The Hallowell-Ratey Criteria for ADD

 The Hallowell-Ratey Criteria for A

DD

from page 14 of Thom Hartmann's Complete Guide to ADHD

 

 

In 1992, psychiatrists Edward M. Halowell and John J. Ratey developed, through years of clinical practice, study, and observation, their own set of criteria for spotting probable ADD, particularly in adults. While this isn't an "official" set of diagnostic criteria, since its first appearance in their book Driven to Distraction it has become both lay people and clinicians measure the probably of a person having ADD.

 

In publishing this, they added this caveat: "The following criteria are suggested only. They are based upon our clinical experience and constitute what we consider to be the most commonly encountered symptoms in adults with Attention Defict Disorder. These criteria have not been validated by field trials, and should be regarded as only as a clinical guide. Consider a criterian as met only if the behavior is considerably more frequent than that of most people of the same mental age."

According to Hallowell and Ratey, ADD may be present when we see a chronic disturbance in which at twelve of the following criteria are present (quoted from Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood [Simon & Schuster, 1995] with the kind permission of the authors):

 

 

 

1. A sense of underachievement, of not meeting one's goals (regardless of how much one has actually accomplished).

We put this symptom first because it is the most common reason an adult seeks help. "I just can't get my act together" is the frequent refrain. The person may be highly accomplished by objective standards, or may be floundering, stuck with a sense of being lost in a maze, unable to capitalize innate potential.

 

2. Difficulty getting organized.

Organization is a major problem for most adults with ADD. Without the structure of school, without parents around to get things organized for him or her, the adult may stagger under the organizational demand of everyday life. The supposed "little things" may mount up to create huge obstacles. For want of the proverbial nail -- a missed appointment, a lost check, a forgotten deadline -- their kingdom may be lost.

 

3. Chronic procrastination or trouble beginning a task.

Often, due to their fears that they won't do it right, they put it off, and off, which of course, only adds to the anxiety around the task.

 

4. Many projects going simultaneously; trouble with follow-through.

A corollary of #3. As one task is put off, another is taken up. By the end of the day, week, or year, countless projects have been undertaken, while few have found completion.

 

5. Tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark.

Like the child with ADD in the classroom, the adult with ADD gets carried away in enthusiasm. An idea comes and it must be spoken; tact or guile yields to childlike exuberance.

 

6. A restive search for high stimulation.

The adult with ADD is always on the lookout for something novel, something engaging, something in the outside world that can catch up with the whirlwind that's rushing inside.

 

7. A tendency to be easily bored.

A corollary of #6. Boredom surrounds the adult with ADD like a sinkhole, ever ready to drain off energy and leave the individual hungry for more stimulation. This can easily be misinterpreted as a lack of interest; actually it is a relative to sustain interest over time. As much as the person cares, his battery pack runs low quickly.

 

8. Easy distractibility, trouble focusing attention, tendency to tune out or drift away in the middle of a page or a conversation, often coupled with an ability to hyperfocus at times.

The hallmark symptoms of ADD. The "tuning out" is quite involuntary. It happens when the person isn't looking, so to speak, and the next thing you know, he or she isn't there. An often extraordinary ability to hyperfocus is also unusually present, emphasizing the fact that this is a syndrome not of attention deficit but of attention inconsistency.

 

9. Often creative, intuitive, highly intelligent.

Not a symptom, but a trait deserving of mention. Adults with ADD often have unusually creative minds. In the midst of their disorganization and distractibility, they show flashes of brilliance. Capturing this "special something" is one of the goals of treatment.

 

10. Trouble in going through established channels, following proper procedure.

Contrary to how it often appears, this is not due to some unresolved problem with authority figures. Rather, it is a manifestation of boredom and frustration: boredom with routine ways of doing things and excitement around novel approaches, and frustration with being unable to do things the way they're supposed to be done.

 

11. Impatient; low tolerance for frustration.

Frustration of any sort reminds the adult with ADD of all the failures in the past. "Oh, no," he thinks, "here we go again." So he gets angry or withdraws. The impatience has to do with the need for stimulation and can lead others to think of the individual as immature or insatiable.

 

12. Impulsive.

Either verbally or in action, as in impulsive spending of money, changing plans, enacting new schemes or career plans, and the like. This is one of the more dangerous of the adult symptoms, or, depending on the impulse, one of the more advantageous.

 

13. Tendency to worry needlessly, endlessly; tendency to scan the horizon looking for something to worry about alternating with inattention to or disregard for actual dangers.

Worry is what attention turns into when it isn't focused on some task.

 

14. Sense of impending doom, insecurity, alternating with high-risk-taking.

This symptom is related to both tendency to worry needlessly and the tendency to be impulsive.

 

15. Mood swings, depression, especially when disengaged from a person or project.

Adults with ADD, more than children, are given to unstable moods. Much of this is due to their experience of frustration and/or failure, while some of it is due to the biology of the disorder.

 

16. Restlessness.

One usually does not see in an adult the full-blown hyperactivity one may see in a child. Instead one sees what looks like "nervous energy:" pacing, drumming of fingers, shifting position while sitting, leaving a table or room frequently, feeling edgy while at rest.

 

17. Tendency toward addictive behavior.

The addiction may be to a substance such as alcohol or cocaine, or to an activity, such as gambling, or shopping, or eating, or overwork.

 

18. Chronic problems with self-esteem

These are the direct and unhappy result of years of conditioning: years of being told one is a klutz, a space-shot, an underachiever, lazy, weird, different, out of it, and the like. Years of frustration, failure, or of just not getting it right do lead to problems with self-esteem. What is impressive is how resilient most adults are, despite all setbacks.

 

19. Inaccurate self-observation

People with ADD are poor self-observers. They do not accurately gauge the impact they have on other people. This can often lead to big misunderstandings and deeply hurt feelings.

 

20. Family history of ADD or manic-depressive illness or depression or substance abuse or other disorders of impulse control or mood.

Since ADD is genetically transmitted and related to the other conditions mentioned, it not uncommon (but not necessary) to find such a family history.

 

In addiction to requiring 12 out of 20 hits on this test, Drs. Hallowell and Ratey add that these characteristics must include a childhood history of similar behaviors and not be explainable by other medical or psychiatric conditions.

 

The DSM says a psychiatric diagnosis isn't warranted unless something's wrong -- unless there's some significant impairment of a major life function. My friend and editor, Dave deBronkart, found that he meets the criteria for ADD on above tests. When he told an ADD expert that he was quite successful in his life nonetheless, the unfortunate response was, "You probably have something wrong with you and don't even know it."