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.