POST 50
01/19/2012 08:26 am ET Updated Jan 19, 2012

Adult ADD/ADHD: Where Did All the Squirmy Kids Go?

Even when Tillie Feldman of Los Angeles was a child, she knew she was different than other kids. She feared nothing, showed no deference to authority at school, and lacked self-control -- especially when it came to making outbursts. If you are a Post 50er, you probably knew someone like her in grade school: the unruly kid who couldn't sit still.

The teacher would say he had "ants in his pants" and seat him way in the back to minimize his constant disruptions to the class. He was the wild kid who was sent to the principal's office a lot for pushing on the playground and throwing food in the cafeteria when everyone knew you don't do stuff like that. Never mind that he never completed assignments on time.

Today, the medical community has names for kids whose behaviors follow those patterns. They say the child has either attention deficit disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD). And while the pharmaceutical industry has risen to the profitable occasion of treating them with stimulant drugs that work to sharpen focus, there is still much debate whether ADD and ADHD labels are too over-zealously slapped on kids who struggle in school.

But at least there is debate. When it comes to these same behaviors in the boomer community, there is little conversation about what happened to the Tillies of the world.

How did boomers who suffered with these problems in childhood fare as adults? And are they getting medicated now too?

According to Dr. Lawrence Diller, who wrote the seminal book "Running on Ritalin," nobody really knows. Nobody really even knows how those more-recently diagnosed ADD and ADHD kids who grew up in the early 1990s (when the diagnoses were first being made) are faring. "Some -- the seriously impaired ones --are undoubtedly in jail," said Diller. That's where lack of impulse control and not fearing consequences generally lands you.

Diller, who practices behavioral pediatrics in California and is an assistant clinical professor at the University of California, San Francisco, tracks about a dozen of his former child patients and says there is a university-backed program that tracks another 140. All totalled, there have been followups of "maybe 400" people diagnosed as a child with a medical problem that some studies claim affects 10 percent of the population.

So the bottom line is, we don't really know whether ADD and ADHD is something that fades or worsens with age. Nor do we know how those squirmy kids in the back of the room in 1960 wound up functioning as adults. But we all know adults today who fit the pattern.

It's the spouse who can't finish tasks, loses things constantly, can't organize his day or keep track of things. Bills don't get paid on time, routine maintenance around the house doesn't get done; they bring in the mail but get distracted and don't open it -- and then forget where they put it down. They are incapable of putting their car keys in the same spot when they walk in the door. In some cases, they walk away and begin doing something else in the middle of a conversation. The kid who takes off his shoes and can't remember where he put them is likely still doing that now as a grown man. But do you medicate for absent-mindedness?

"It's all a matter of degree," said Diller. Because the most popularly prescribed amphetamine drugs for the treatment of ADD and ADHD are controlled dangerous substances, Diller no longer accepts adult patients seeking ADD or ADHD treatment if he doesn't already know the person. Which means that about the only new adult patients he treats for ADD or ADHD are the parents of his child patients.

There's another reason why he is reluctant to treat adult ADD and ADHD patients. "I don't know what I'm doing anymore," said the guy who one of the world's leading authorities on the subject with more than a little exasperation in his voice.

The publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in May 2013 is one the most anticipated events in the psychiatric world, and one of the things the new manual will do is separate ADD from ADHD. There will presumably be new guidelines for diagnosis and treatment, instead of the guessing game that occurs now, said Diller. The vast bulk of adults with this problem have the inattentive form, not the hyperactive impulsive form. We've conflated the two conditions, says Diller, when the only characteristic they share is the universal response to amphetamines.

Meanwhile, there are an awful lot of unfocused adults walking around. And as for how the adults with ADD and ADHD function, it's kind of a mixed bag. Diller says that while schools make accommodations for children with ADD and ADHD -- a quiet distraction free place for test-taking, extended time on tests -- there have been no workplace accommodations for adults with these disorders ala the Americans With Disability Act.

"What would that even look like?" Diller ponders. "Being given a quiet office to minimize your distractions and being allowed extra time to complete tasks?" Not very realistic.

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