ADD or Anxiety?

In recent years, ADD has grabbed a lot of attention (pun definitely intended). The diagnosis of ADD (it’s offcially called AD/HD now, but many people still call it ADD, so I will do so here) has become far more prevalent in the last 10 years. Why the increase?  Here are a few possible explanations: 1. More people may actually have the disorder. This is entirely possible. The reasons for this increase are debatable (Diet? Sleep deprivation? The internet? Cell phones?), but the increase may be real. 2. The same proportion of people have the disorder, but more are seeking treatment. Also possible. Why?Heightened awareness may encourage people to seek the help they need. It may also contribute to reduced stigma. When people see their symptoms as a weakness or character flaw, they're unlikely to do much about them, aside from beating themselves up and feeling bad. But when people see those symptoms as what they are--symptoms--they're more likely to look for help.

This is hugely important. One of my clients who had been diagnosed with ADD told me that he felt like he spent his whole life trying to understand why he could never be "on top of things."  He said he secretly suspected that he was subconsciously trying to undermine his own life, because of some dark, self-destructive impulse.  But once we started to pinpoint some of his problematic habits, and we implemented a few key behavioral changes (such as making checklists, using his smartphone to set reminders, and scheduling routine tasks on his Google calendar),  he developed a much greater sense of control over his life.

3. People with anxiety and other disorders are being misdiagnosed with ADD. This is also likely to be true.

To be clear, I am NOT suggesting that ADD is not a real diagnosis. It is, and it can be hugely problematic for those who have it, many of whom continue to go undiagnosed.

But, here's the thing: Reliably diagnosing ADD can be really, really difficult.  This is true for mental health professionals who have the time to do thorough diagnostic workups, and its doubly true for primary care doctors who have to make diagnoses in a few short minutes.

This is because the cardinal symptoms of ADHD (such as distractability and difficulty concentrating) are not unique to the disorder; they can also be caused by anxiety or depression.  When people are stressed out, they can look like they have ADD. Chronic anxiety interferes with interferes with learning and memory, emotion regulation, and impulse control.  And, it tends to interfere with sleep, which makes these problems even worse.

For clinicians, diagnosing ADD requires a careful ruling out of other problems that may be causing ADD-like symptoms.  Many providers simply don't have time to provide such a thorough exam, so it's likely that many people are given the ADD label and prescribed meds that they don't need.

The good news is that anxiety is highly treatable with therapy.  And when it is treated successfully, the ADD-like symptoms tend to go away.