Adult Attention Deficits – The Psychiatrist as Detective

There has been increasing interest in adults with attention deficit problems in both the popular press as well as the psychiatric literature. Some of this results from a greater awareness that the attentional deficits of childhood often persist into adulthood; while other aspects relate to a pervasive anxiety over the need to perform at ever higher levels in the workplace, given the Great Recession and its attendant job loss and painfully slow recovery.

Symptoms such as trouble sustaining attention, being easily distracted by internal or external stimuli, trouble staying on task, jumping from one task to another without completion, procrastination, problems with organization, difficulty focusing and executing on tasks particularly when they are boring, fidgeting, frequently being in motion, and interrupting others while they are speaking, are among the hallmarks of classic adult attention deficit disorder.

However. a note of caution is in order, given the risk that “Adult ADD” may become over-diagnosed, and stimulants may become over-prescribed, much in the same fashion as childhood ADD. It is important to recognize that there are many causes of disrupted attention in adults that bring about symptoms similar to adult ADD, but have differing origins and treatments. A careful diagnostic assessment is in order.

Attentional problems can result from a number of conditions including: anxiety disorders, ranging from OCD to recurring panic attacks; certain prescription and non-prescription medications; vitamins, supplements and nutriceuticals; concussion and/or whiplash injuries; alcohol abuse; use of marijuana, and other illicit drugs; sleep apnea syndrome; thyroid disorders and other hormonal or metabolic disorders; lead, or other heavy metal intoxication; overexposure to pesticides; vitamin deficiencies; mood disorders; petit mal or partial complex seizures; or other conditions.

The optimum approach to determine a correct diagnosis and treatment plan is called the BioPsychoSocial Model. Only through a careful history of potential biological, psychological, and social/environmental factors can the various contributors to attentional problems in adults be delineated and addressed. Sometimes it is helpful to bring in a spouse or significant other to corroborate symptoms, or to detect the subtle gazing spells that characterize petit mal or partial complex seizures.

Ultimately, the correct diagnosis and initiation of successful treatment can bring to a close years of frustration, demoralization, despair, and anxiety over these attentional problems and their destructive effects on self esteem, important outside relationships; and one’s relationship with oneself. A new chapter may begin, characterized by greater personal fulfillment, and a richer awareness of a life that was previously overlooked.