What's in an acronym?
Many people are affected by symptoms of attention deficit hyperactivity disorder (ADHD), anxiety and depression. These conditions are described at great length in the current version of the Diagnostic and Statistical Manual (Fifth Edition, 2013). While these descriptions are quite inclusive, it can be difficult to remember all of the symptoms in a short-form version that everyone understands.
For example, this has led to an acronym such as SIGECAPS for depression. This is often used by clinicians as an easy way of remembering important symptoms of depression. It also makes it much simpler for all of us to understand the symptoms of depression without resorting to a clinical textbook.
The core symptoms of adult ADHD are also easy to remember with the acronym FAST MINDS:
The F stands for forgetfulness (short-term memory), A is aptitudinal underachievement, S is stuck, T is time challenged, M is motivationally challenged (procrastination), I is impulsive, N is novelty seeking, D is distractible and S is scattered.
Adults on a daily basis may be challenged by FAST MINDS traits. If FAST MINDS is a good way to remember symptoms of adult ADHD, is there an even shorter version that people can use to quickly recognize whether they may or may not have this condition?
We could all have some of these traits, but the difference with ADHD is that there must be two areas of impact in a person's life to qualify for the diagnosis.
A simpler way to help with recognition of ADHD symptoms is what I call the PDF for adult ADHD. Many people who come to us who feel that they may have ADHD describe longstanding difficulties with procrastination, distractibility and forgetfulness (PDF). It takes only a matter of minutes to discuss a person's version of the PDF and the context for where the symptoms come and go in a person's life.
Often adults will describe situations where they feel less interested, perhaps a little bored, and then they become more prone to procrastination, distractibility and forgetfulness. Against this, adults can often focus much better in novel stimulating situations, and in this way ADHD may be viewed as an "engagement deficit" condition depending on the context.
We could all have some of these traits, but the difference with ADHD is that there must be two areas of impact in a person's life to qualify for the diagnosis. This criterion for the diagnosis is often misunderstood. Examples of procrastination include putting off important day-to-day functions, often resorting to last minute strategies.
Procrastinating on bills and taxes occurs often. Not following through on promises to a partner so that chores and work around the house do not get done commonly leads to marital strife. Like all PDF symptoms, there is a lifelong natural history for procrastination; not doing homework until the night before and avoiding responsibilities around the house will have this chronic pattern.
With distractibility, people describe their minds wandering or beginning to half listen when they do not feel engaged in a topic that does not interest them. This could take the form of a conversation with someone's partner or during a lecture where the material or the speaker is not felt to be interesting or stimulating.
It is not that people "zone out" in the sense that they are not thinking about anything; they are often thinking about more interesting things. Adults will describe often having many thoughts going on at the same time. The second type of distractibility happens when a person is trying to concentrate, for example, sitting in a university or college lecture, but things around them like loud conversations, computer screens and so forth distract them from what is going on.
Adults with ADHD will remember that as children in elementary school, they often looked out the window or watched the clock and maybe doodled or daydreamed while the teacher talked about something at the front of the class.
The final symptom of PDF is forgetfulness, which refers to short-term working memory, or the ability to hold onto information, to comprehend something that we read, solve a problem, memorize something, etc.
While people with adult ADHD can have very good remote memories, they would have much more difficulty remembering something that their partner told them about an upcoming event, six things from the store, etc.
They often compensate by having to write things down or have lists written for them (which also creates stress in a relationship). This compensatory measure may make them look as if they actually do not have a poor memory, but when you take away all of the strategies, lists and a supportive partner, the memory difficulty becomes much more evident.
Lifelong PDF symptoms of adult ADHD are subtle and certainly less graphic than anxiety or symptoms for depression. It helps during an evaluation for ADHD to interview a significant other who can offer a 360-degree perspective of a person's life and impact of symptoms to help with this diagnosis.
So, if you have a positive PDF profile that has been lifelong and you have a couple of areas where it has significantly impacted on your life, it might be helpful for you to go to your doctor and see if you do have adult ADHD. A very helpful rating scale that you can use for it is the World Health Organization's ASRS, which you can check online, download and take to your doctor.
If you need further assistance, there are usually local specialists who can provide support in making the diagnosis. There are many services available to you that make a real difference in your life.
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"I'm so scatterbrainedI must have ADHD." It's a lament that doctors like Michael Coates, MD, are hearing more and more from adult patients, many of whom assume medication is the answer to their woes. Yet most people don't have ADHD, nor do they need a pill, says Coates, who chairs the Department of Family and Community Medicine at Wake Forest School of Medicine. "What they need is a better routine." In fact, only about 4.5 percent of American adults are estimated to have ADHD, according to a report in the American Journal of Psychiatry. For the rest of us, feeling unfocused is not the result of a disorder or even a personality trait -- it's simply a habit. "There's never been another time in history when there was so much to be distracted by, and all our technology reinforces the feeling that you're missing out on something if you're not able to pay attention to a bunch of things at once," says Charles Folk, PhD, director of the cognitive science program at Villanova University. To regain your focus, a few tiny lifestyle tweaks may be all you need.
If you rely on triple lattes to pay attention, you'll likely find it harder to focus when you're not buzzed. "Your brain will begin to operate as though it requires caffeine to be alert," explains Coates. A more effective stimulant: exercise. Physical activity has been shown to sharpen focus, in people with ADHD and without, possibly because it can help trigger the release of chemicals in the brain that are thought to affect learning and memory. One report from the University of Illinois at Urbana-Champaign suggests that aerobic exercise in particular may improve immediate and long-term functioning in regions of the brain relating to attention.
A 2012 study in The Journal of Nutrition found that mild dehydration (so subtle that you don't really feel it) can lead to inattention. When women were less than 2 percent dehydrated (in this case, from not drinking enough water after exercise), their ability to concentrate on a series of cognitive tests was impaired. "When the brain detects even the smallest changes in physiology, it may begin operating at a suboptimal level to get your attention," explains study coauthor Harris Lieberman, PhD, a research psychologist at the U.S. Army Research Institute of Environmental Medicine. "Thirst is not the best measure of hydration, so a decrease in your ability to focus is an early warning signal that it's time to drink up."
"When a patient suspects she has ADHD, one of the first things I investigate is her sleep routine," says Vatsal G. Thakkar, MD, clinical assistant professor of psychiatry at New York University School of Medicine. "The inability to concentrate is often caused by a lack of delta sleep." Thakkar is referring to the slow-wave stage that precedes REM sleep; it's the time when the brain powers down, and some evidence suggests it's the period in which certain cognitive functions consolidate and strengthen. "If you're regularly dipping below seven hours, you're likely cutting into the delta phase, and this can make it difficult to focus when you're awake," says Thakkar. His Rx: Get a solid seven to nine hours a night for at least two weeks. If your concentration doesn't improve, see a sleep specialist to determine if an undiagnosed disorder like sleep apnea might be to blame.
Ever catch yourself nodding along absentmindedly during a conversation as your brain flits to a million other things? "The frenetic nature of our society -- constant updates via e-mail and Twitter, for example -- provides some sort of excitement every few minutes, and we've become trained to expect that," says Olivia Fox Cabane, author of The Charisma Myth. "If we're not stimulated after a short period of time, we look around for something that will do the job. This is true whether we're reading a dull news story or involved in a conversation." To be a more attentive listener, Cabane recommends taking a moment to focus your attention on your toes. This mindfulness trick will instantly bring you back to the present -- right where you belong.
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