Alice, Lost & Found

The sofa would be comfortable if only it didn’t have all those books, dishes, and DVDs covering the surface. Alice sweeps everything to the floor and stretches out within the soft green leather. She plays video games for a living—that is, she earns a six figure salary as a video game tester. After a non-stop workday of twelve hours, she is exhausted, yet unable to sleep as her brain is still on fire.

After an hour of rest, she rolls off the sofa, changes into dancing clothes and is out until 3am. When she shows up at work at 10 AM the next day, she has a hangover, but she will work late into the evening and then be out again until early morning. This is a normal pattern of life forAlice, and she is fortunate to have a job that allows for it. These unhealthy patterns in her work, social life, and sleep are typical for many professionals in their 20s, but Alice is 37 years old.

Her impulsive lifestyle extends to other areas of her life. Despite a weekly maid service, her place often looks like it has been struck by a tornado. This problem is exacerbated by the fact that she buys new clothes, shoes, and jewelry almost every week and is running out of space to put them. With dwindling savings and escalating credit card debts, Alice is aware that her lifestyle is not sustainable. She is unable, however, to modify her impulsive behavior in order to improve her finances and living conditions.

From an outsider’s perspective, Alice is an attractive, successful, and energetic woman. Her friends describe her as brilliant, impulsive, restless, funny, and kind. Nonetheless, they all complain that she never shows up on time. Her ex-boyfriends would probably say that she has poor listening skills and is quick-tempered. Despite having many friends, she is unable to develop lasting and intimate connections. Consequently, she has no close friends, has a superficial relationship with her parents and siblings, and her romantic relationships do not last beyond a few months.

Alice feels that she is always in a state of perpetual overdrive, yet unsatisfied.  She likes her job and is productive, but she often misses deadlines. The late-night dancing and drinking is emotionally unfulfilling. She fills her free time with shopping sprees which provide the instant gratification she craves but which have left her in debt. She is unable to organize her apartment, and the mess makes her feel overwhelmed. She realizes that this is not the life she wants, yet she feels helpless in her ability to change her patterns of behavior.

After an unusually heavy night of partying, Alice takes three sleeping pills instead of the usual one. She wakes up in the afternoon, shows up to work at 5 PM, and almost loses her job. This is a turning point for her. She takes the first step towards a better life and finds a therapist, which leads to a surprising discovery. Alice has ADHD: Attention Deficit Hyperactivity Disorder, also known as ADD. Her doctor also tells her that she is very fortunate to have found a job playing video games, because that is one of the few activities where an ADHD brain is able to focus for long periods of time.

Neurobiology research has discovered that an ADHD brain is sluggish in the part of the frontal lobe that controls impulses. The primary chemical implicated in the existence of this lack of activity is dopamine. Prescription drugs like Ritalin®, Adderall®, and Dexedrine® can be used to help the brain release more dopamine. This extra dopamine helps control the impulsive behavior which often leads to the other behavior problems associated with ADHD.

Medication does not work for everyone, but it is helpful for the vast majority of people with ADHD. Some ADHD symptoms often exist in people who do not have this disorder. Therefore, it is important not to self-diagnose. A critical part of ADHD diagnosis is that this disorder causes frustrating inability to function in two or more important areas of life such as education, work, finances, and relationships. Alice has started to take a medication that works well for her, and she is learning more about the disorder. Her therapist is helping her to learn and apply time and money management skills. Alice has also joined a support group for adults with ADHD. Medication itself is not sufficient; behavioral modifications and other therapies are also recommended to manage ADHD.

Attention Deficit Hyperactivity Disorder is a controversial subject. The medications have been overprescribed and abused, despite the possible side effects of high blood pressure and increased risk of heart attack and stroke. Some medical professionals doubt whether ADHD is a real disorder, even thought it has been formally recognized by the American Psychiatry Association. Thus, further research is important for understanding the neurological basis for ADHD.

As far as Alice is concerned, it is a very real disorder because her medication has started to make a significant difference in her life. She is making an effort to prioritize her work tasks, has cut down on her clubbing and shopping, and her apartment is slightly more organized than before. It will take some time to improve her anger management and listening skills but the awareness of the disorder combined with a better-functioning brain is a good starting point for her.

Leena Prasad has a writing portfolio at http://www.FishRidingABike.com. Links to earlier stories in her monthly column can be found at http://www.WhoseBrainIsIt.com.

Dr. Nicola Wolfe is a neuroscience consultant for this column. She earned her Ph.D. in Clinical Psychopharmacology from Harvard University and has taught neuroscience courses for over 20 years at various universities.

References:

1. Ratey, John J. Md; Hallowell, Edward M. Md (2011-09-13). Driven to Distraction (Revised): Recognizing and Coping with Attention Deficit Disorder. Random House
2. Boyle, Mary ET, Ph.D., Neuroscience of ADHD. Department of Cognitive Science UCSD.