Attention Deficit and Hyperactivity Disorders

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I have seen in the past couple of years more than a few questions from attorneys/law school students about ADD/ADHD. I was also recently diagnosed with this disorder after some painful experiences at work relating to organization/productivity. My psychiatrist told me this is nothing new for him, that he treats several lawyers for ADD and several people in law school. Would LCL be willing to set up a support group for attorney’s with ADD/ADHD?

Yes, we have responded to a number of attorneys and law students with apparent Attention Deficit Disorder, with or without Hyperactivity. We now have monthly meetings for ADHD Support (and regular workshops as well!) As you note, it often comes up around problems with organizing, prioritizing, and completing tasks. A cluster of these and other features, formerly thought of as personal characteristics, have now been re-conceptualized as a disorder, which seems to help people with (1) self-acceptance, (2) finding compensatory strategies and/or avoid certain types of work, and (3) considering interventions including coaching and medications, which for many people reduce the difficulties. LCL is always ready to offer groups to lawyers and law students.

I have always had suspicions of ADHD. Now, that I just received a phone call from the neuropsychologist, it is confirmed that I do indeed suffer from ADHD. What I would like to know is that when I’m done seeing my medical doctor and get the prescription, will I get into law school? The problem I’ve always had is that I did poorly on standardized tests. And so, with the LSAT coming up, I am scoring low as of now and am scheduled to take it October 4th, next Saturday. My doctor, advisor, and mom all told me to cancel the test and take in December. But the personal struggle I’m having is whether I want to take that chance? Will my score go up now that I’m on medication that can help me concentrate? Please help me…I am so confused!

What we don’t know – but you could check with the folks who administer the LSAT – is whether a later, higher score would supercede an initially low score, or whether they would be, for example, averaged. If only the later score matters, then perhaps you have little to lose by taking the exam on October 4. Otherwise, we tend to agree with those who are suggested you postpone it.

There is a good chance, if you have ADHD, that medication will help you stay focused. That may increase your chances of completing more test items and thinking through your answers in a more organized way. But we think it makes sense to take some time to figure out the best dosage, time of day to take the medicine, etc., and to take a number of practice exams while on the medicine. It is also possible that an LSAT preparation course or tutoring would be more helpful to you while on the medication than it might have been before. We also wonder whether, armed with those neuropsychological test results, you may be eligible for certain special considerations, such as extra time to take the test – we know that this is often the case in colleges, and it’s another reason to call the organization that administers LSATs.

Another thing to consider carefully is the extent to which your ADHD would be an ongoing hindrance in the field of law, and what types of law would fit you best. For those kinds of questions, we can probably refer you to an appropriate career consultant. We suggest that you begin by calling us to make an appointment for a (free) initial consultation with one of the LCL clinicians.

I noticed that you have self-tests for addiction and depression on your web site. I found the test on depression particularly helpful. I recently came to suspect that I have adult ADD. I spoke to a psychologist who is a friend of my family and he also believes I have it. I have seen some of the self tests on ADD/ADHD and noticed that some of the symptoms are exactly the same for ADD as for depression. My questions are: 1. How do I know whether I have ADD or simple depression; 2. Is there a self-test for ADD that you’ve found to be particularly good; 3. Is ADD a common problem for attorneys? (if so, how do many of us get through law school without discovering the problem?).

Diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD, often called ADD when referring to the sub-type in which hyperactivity is not prominent) is difficult to diagnose with certainty for a number of reasons. As you mention, its characteristics overlap with other diagnosis – for example, the inattentiveness may resemble the decreased concentration of depression, and the restless energy may resemble manic aspects of a bipolar disorder. In addition, the commonly held notion of what constitutes ADD seems to keep expanding. Not long ago, ADD/ADHD was considered exclusively a childhood condition and thought to be “outgrown.” Now it seems clear that this is not the case. In addition, an argument can be made that designating a cluster of traits as a “disorder” constitutes a kind of “disease-ifying” of characteristics that were previously considered normal variations. People who were formerly considered simply unorganized, “fidgety,” “absent-minded,” etc. may now be classified as having ADD. There are no doubt negative aspects to this development. But on the positive side, certain interventions (for the most, part medication and/or “coaching” and developing compensatory strategies) may truly enhance people’s lives and expand their opportunities.

There is no one scale that serves as a litmus test for ADD. Childhood and family history are relevant. Different people have different kinds of features (so that even lumping them all into the same classification may be somewhat arbitrary). Neuropsychological testing, which is expensive, can be helpful, though not definitive. A relatively new measure, the Conners Adult ADHD Rating Scales (CAARS) is copyrighted and meant for professional use. We often recommend reading Driven to Distraction, a readily available book that captures the syndrome and includes useful checklists. General characteristics include: (a) difficulty staying focused, easily distracted, not completing tasks [except in some cases “hyperfocusing” on something like a project due tomorrow or fast-moving video game]; (b) restlessness/impulsivity/impatience, e.g., can’t sit still, blurting/interrupting; (c) problems organizing, planning, prioritizing (often late and hurried); (d) starting projects and not finishing them. These traits obviously have an impact on relationships, self-esteem, and career.

We have found ADD to be an issue for a surprising number of attorneys seen at LCL. Law school may have provided sufficient structure to allow adequate organization, attention to tasks, etc., though we would suspect that these individuals typically did their academic tasks at the last minute. Since ADD in no way indicates lower intelligence (in fact, many people with ADD seem to be highly creative), some law students may have made up for their focusing and organizing deficits in the quality of their work and class participation.

But new problems may arise once in practice. An attorney in a large firm may find that he/she has to pull many more “all-nighters” than others, for example. More threatening to career, a lawyer in solo practice may miss crucial deadlines, fail to track billable hours or even get around to billing clients, or make critical errors in documents. When such errors reach BBO ears, they are not likely to be considered signs of a disorder so much as signs of professional misconduct. Let us quickly note, however, that probably some of the world’s most successful people have ADD, for example some of the most creative CEO’s – but they also have secretaries or others who do the organizing, prioritizing, and detail work for them. In addition, some of the same lawyers who flounder when it comes to organization may shine in the courtroom or other situations that call for “thinking on your feet.”

Sometimes the bottom line is simply finding out, through trial and error, what kind of treatment actually helps. We recently referred a client for neuropsychological testing, the results of which suggested that he did not have ADD, but rather some kind of learning disability along with some depression. After some contemplation and discussion, we nevertheless referred this lawyer for a trial of stimulant medication, and it helped! As usual, we recommend that you come in for an in-person evaluation, at which we will seek to sort it all out with you.

A client has just filed a complaint about me with the BBO. I can’t blame her, because I allowed aspects of her case slide until it was too late to get her a fair result. To be honest, I’m beginning to recognize a life-long pattern of procrastination and avoidance that has all too often jeopardized my career and created personal problems (i.e., missing IRS deadlines, alienating friends, etc.). I don’t really understand why I behave this way, and my fervent intention to change has proved futile.

Our experience at LCL indicates that this is a very common problem among lawyers, especially those in solo practice who answer only to themselves. It also seems to come up more in certain kinds of cases, e.g., litigation or probate, less so in criminal work which imposes its own deadlines.

Procrastination and avoidance produce a strong and immediate, albeit, short term reinforcement: reduction in pressure and anxiety. But this inclination is usually outweighed by factors such as enthusiasm and the anticipated gratification of accomplishment, making an impact, or just getting the job done. A healthy fear of foreseeable consequences is also a motivator. How many people would finish preparing their income tax returns if they had no fear of the consequences?

Your avoidance could stem from a number of causes. (The crucial factors probably vary from one person to another.) Here is an incomplete list of possibilities:

· Attention Deficit Disorder: There may be difficulties with sequencing, focusing, and prioritizing that are inherent in how your brain is “wired.”

· Depression: The low energy, motivation, concentration, pleasure, etc. of depression can set the stage for neglecting important tasks and, when severe, even basic hygiene.

· Personality features: Low self-confidence, exaggerated anxieties about failure, or fear of making a mistake can all trigger avoidance. Another example is the person with “passive-aggressive” features, who (without realizing it) uses lateness or inaction as an indirect means of expressing anger.

In his book, Do It Now, Dr. William Knaus identifies a variety of “procrastination styles,” such as fantasizing rather than acting, or “drifting” with only vague goals and plans. (This and other relevant books are available in LCL’s library.) Aside from treating underlying conditions such as those listed above, a procrastinator breaks out of such patterns, typically, by scheduling and essentially forcing new behaviors. Changing such behavior is not easy and often benefits from collaboration with someone else, for example, a therapist/counselor, personal coach, or when appropriate an attorney-monitor. LCL can help you better evaluate your problem and can provide you with resources to deal with it.

After reading your June 1997 column, I realized that I probably had Attention Deficit Disorder, and started getting treatment for it (psychotherapy and medicine). This has made a real difference as I am less restless and better able to stay focused. Unfortunately, though, I still forget crucial details, work in a very unorganized way, tend to focus on less important tasks before important ones, and in general, still get into some pretty big messes. If someone could just follow me around all day and keep me organized, I would do just fine. Obviously that can’t happen but do you have any other ideas?

While there is no simple or completely effective fix for Attention Deficit Disorder (ADD) — including the use of medicine and therapy — a new field has evolved of organizational and career “coaches.” Coaches work with all kinds of people who feel the need for assistance in organizing their lives and pursuing goals in a more directed manner. Additionally, some coaches specialize in helping those with ADD.

Although coaches cannot “follow you around” all day, many do their work by phone as needed, so that you can get closer to “real time” input than you can from a therapist. Along with strategies to better organize your work and home life, you might also be assisted and supported in identifying strengths and limitations, obtaining and reviewing relevant testing, and making longer range plans.

Career coaching is a still emerging field but LCL has assembled a working list of career/ADD coaches. We recommend first meeting with a staff clinician for an evaluation to confirm the nature of the problem and formulate a more comprehensive set of recommendations. You can also get information from a referral service provided by the International Coach Federation of New England, whose president can be reached at 978/692-4454.