Forbes: Adults With ADHD

A growing population of adults is being diagnosed with attention deficit hyperactive disorder. Bosses and workers are seeking ways to cope.

On a Friday evening in September Deborah Hoyt, a 46-year-old chief financial officer of a fund-raising organization in Atlanta, sat at her desk frustrated with a financial analysis, still tackling other tasks. "My brain was in total meltdown," says Hoyt. She gave up 15 minutes later, only to walk through a fog of self-doubt on Saturday. She could not get the numbers swirling through her head to make sense. Finally, early Sunday morning, with Saturday Night Live on in the background, the pencil hit paper.

This kind of frustrating paralysis followed by flashes of insight is common for Hoyt. Five months ago she was diagnosed with adult attention deficit hyperactive disorder (ADHD), an affliction that hits 3 percent to 7 percent of U.S. adults. Hoyt now takes one pill a day, a potentially addictive stimulant called Concerta, to help her run the finance and administrative functions of a 50-person company. "I'm working on many things at one time," she says, echoing the mantra of the afflicted.

Read tips on dealing with ADHD.

ADHD, long associated with boys who say and do whatever comes to mind, has been recognized among adults only in the last 10 years. The people who make a career of treating this problem will tell you that only 20 percent of adults with ADHD know they have it. (The disorder used to go by the shorthand ADD, but ADHD is now its official name.)

As with children, adults with ADHD range from the mildly affected, inattentive employee who needs constant reminders to keep from missing deadlines and meetings to the severely inattentive hyperactive who flies out of the office in a tantrum. Without treatment the acutely afflicted fail to divide work from home life, winding up losing both their jobs and marriages.

Misdiagnosis is common, as psychiatrists sometimes mistake ADHD's symptoms for depression or anxiety. And ADHD adults, notoriously bad self-reporters, often don't see their shortfalls. Oddly enough, ADHD can be a performance booster, as those afflicted can concentrate and work nonstop for hours when they are vitally interested. Studies cited in the Journal of the American Medical Association found that one-third of ADHD adults become entrepreneurs by their 30s. One case in point is JetBlue's idea-spinning chief executive, David Neeleman, who has admitted to having ADHD, though he no longer discusses it in interviews.

As adult ADHD has come into sharper focus, the disorder has become a growth business. Drug sales are booming, as is the nascent industry of workplace coaches. Sales of medications for the child and adult markets were $1.7 billion in 2002, up 39 percent over 2001, according to IMS Health. This year's numbers will likely exceed that by 50 percent. And the percentage of adults on ADHD meds went from 11.4 percent in 2002 to 19 percent in 2003.

Ritalin gets all the headlines as the drug for the treatment, or overtreatment, of ADHD, but it is no longer the market force it once was. Sales have fallen, from $260 million in 1998 to $54 million last year. Those sales have been more than made up for by newer ADHD drugs. The top three are powerful stimulants: Alza's Concerta, Shire's Adderall and Cephalon's Provigil. They're followed closely by Strattera, Eli Lilly's new pill that was the first nonstimulant approved for adult use by the Food & Drug Administration. Strattera has captured 13 percent of the market since its debut in January.

ADHD's causes are still being determined, but they are likely genetic. A link has been found between ADHD and faulty regulation of dopamine, a brain neurotransmitter regulating movement and emotional response. Low dopamine activity may cause undiagnosed ADHD sufferers to self-medicate, first with sugar in childhood, then with caffeine, cigarettes or cocaine — whatever helps them focus. Stimulants such as Concerta and Adderall keep dopamine in the brain synapses longer, but these pills can be addictive. Strattera takes a slightly different approach:preventing the reuptake of norepinephrine, another neurotransmitter in the brain.

Like depression or anxiety, ADHD is often a closet sickness. Deborah Hoyt told her employers only recently, after 10 years on the job. Most big companies, like Ford Motor, have tucked confidential counseling for their employees with ADHD into their employee-assistance programs.

For others, a cottage industry of some 1,000 ADHD coaches has sprung up in response. Coaches are something like long-distance pseudotherapists who understand the ADHD mind. Phone sessions cost between $50 and $400 an hour but aren't covered by insurance. No standards or guidelines yet exist for coaches to live up to, and the coaching process can last for weeks or months. David Giwerc, a former Young & Rubicam marketing director, was diagnosed with ADHD in 1994 while training as an executive coach. He tells clients to find work that gets them moving around, to guard against the tendency to reply to every last e-mail or voice mail, and, as he does, squeeze a grip ball to stop from interrupting people on the phone.

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