound a lot like me and like a lot of inattentive-type ADHDers.* If you read the literature, you'll also encounter descriptions of a lot of ADHD-ers that sound very little like us. Some of those are hyperactive-type. Some have issues other than ADHD, which is often co-morbid with other things.

* not a diagnosis, blah blah blah
posted by Zed at 2:40 PM on September 30, 2010

1) If you can read a book, you probably don't have ADHD
2) It has to severely disrupt your life
3) It has to show up by the time you are 7 years old

I have ADHD. I am a book editor (and have always read books voraciously and in great quantities). My ADHD was always there, but because I am also smart and test well, my ADHD wasn't a life-disrupting problem until after college.

Descriptions of ADHD that try to take it down to a few very limited criteria don't capture the true breadth of the thing. Like others, I would suggest you see a specialist. Also, know that not all ADHD drugs work on all ADHD patients. Figuring out which one works for you, and what dosage is best, takes a long time.
posted by ocherdraco at 3:02 PM on September 30, 2010 [4 favorites]

Hm, that's a good point. Everyone I know IRL with ADHD traits says it gets worse as you get older. I wasn't nearly so attention-hoppy until after college too. I don't know how the hell the 7-year-olds deal with it if it only gets worse the older you get!
posted by jenfullmoon at 3:11 PM on September 30, 2010

If you are female (as I am) and have ADHD or tendencies toward it (as I do) you may find that your ability to initiate or sustain attention to tasks alters with, shall we say, the cycle of the moon. It may be worth at least considering. I don't know if it will help you, but sometimes knowing that I'm more distractable for a reason (a discrete, definable, natural hormonal reason) is not only comforting, but helps me take a deep breath and focus more on my task.
posted by maryr at 3:18 PM on September 30, 2010 [1 favorite]

Since I am off the charts ADHD with amazing coping skills (however ineffective! My psychiatrist expressed amazement that I'd been continuing to tackle life for 27 years with this brain.), I'd guess that in some people ADHD causes a smaller degree of impairment.

Feel free to look into adhd coping skills, a lot of them are helpful for neuro-typical folks as well.
posted by bilabial at 3:35 PM on September 30, 2010

Running. That is how severely affected 7-year-olds (and I) deal with it.

My unmedicated, more mildly-affected brother is super-into triathlons and mountain biking. My cousin is a hard-core cyclist. Exercise helps inattentive ADHD, too. (I have seen serious exercise get a few mild-to-moderate ADHD people through graduate-professional school. You knew when they missed their daily session, because they'd go from being pretty on-task to either spaced out or wandering the room being disruptive.)

FWIW, my brother swears that when he's hard-core training for a race, he gets the most done at work. The structure carries over.
posted by Uniformitarianism Now! at 4:34 PM on September 30, 2010 [4 favorites]

My ADHD was undiagnosed until my late 30s. I also thought I probably had a mild case. I was wrong, I know now that it was very severe without medication. ADHD tends to fool you into underestimating how bad you are. Just like it tricks you into thinking that something will just take a few minutes and 3 days later you are still at it.
I have a life coach specializing in ADHD, peer support and medication (adderral) to manage the symptoms. It is still quite hard though. Initially Adderal was like a magic pill, but the coaching has been very necessary to keep me from regressing.
posted by humanfont at 5:24 PM on September 30, 2010

People have personalities. Distractability is something people vary on. It's quite possible to have trouble focusing sometimes without "having" ADHD. Understanding yourself, and knowing your strengths and weaknesses, isn't all about diagnosis.
posted by nangar at 8:54 PM on September 30, 2010 [1 favorite]

Response by poster: Neuropsych! That's the link I've been missing. I've gotten so used to the "consult the DSM and talk to your psychologist" method that I didn't even consider that there could be actual tests for ADHD.

I think I'm going to keep working on developing good work and organizational habits, since that's useful whether or not I have a diagnosis. I've got a regular-old-psych checkup in a month or two; if I'm still concerned I might ask him for a referral.

Thanks!
posted by Metroid Baby at 8:04 AM on October 1, 2010