Q: As a recent law school graduate, I am wondering if I might
have Adult ADHD (Attention Deficit/Hyperactivity Disorder), and if
it might account for what seems like a pattern of "sloppiness" that
has been interfering with both my current job (not as a lawyer) and
my attempts to get a job commensurate with my skills. A close
friend, who has long been diagnosed with ADHD, suggested to me that
I may have it too, based on my way of operating (constant sloppy
mistakes and distraction, getting sidetracked and not finishing
things, dating back to childhood). I brought it up with my primary
care doctor, who sent me to a psychiatrist, who in turn referred me
to a psychological assessment clinic that wants more than $2,000 to
give me neuropsychological testing, which my health insurance will
not cover. I really cannot spare this kind of money; my friend says
he never had to do this. My doctor seemed angry when I asked for a
way around it. Any ideas?
A: As you know, ADHD (which may be characterized by inattention,
hyperactivity or both) begins in childhood and, we now know, often
persists into adulthood. How it presents itself can differ
considerably from one person to another, but the kinds of features
you describe certainly can be indicative of ADHD. Many useful books
on the topic, geared toward a wide audience, have been published,
including the early and widely read Driven to Distraction;
another very clearly written book that can be helpful with
diagnosis and seeking appropriate treatment is More Attention,
Less Deficit. Although people with ADHD face particular
obstacles, they are also often quite creative, and good at thinking
on their feet or outside the box (indeed, often they are not
inclined to think inside the box at all).
Although some providers are inclined to view neuropsychological
testing as the litmus test for ADHD, many others believe that this
kind of testing can miss ADHD (though it is extremely helpful in
diagnosing a number of cognitive/neurological conditions); a
thorough and detailed history may actually be most useful. When
money is short and managed care rules out coverage, testing would
be quite an expensive way to go.
Your primary care physician does have reason to be cautious
about too easily launching into medication treatment (generally
with stimulants), since the condition is widely over-diagnosed and
stimulants can be used inappropriately (for example, by students
seeking an edge to study for exams though they do not actually
suffer from attention problems). But, again, a careful history
taken by a knowledgeable psychologist or psychiatrist may be the
best way to determine who is an appropriate candidate for
treatment.
If a physician (typically a psychiatrist) does decide to
prescribe, it should become evident fairly soon whether the
medication is making a big difference, and also whether it elicits
side effects (such as a mood "crash" when it wears off, or undue
anxiety) that may outweigh any helpful effects. (In the latter
case, there is more than one medicine to try.) But we have seen
some lawyers show marked improvement in their work product (e.g.,
many fewer errors in document details) upon initiation of a regime
of ADHD medication.
Medication is not, however, the only intervention that can help.
ADHD-oriented coaching (techniques for staying more organized,
prioritizing, etc.) is another powerful tool. An ADHD diagnosis can
also be more consciously taken into consideration in career
planning -- some jobs, for example, have a much more here-and-now
quality, and less emphasis on paperwork or extended tasks, and can
be a better choice. In addition, an administrative assistant with
very good organizational ability can be worth his or her weight in
gold. Newer treatment techniques involving technology, such as
neurofeedback, are also showing promise.
LCL staff would be glad to help you seek a helpful approach --
give us a call.
Dr. Jeff Fortgang is a licensed psychologist and licensed
alcohol and drug counselor on staff at Lawyers Concerned for
Lawyers of Massachusetts, where he and his colleagues provide
confidential consultation to lawyers and law students, and offer
presentations on subjects related to the lives of lawyers. Q&A
questions are either actual letters/emails or paraphrased and
disguised concerns expressed by individuals seeking LCL's
assistance.