Long article behind a cut

[grinninfoole]

Millari read me a long article from the NY Times about ADD this evening. I find it quite depressing. The people and their stories were all familiar. The main difference between them and me is that I haven't had a ton of jobs, and I haven't ever been fired, but that's a reflection of my avoidance of employment as much as anything. I find it really hard to read about people trying to make something of their lives and stumbling over the same damn obstacles all the time, just as I do. It's stirred up my big fear of not doing anything worthwhile with my life. Millari has helped me to cheer up a bit, happily. I shall now go and shower and shave, so I am ready for work tomorrow--might as well do something right.


Anyway, it's a well-written article, if long, so if you are curious about adult ADD and have 10 minutes, read on.



July 18, 2004
By LISA BELKIN



When Vivienne Sales finally broke her silence, she did so
loudly, losing her temper in the hushed library where she
worked. It was August 2003, and she had been hanging on to
her job as a reference librarian by the most fragile of
threads. For more than a year her supervisors at the
Embry-Riddle Aeronautical University in Prescott, Ariz.,
had been warning her that she was sometimes sloppy and
inaccurate. She was late for work too often, they said. She
didn't dress neatly and appropriately. Her desk was always
a mess.

Sales knew all this. She also knew why. Three years
earlier, when she was 36, she was told she had
attention-deficit and hyperactivity disorder. (That's the
full name of the condition, and while its initials are
technically a.d.h.d., not all who have it exhibit the
hyperactivity symptoms, so it is often referred to
conversationally as simply A.D.D.) The news was a relief
because it seemed to explain everything -- why she rarely
seemed to fit into a workplace, why she left nine different
jobs in 1999 alone, why, despite two master's degrees and
years of dogged hard work, she never seemed to get
anywhere.

Although the diagnosis was illuminating, Sales was
determined to keep her condition to herself. ''Work isn't
like school, where they have to give you more time on the
tests'' if you have A.D.D., she explained. ''In the real
world, if you tell during the interview, they won't hire
you. And if you tell after you're hired, they can fire
you.''

That's not a precise reading of the law, but it is an
accurate reading of the stigma, and of the dilemma that
will probably become more common in the coming years. First
there was A.D.D. in children, and the debate over whether
too many are being medicated for what is arguably normal
behavior. Now that conversation has widened to include
adults. Psychiatrists used to assure parents that A.D.D.
was something their children would outgrow, but more recent
research shows that the disorder is longer-lasting than
originally thought. A.D.D. does not develop in adulthood,
but neither does it always disappear after childhood.

Instead, up to 60 percent of children with A.D.D. grow up
to be adults who still have A.D.D., and experts estimate
that more than eight million grown-ups in the United States
have the disorder. These numbers, presented by researchers
from Harvard and the World Health Organization at the
annual meeting of the American Psychiatric Association this
spring, mean that attention-deficit disorder affects 4.4
percent of the adult population, making it the
second-most-common psychological problem in adults after
depression.

A mere 15 percent of those eight million actually know they
have A.D.D., however, and they have learned that fact
recently -- within the last decade, give or take -- because
psychiatric textbooks didn't even recognize adult A.D.D. as
an official diagnosis until 1987. Now that A.D.D. is an
accepted part of the psychiatric repertory, however,
doctors are seeing a surge in adults looking for a label
for their lifelong restlessness. And just as the rise in
the number of children given a diagnosis of A.D.D. brought
measurable change to the world of education, the wave of
adults with the same constellation of quirks and needs is
affecting the world of work.

''A.D.D. makes work more complicated,'' said Harold Meyer,
whose organization, the A.D.D. Resource Center, in
Manhattan, advises both employers and employees on how to
manage the condition in the workplace. Already employers
are expected to be exquisitely sensitive -- granting
maternity, paternity and adoption leave; subsidizing
programs for weight loss and smoking cessation; providing
domestic-partner benefits; adapting physical space for
every category of handicap; allowing for flextime,
telecommuting and job sharing. Adding yet another
responsibility -- and particularly for a syndrome whose
symptoms look suspiciously like bad work habits -- creates
some skepticism. Meyer is regularly invited to address
large companies, and whenever there are ''15 or 20 managers
in a room, they all think they have employees with A.D.D.,
and they don't know what to do about it,'' he said. ''They
want to help. But they also ask: 'Is it real? Or an
excuse?'''

Cheryl Moreno, a manager of human resources at
Embry-Riddle, who has spent months working with Vivienne
Sales, trying to save her job, said she feels the same tug
-- a desire to do the right thing mixed with frustration.
''We're feeling our way here,'' she said. ''Years ago this
wasn't on the radar. Now we're seeing more of it. There's a
climate here for helping people with impairments,'' she
continued, ''but sometimes the impairments are too great.''


It was Moreno, in fact, who inadvertently led Sales to
reveal her diagnosis last summer. Sales's job description
included being backup for the specialist in charge of
interlibrary loans, but she said she felt shaky in that
role and had been told during her training for it that she
had an ''accuracy problem.'' As it happened, Moreno needed
to borrow a book from another library, and she came in on a
day when the interlibrary-loan specialist was out. Sales
said she is certain that she entered that request into the
computer and also printed out a copy for the specialist's
records. But when Moreno returned to pick up her book a few
weeks later, it wasn't there. Neither was the paperwork,
nor any record in the computer.

What resulted was a heated argument between Sales and the
specialist who ran interlibrary loans. It ended with Sales
sending a memo to her supervisor saying that she had a
''documented disability'' and was requesting an
''accommodation plan.''

''My decision to come out of the closet was one of
desperation,'' Sales told me. When she speaks, her head
darts in a nervous, birdlike way, her eyes magnified behind
glasses that constantly slide down her nose. ''The library
director was ready to let me go,'' she said. ''I was
playing the a.d.h.d. card.''


On the third floor of the New York Helmsley Hotel, in the
red-carpeted Knickerbocker Suite, a steady stream of adults
sat at long, cloth-draped tables and filled out a short
six-question form. ''How often do you have trouble wrapping
up the final details of a project, once the challenging
parts have been done?'' the questionnaire asked. ''How
often do you have difficulty getting things in order when
you have to do a task that requires organization?''

''How often do you have problems remembering appointments
or obligations?'' it continued. Then: ''When you have a
task that requires a lot of thought, how often do you avoid
or delay getting started?'' And: ''How often do you fidget
or squirm with your hands or feet when you have to sit down
for a long time?'' Finally: ''How often do you feel overly
active and compelled to do things, like you were driven by
a motor?''

The participants answered in gradations, from ''Never'' to
''Very Often.'' When they finished, they met one on one
with staff members from the Adult a.d.h.d. Program at New
York University, who were there to tell them whether they
were, as one counselor put it, very good candidates for
a.d.h.d. Between 8:30 a.m. and 3:45 p.m. on this weekday in
May, about 450 people registered for the screening. Of
those who took the test, 85 percent were found to be at
high risk for the disorder.

''That's far higher than in the population at large,'' said
Dr. Lenard Adler, the associate professor of psychiatry and
neurology at the N.Y.U. School of Medicine. ''This is a
self-selecting group, and they came here in the first place
because they were highly suspicious that they have this.''

What Adler was saying is this: Yes, the numbers from this
screening are high, but final determinations, the real
diagnoses, are not made willy-nilly; everyone who loses his
keys once in a while or drives off with the coffee cup on
the roof of the car does not have a syndrome. The reason
Adler makes his point so carefully is that he understands
that many people, whether they say so outright or not, have
a sneaking suspicion that A.D.D. is little more than
spaciness redefined as disease.

''You can't see it, you can't touch it, there's no litmus
test for it,'' said Dr. John Ratey, co-author (with Dr.
Edward Hallowell) of ''Driven to Distraction,'' which, when
it was published in 1994, brought adult A.D.D. to a
mainstream audience for the first time. ''It's a spectrum
diagnosis. There's no real test for depression either, but
we accept that people are depressed. There are no real
tests for a lot of things.''

What is different about A.D.D., though, is that its
symptoms are a cluster of behaviors that nearly every human
has at some point: forgetfulness, disorganization and
restlessness, along with the seemingly incongruous ability
to focus intensely on one task to the exclusion of
everything else. It is that very familiarity that breeds a
level of contempt. So researchers like Adler and Ratey
spend a lot of time explaining the difference between
A.D.D. and run-of-the-mill messiness.

For starters, there are the physical differences. ''Brain
scans show a difference in prefrontal cortex glucose
metabolism in people with a.d.h.d. compared to control
groups,'' said Dr. David W. Goodman, assistant professor in
the psychiatry and behavioral sciences department at the
Johns Hopkins University School of Medicine. ''And dopamine
receptor density is greater in a.d.h.d. brains. Also,
volumetric changes. In general, a.d.h.d. brains are
smaller. If you have a patient do a color/word sorting
test, a.d.h.d. lights up in a different area of the brain
than non-a.d.h.d. The hard-wiring of the a.d.h.d. brain is
different.''

Then there is the genetic evidence. ''If your child has
it,'' Adler said, ''there's a 40 percent chance that a
parent has it. If a parent has it, there's a 50 percent
chance that a child will.''

These tendencies are not diagnoses, however. Brain imaging
and genetics aside, A.D.D. really exists only if it affects
your life. ''What makes this real is the impairments,''
said Dr. Margaret Weiss, director of the a.d.h.d. clinic at
the Children's and Women's Health Center in Vancouver,
British Columbia. ''There is a tremendous difference
between having some of the qualities and having the
disorder. What we are talking about here is chronic, it's
prevalent, it causes severe impairment.''

In other words, doctors know it when they see it. And what
they see is a cohort of people who ping-pong from career to
career and job to job; who are dynamite salesmen but who
never fill out expense accounts; who look like workaholics
because they are at their desks until midnight, but only
because they don't really start to concentrate until panic
sets in at 11 p.m.; who are creative geniuses but forget to
bring the data to meetings.

I've seen it, too, in recent months, while doing the
research for this article. The interviews have been
qualitatively different from those I have done with any
other group in 20 years of reporting. The conversations
could not be kept on track; the people I spoke to jumped
from one subject to the next. And they were longer than
most interviews I usually do, because the subjects were
unusually animated, articulate and chatty.

They arrived late. They fidgeted while we talked. They
started to ask questions but forgot where they were headed.
They kept saying, ''One more thing,'' until I learned to be
blunt to the point of rude in my goodbyes. One woman sent
me long, bursting e-mail messages, sometimes several of
them a day, one of which literally ended, ''running off to
my next projecttttttttttttttttttttttttttttttttttt
zoommmmmmmmmmmmmmmmmmm!'' One man called me on my cellphone
at 8 on a Saturday night because he thought of a question
he had to ask. He would not be deterred, even when I told
him I couldn't really talk because I was visiting my father
in the hospital. Robert Tudisco, a lawyer whose A.D.D. was
not diagnosed until he was an adult and who now represents
clients with the disorder, tried to explain how it feels to
live inside an A.D.D. brain. ''As I sit here and talk to
you in a relatively calm conversation,'' he said, ''there's
an amusement park going on in my head.''

But even once you come to accept the reality of A.D.D., the
question lingers, Why now? If A.D.D. is a function of
biology as old as humankind, then why this growing clamor
for diagnosis at this particular moment? One answer is that
medical diagnoses ebb and flow with the times. Looked at
through that lens, Western society seems ripe for this
disorder. Now is a time when diagnosis can lead to action
-- not only are there more medications to treat A.D.D., but
Americans are arguably more willing to take pills to change
their temperament. Also, other eras provided more jobs for
people who needed to move and do rather than sit and think
-- more jobs in factories, on farms, in door-to-door sales.
Go even further back, and there were adventurers and
pioneers. Today we sit at desks, in cubicles, staring at
screens.

Add to this the fact that the support systems that
disguised disorganization for some people at work have
eroded. ''People wouldn't suffer the effects of A.D.D. if
they could have the classic executive secretary who would
proof their expense accounts and keep their calendars and
get them to meetings,'' Ratey said. ''If I were to create
an environment that is bad for A.D.D., it would be today's
typical office.''

Ratey is the first to agree with what he sees as the
''general public's belief'' that A.D.D. is probably
overdiagnosed, in children and in adults. But, like most in
his field, he also says that it is simultaneously
underdiagnosed. ''Yes, there are people who will throw this
label at behavior that does not fit the criteria'' of the
condition, he said. ''But there's no doubt that the
condition is real. And the much bigger number is those who
have it but have not been diagnosed.''

A.D.D. looks different in adults than it does in children.
There are two general categories of the disorder -- with
and without hyperactivity -- and adults tend to exhibit the
kind without. That may explain another difference as well.
It was long thought that A.D.D. was primarily a disorder of
boys (twice as many boys receive the diagnosis as girls),
but psychiatrists like Adler are finding that the ratio of
men to women in his adult clinic is a fairly even split.

The most logical explanation for the discrepancy is that
boys are much more likely to have the hyperactive form of
A.D.D., and it is the children who are bouncing out of
their seats in class who are most likely to be given the
diagnosis. The subtler inattentive form is more common in
girls, who may well appear spacey or disorganized through
their school years but who underachieve quietly and don't
disrupt the class. They hit the wall only when they reach
adulthood and need to juggle the demands of life and work.

Today's children -- or at least the ones who call enough
attention to themselves -- may prove to be fortunate. Those
whose condition is diagnosed early are armed with a modern
arsenal of weapons, chemical and otherwise, and ''have
spent their school years learning how to manage their
A.D.D.,'' said Wilma Fellman, author of numerous books
about A.D.D. and work. ''They have had the chance to become
quite prepared.''

Those whose conditions are diagnosed when they are adults,
however, like Vivienne Sales, have no such preparation.
They have to undo decades of damage, and do so while
somehow holding on to a job.


Carl Mandiola is 37, and he can list more than 50 jobs that
he has run through in his working life. He has tended bar,
served in the Air Force and been an e.m.t. He has sold
Amway products, waterbeds, cookies, shoes and long-distance
phone service. He has worked security at a supermarket,
been a janitor in a medical lab, made pizza at a fast-food
joint and assembled butyl rubber innards for compression
tanks on a factory line. In all, he has been fired from a
dozen jobs for poor performance and from a half-dozen more
because he was downsized, and he left the rest because he
became antsy and bored.

For most of these years he had no label for this
restlessness. But he called himself quite a number of
names: lazy, loser, stupid. In his late 20's, however, he
found a niche in the world of graphic design. He taught
himself to do artwork on the computer in a style that is
whimsical and bold. He landed a position at a small
publishing house in Boston, creating invitations,
advertisements and brochures. It was one of the few jobs he
had ever had in which he was closely supervised (an
advantage for most workers with A.D.D.) but also free to
set his own hours (another advantage). ''I turned on at
night,'' he said. ''That's when I got things done. All I
needed was a good cup of coffee. All the distractions were
gone.''

Mandiola had been working at the publishing house for more
than two years -- a personal record -- when he moved to New
York to marry in early 2001. By then his field was changing
rapidly, and cost-cutting meant that fewer people were
expected to do more work with less

direction. He found, and lost, several jobs that had
neither the structure nor the flexibility he needed. ''I'm
not a multitasker,'' he said, words that could be a slogan
for A.D.D. ''I was used to one or two projects at a time,
and they were working seven or eight projects, and they
wanted it all done in a day.'' It was this crisis that led
him to a psychiatrist and a diagnosis of A.D.D. Now
unemployed and with a newborn son, he is thinking of
leaving the design field entirely. He says he wants to
become a real-estate investor. Or a television writer.

A.D.D. shows many faces in the workplace, but Mandiola's
story includes the features prominent in most of them --
the choppy resume, the tendency to rise to a challenge in
the beginning but to unravel as the work devolves from
interesting to routine. True, changes in the world of work
mean that a peripatetic work history has become more
acceptable to potential employers, and while that does make
it somewhat easier than it might otherwise be for workers
with A.D.D. to get a job (at least in a good economy), it
does not make it easier for them to keep one. A recent
Roper poll of adults who identified themselves as having
a.d.h.d. found that they held 5.4 jobs over the past 10
years, compared with 3.4 jobs for adults without the
disorder. The same poll found that only 52 percent of
adults with A.D.D. are currently employed, compared with 72
percent of unaffected adults.

Vivienne Sales had an equally checkered work history. After
graduating from Indiana University in 1986, she earned a
master's degree in international studies from Ohio
University. She then worked as a building inspector with
the Indiana Department of Labor, did data entry for the
Long-Term Credit Bank of Japan, waited on tables at a
Japanese restaurant and taught English in Korea. Few jobs
lasted for more than a year. In 1999, she was fired from
two technical-writing jobs within three months, then went
on to leave seven part-time jobs and fail a four-week
teacher-training course.

Near the end of 1999, she entered graduate school again,
for a degree in library science. ''I'm good at finding
information,'' she reasoned. She was also better at being a
student than being an employee. She said she thinks the
discipline of the classroom kept her on track. While she
maintained a B average in the program, concern over her
fractured career path led her to see a job counselor in
July 2000.

The trip to the counselor led to testing, which led to a
diagnosis of A.D.D. (Like many others with the condition,
Sales has other issues as well. As many as 50 percent of
A.D.D. patients have another syndrome during their
lifetime, most commonly depression, anxiety disorder,
learning disabilities or bipolar disorder, Adler said. For
Sales, the co-travelers were narcolepsy and dyslexia.) It
was a diagnosis that brought both relief and regret. ''It
explains so much,'' she said. ''Most people cannot believe
that someone with three university degrees could be such a
washout in the real world.''

The first step after diagnosis is often medication. Drugs
tend not to work without monitoring and therapy, Adler
said, but he also finds that counseling alone is not
enough. Psychiatrists like Adler compare A.D.D. medications
to driving a car. It's easier than walking, but only if you
know how to drive. Robert Tudisco (the lawyer with the
amusement park in his brain) describes the role of
medication this way: ''Before the drugs, I could walk
through a room and I wouldn't even see it was a mess. With
the drugs, I see it's a mess. It bothers me that it's a
mess. I want to do something about it. So now I'm ready to
learn how to clean it up.''

Unlike nearly every other medicine on the market, A.D.D.
treatments were first tested in children, because for
decades it was not thought that they were needed for
adults. Until very recently all these drugs were officially
approved for A.D.D. only in those under 18 and were
prescribed off-label for that purpose to anyone else.

These drugs were stimulants, like Ritalin, and they were
dispensed in dosages meant to get a child through a school
day. Recently the pharmaceutical world began to develop new
formulations designed to last longer -- particularly
helpful in the workplace. At the end of 2002, the Food and
Drug Administration approved the first medication
specifically for use in adults. Atomoxetine, which is sold
under the name Strattera, is not a stimulant, but a
norepinephrine reuptake inhibitor, and it can last for a
full day. Strattera has an additional advantage because it
allows workers to do jobs -- machine or truck operator, for
instance, or airplane pilot -- that could be dangerous
under the influence of such stimulants.

Even when drugs mitigate the symptoms of A.D.D., however,
they rarely eliminate the complications of workplace
interactions. At 50, Sealani Weiner has the typical
wandering A.D.D. resume -- jobs in office administration,
followed by jobs in sales, followed by her current
profession, social work. In fact, she has struggled so much
in her work life that she changed her name along the way.
She became Sealani in 2002, in order to leave the failures
of Cheryl Lani behind.

Weiner also battles depression and suffers from thyroid
disease and diabetes. ''I think it's hysterical,'' she
said, laughing (remarkably, she is often laughing), ''that
it takes eight medications every day to make me feel
normal.''

A longtime New Yorker, she moved to New Mexico seven years
ago and went through five jobs there in the next six years.
Since 2003, she has worked as a social worker for an area
hospice and part time at a psychiatric hospital. Both jobs
were at risk shortly after she began.

Her supervisor at the hospice found her difficult to work
with and worried about her effect on families. ''It was
hard for Sealani to focus,'' said Karen Newcom, who became
Weiner's boss last summer. ''She'd come in and tell me she
wanted to talk to me. She'd end up going in five or six
directions. She couldn't decide what was the most important
thing to talk about. She was just taking so much of my
time. More so than any other employee.''

It didn't take Newcom long to decide that Weiner was
creating other problems at work. ''She's in hospice,''
Newcom said. ''She's dealing with families in crisis. She
was supposed to calm them down. I know the effect she was
having on me, and I can't see how she would be very
helpful.''

One of the myriad wrinkles of A.D.D. is impulsivity. In
Weiner's case this shows up in her tendency to speak before
stopping to think. In one staff meeting at a previous job,
for instance, she voiced the opinion that a patient about
to be released from the hospital ''won't pay attention to
anything anyone says, and we should just let him drink
himself to death.'' In another meeting: ''I said a patient
was a bitch. It was true, and everyone knew it was true,
but I was fired for it.''

The fallout from similar behavior in her current job sent
her in tears to the therapist who had diagnosed her
disorder. She met with a psychopharmacologist the next day
and left that appointment with a prescription for
Strattera. She had resisted taking medication until then,
she said, feeling that she was already taking so much for
her other medical conditions. But she started on this
newest pill, she said, ''to save my job.''

She did not immediately mention that choice to anyone at
work, but Newcom said she noticed a change within days.
''Out of nowhere she started coming into my office and was
more focused,'' Newcom told me. ''I commented to her that I
had seen a change, and that's when she told me about the
A.D.D. and the medication.''

As Weiner described it, Strattera slows her frenetic brain.
''I've gone from 100 miles per hour to 80 miles per hour,
which is still way faster than anyone I know,'' she said.
''I feel calmer inside. Instead of darting from one thing
to the next and never finishing anything, I can take on one
thing at a time.'' Which does not mean that she has become
a shy and circumspect employee: medication addresses A.D.D.
symptoms; it does not transform personality. In the year
since she began taking medication, Weiner has been written
up for ''inappropriate comments.'' But she said she feels
victorious nonetheless, knowing what her bosses don't --
that many times she followed the advice of her therapist
and did not ''fly off the handle.'' Instead, she waited 24
hours and used that time to role-play a more measured
response with her husband.

So far she has managed to save her hospice job. ''If she
had not gone on medication, she would have put her job in
jeopardy,'' Newcom said. But she acted too late to keep her
part-time position at the psychiatric hospital, where both
patients and staff members have complained about her
rudeness. ''I think before I went on meds, I burned my
bridges there,'' Weiner said. When the time came for her
annual review this spring, she said, she was taken aside by
a supervisor and told that it would be best if she
resigned. So she quit before she could be fired.


In this litigious age, where suits are brought over the
temperature of a cup of coffee, you would expect a flood of
employees with A.D.D. seeking job protection under the law.
Yet, at best, there is barely a trickle.

''There's no landmark case,'' said Patricia Latham, who,
with her husband, Peter Latham, is the author of a series
of seminal books on disabilities and the law. The message
sent by the scattered cases that do exist, she said, is not
encouraging to others who might think of bringing more.

A.D.D. can be covered under the Americans With Disabilities
Act, as well as state antidiscrimination laws. But those
who try to prove they have been discriminated against
because of their A.D.D. must show that they are highly
debilitated by their disorder yet still capable of doing
their jobs if their employer would provide ''reasonable
accommodations.'' In short, plaintiffs must walk the
tightrope of all disability employment law. ''You have to
be substantially impaired,'' Latham said, ''but not so
impaired that you do not qualify for your job in the first
place.''

That narrow line is why more than 90 percent of cases
brought by employees under the A.D.A. ''are not won,''
Latham estimated. That statistic includes all disabilities,
she added, and does not account for the additional,
intangible hurdles faced by workers with hidden syndromes
like A.D.D.

Ours is a society in which excuses are inexcusable. Over
the generations we have learned tolerance for some
disabilities, but mostly those that we can see. Quirks in
the wiring of the mind still generate very little sympathy.
If you are missing a limb, I understand that you can't do
the same job as I can without help. If you are chronically
late for work, however, I am much less likely to understand
why you can't try harder to be on time. It doesn't feel
wrong to dismiss someone for disorganization, or laziness,
or a brusque manner with customers. In fact, it feels
right.

Taking A.D.D. to court, therefore, is often an uphill
battle. Unless there is some clear evidence of
discrimination -- glowing reviews that turn negative
immediately after the boss is told a worker has A.D.D., for
instance -- there isn't much chance of prevailing under the
A.D.A., said John Beranbaum, a plaintiff's attorney who
specializes in disability law. Employees who are not given
reasonable accommodations have some recourse, but the
definition of reasonable is limited under the law and does
not involve changing the essential job description. Those
who counsel A.D.D. employees, therefore, often advise them
not to bother with the courts. ''I get calls saying, 'I
need to come in late, and my boss won't let me, can I
sue?''' said Harold Meyer, who, in addition to advising
companies and employees on A.D.D.-friendly workplace
strategies, is chairman of the New York City chapter of
Children and Adults With Attention-Deficit/Hyperactivity
Disorder, known as Chadd. ''I tell them, 'You can sue, but
you won't win.'''

In short, the realm of work is a universe away from the
realm of education for those with A.D.D. In the
public-school system, a child's diagnosis is like an
admission ticket; districts are obligated to help students
whose learning is impaired by their A.D.D. In the world of
work, the burden is on the A.D.D. employee to help himself.


That did not stop Vivienne Sales from asking her employer
for help. The day after her argument over the
interlibrary-loan request, she sent a memo to her
supervisor. It read, ''I have the following documented
disabilities that require accommodation,'' then listed her
A.D.D., followed by her accompanying diagnoses. ''I am
requesting a 504 accommodation plan,'' the memo continued,
using the language of disability law, which she had looked
up on the Internet.

That first memo was followed by a second one, two weeks
later, addressed to Cheryl Moreno, the manager of human
resources, whose book request had been lost.

''I need an accommodation to be able to perform my job
duties because of a disability,'' Sales wrote, and she went
on to explain what steps she had already taken on her own:

''Using two different day planners. One is left at work;
the other is always with me. Each day at work, I compare
the entries in both day planners to make sure I do not have
any scheduling conflicts.

''Create tracking charts for projects. I use tracking
charts to keep track of the . . . seminars that I present
for the semester.

''Using a small microcassette recorder, I record items that
need to be done for the next day. Then I play back the tape
and write down what I have said into my day planners.

''Using flex-scheduling to go to counseling and doctor
appointments. I make up my time by working late.''

But these strategies alone were not enough, she wrote in
her memo, and she told Moreno what else she would need:

''Educating my co-workers about my condition so they will
get a better understanding of it.

''Having set deadlines on when projects should be
completed.

''Giving weekly progress reports to my supervisor. In turn
my supervisor checks on my progress on a weekly or biweekly
basis.''

She sent the memo via interoffice mail. Then she waited to
be fired.


Ayana Kee did not walk into Jennifer Koretsky's office on a
recent spring day, so much as she swept in, radiating
exuberance and energy. Kee is a second-grade teacher -- by
all accounts the kind you would want your child to have.
Koretsky is her A.D.D. coach. Their twice-weekly sessions
are rivets in the infrastructure that is rising within the
world of adults suffering from A.D.D.

Kee settled herself on the couch across from Koretsky and
started to explain that she loves her job, loves teaching
children. But while all the other teachers are gone by
4:30, after an eight-hour workday, Kee is sometimes there
until 7. ''The custodian tells me I have to leave because
he has to mop the floors,'' she said. Then she brings a
satchel of materials home and works until bedtime.

The two women spent the rest of the session mapping out a
time-management plan for Kee. ''Let's look at some things
you can take off your plate,'' Koretsky said. ''It's not
like you have an assistant you can delegate to, but what
you do have are kids in the classroom. How much of the
classroom management can go to them?''

Kee's eyes widened. She had never thought of this.


''Everything in your class is already clearly labeled,
right?'' Koretsky asked.

''It is, it is,'' Kee answered.

''And the children like to help, right?''

''Oh, yes,
they do,'' Kee said, and she was off and running. ''The
books in the classroom library are labeled on the back to
show what baskets they go in. They can put the books away.
They can put away the crayons and pencils and things that I
am forever cleaning up after they are gone. I can make a
list of all the possible jobs within the classroom. We
already have a daily job board. I can also make an
afternoon job board, and each afternoon we could stop and
take just a few minutes to do those. I have 19 students. If
we spent 10 minutes. . . . I just thought of a job! Museum
curator! They could help me set up the boards where their
work is displayed.''

''So this idea sounds like it would work?'' Koretsky asked.


''It's a plan,'' Kee said.

Coaches are not therapists. They are either self-taught or,
like Koretsky, they are graduates of places like the A.D.D.
Coach Academy, which charges $3,695 for a nine-month
curriculum taught over the phone and online. ''Coaches
concentrate on what, how and when, never why,'' said Nancy
Ratey, a nonstop whirlwind who helped create this field
from scratch as a roundabout way of managing her own
a.d.h.d. Married to John Ratey, co-author of ''Driven to
Distraction,'' she coaches from her home, which is covered,
bedrooms to boiler room, with notes reminding her to close
this door, leave that one open, plan a vacation, fix the
garage door.

Unlike Koretsky, who meets with Kee in person once a week
(and again by telephone or e-mail that same week), Ratey
does nearly all of her coaching by phone. She has coached
clients as far away as Moscow and as close as across town
without ever seeing them, charging up to $400 an hour for
her services. Ratey takes 15 clients at a time, and she
describes them as a mix of executives, professors, lawyers,
doctors and authors. One attorney called her because his
secretary threatened to quit unless he found himself a
coach. One chronically late advertising executive asked
Ratey to train his administrative assistant to check on his
preparation progress every 15 minutes. Ratey has instructed
assistants to ask the boss to empty his pockets of all
accumulated business cards when he returns from meetings
and to take the boss's car keys until important reports are
finished.

(Permit me a detour here, since detours are certainly
fitting for this story. My favorite adaptive strategy was
used by Robert Tudisco. His son was enrolled in a preschool
directly across the street from his law office. Yet every
afternoon, Tudisco arrived late for pickup. Tudisco tried
everything he could think of to get himself out the door on
time -- reminders on his watch, his computer, his Palm
Pilot, his alarm clock -- and then he noticed that his
paralegal, whose workday stopped at 5, always left
precisely on time. So he told her ''that she wasn't allowed
to walk out the door without me,'' even if she needed to
physically yank him from his chair.)

Most often, though, it is the A.D.D.-afflicted individual,
not the support staff, who signs up for coaching. While the
coach's role is technically to help with the day-to-day
mechanics of work, most coaches find themselves advising
clients on less concrete problems, like whether their
particular job, and even their entire profession, is a good
fit. It is accepted wisdom in A.D.D. circles that certain
types of work are a nightmare for those with A.D.D.
(accounting comes to mind) and that others are virtual
magnets for those with the condition: sales, contracting,
waitressing, hairdressing -- any job that involves chatting
and moving around. Stock trading, acting, law enforcement,
emergency medicine -- any job that runs on adrenaline and
deadline. Journalism is thought to be full of people with
A.D.D., doctors and coaches tell me. (Yes, I took the
screening test. I have many of the tendencies, but not the
disorder.) Entrepreneurs with A.D.D. often thrive as well,
but only if they have a partner who is good at paperwork.

Unfortunately for Vivienne Sales, librarian is not on the
list. And yet, it is what she most wants to be.

Sales was not dismissed after her argument in the library
last summer. Instead, she found an unexpected advocate in
Cheryl Moreno. The h.r. manager said she believed that the
rules would have permitted the library to dismiss Sales
until the moment Sales declared that she had a disibility.
At that point the rules change. ''The median cost of
accommodations for impaired employees is $240,'' Moreno
said, quoting a statistic in vogue at human-resource
conferences. ''So we tried to help.''

In Sales's case, the help cost more than $240 and came in
the form of a job coach whose $100-per-hour services were
paid for by the university. Finding such a coach in
Prescott, Ariz., took most of last autumn, and it was not
until the end of last year that Sales began working with
Evelyn Larriba, a vocational specialist from the West
Yavapai Guidance Clinic who was not specifically trained to
work with adults with A.D.D. but who brought up a grandson
who has the condition.

During January and February, Larriba met with Sales at the
library. Their work started with her desk, which took two
hours to straighten up. Then they tackled her time
management, dividing Sales's workload into sections and
creating interim timetables. That worked when it came to
ordering her quota of graphic novels, which she finished on
time, but was not quite as successful when it came to
reviewing periodicals for the library's collection. Despite
a detailed template, the first batch of reviews that Sales
turned in were handwritten, and her boss had to advise her
to type them up on the computer. Larriba said she has never
seen a client work harder. ''You couldn't ask for anyone
who is more dedicated to doing a good job,'' Larriba said
of Sales. ''She tried desperately hard.''

Once a month, Sales met with her supervisor, Evelyn Harris,
to discuss her progress. The portrait painted in Harris's
memos is one of incredible determination and effort but
only incremental change. Harris said that both she and
Sales were determined to make it work. ''I approached
Vivienne's training as I would with a brand-new person,''
Harris said. ''We agreed we would start from ground zero
and build.''

In the January report, Sales was chided for missing a
deadline for a student newspaper because of a computer
problem; missing a meeting because she forgot, despite
three e-mail reminders; and missing a day of work because
she forgot to take her medication. She failed to straighten
the library bulletin board where students post ''for sale''
and ''for rent'' notices. She yawned through an entire
meeting, without covering her mouth, leading Harris to
reprimand her for ''unprofessional behavior.''

''From our discussion today and the list of things that are
not getting done, I feel that you are not multitasking,''
Harris wrote. ''You focus on one or two projects and ignore
the other daily/weekly tasks that need to be done on an
ongoing basis. You will work with Evelyn Larriba during the
next two weeks on time-management skills and prioritizing
techniques.''

A startling fact about the world of A.D.D. is the number of
people who are grateful for the disorder, who consider it
the best part of themselves. David Neeleman, for instance,
the founder of JetBlue Airways, has said that he will not
take medication for his A.D.D., fearing that it would make
him just like everybody else.

''It's the source of my creativity and my drive,'' echoed
Thomas Apple, who was given a diagnosis about seven years
ago, when he was in his early 40's, and went on to create
the world's largest video display for stock market
quotations. ''You can think outside the box because you're
not in a box.''

''A.D.D. is the greatest thing that happened to me,'' said
Sam Grossman, who became a partner in the Albert
Corporation, a real-estate company based in Brookline,
Mass., two years ago, when he was 22. ''I wish I could hire
four or five people like me with A.D.D.,'' he said. ''The
impulsivity that comes with this means I can walk into a
building, see things an ordinary person wouldn't see and
act on my gut right away.''

Even the slim chance that such success is possible kept
Sales going. ''I see things in ways that other people
don't,'' she said. As an example, she told me about how
another librarian happened to mention that a copy of the
''Seabiscuit'' dvd was missing. That same morning, Sales
happened to pass the interlibrary-loan shelf and was
distracted by a glimpse of something out of place. It was
the wayward dvd.

At about the same time, Sales was training students to
enter information in a database of aviation-themed
periodicals. It was boring, repetitive work -- year, month,
volume number, titles, features, keywords -- and Sales
hated it. While trying to find new books for the
collection, Sales accidentally found herself not in her
library's database but in a commercial one that included
almost exactly the same information. ''Our project was
reinventing the wheel,'' she said. ''Other companies were
already doing this work.'' So she wrote a memo (on the
computer, not by hand) and presented it to her boss,
practically giddy at her efficiency.

She told her coach these two stories over and over, certain
they would save her job. Success, however, is a matter of
perspective, and what Sales saw as victory, Larriba saw
merely as what others do effortlessly every day. She did
not share that with Sales, however, letting her client
savor the feeling of accomplishment.

''That memo was my best work,'' Sales remembered. ''It only
had one typo.''


Sales's determination to do the job right was certainly
noticed. There was praise in her next evaluation.

''Your presentation was well organized, your PowerPoint
slides were effective and your personal demeanor was
professional,'' Harris wrote in March. (Larriba had advised
Sales on her outfit, double-checking that it was pressed.)
''That was very good.''

But there was criticism too -- and a tone that sounded like
a boss building a paper trail. Sales was cited for lapses
that she says she suspected would not be held against any
of her co-workers. It gave her the feeling that she
couldn't win, no matter how hard she might try. By April,
it was clear that the fight was over. Sales was told that
she had taken too much time with too little result
preparing a display for Black History Month and too little
time updating the library's emergency and disaster manuals.
She had introduced items in meetings that were not on the
agenda. She had recommended the purchase of books without
realizing that the library had already ordered them. She
had recommended the purchase of electronic devices without
first conferring with the electronic-services librarian.
(''Your response when I questioned your recommendation was,
'Whoops!''')

This final evaluation came with an attached list of
available positions elsewhere in the university. Of those,
seven required advanced training or degrees that Sales did
not have, one was a part-time slot in the copying center
and one was interlibrary-loan specialist, the job that
started all the trouble in the first place. After reading
the list, Sales went home and lay in bed with an ice pack
on her head.

As a part of Sales's severance package, she received 16
hours with her vocational coach, and Larriba spent much of
that time discouraging Sales from applying for jobs that
involved too much multitasking or would require her to
relocate. Sales said she thinks a move to another state, or
even another country, might provide a clean slate and a new
start; Larriba said she thinks a move would be nothing but
overwhelming.

''You have to ask yourself, Are you running to something or
are you running away from something?'' the coach told her
client. ''You can't run away from A.D.D.''


Lisa Belkin is a contributing writer for the magazine.