Dear Dr. Jeff: I've been having trouble concentrating on my work for a while. I tried a friend's Ritalin to study for a midterm, and it worked great. I wonder if I have ADD?-J.L.
Dear J.L.: "Concentration troubles" are a very common concern among college students. They may be related to a large number of issues, only one of which is Attention Deficit Disorder (ADD). Most commonly, factors such as inadequate sleep, diet, exercise, or recreational drug or alcohol use, stress, depression, or anxiety can lead to difficulties concentrating. Less commonly, medical conditions like hyperthyroidism can cause similar problems.
ADD is a neuropsychiatric disorder, thought to arise from an inborn problem with brain "hardwiring." Clinically speaking, ADD is characterized by inattention, distractibility, impulsivity, and hyperactivity. These behavioral deficits cause problems that are performance-based, rather than skill-based. People with ADD are of at least average, if not above-average intelligence, and certainly possess their fair share of talents and abilities. Unless diagnosed and treated early on, though, most have to struggle hard throughout elementary school, and up to 35 percent are unable to finish high school.
ADD is a chronic, life-long disorder, usually appearing first early in childhood. It may affect as many as three to five percent of Americans and one to three percent of college students. ADD can be difficult to diagnose, and many experts feel that it is over-diagnosed in highly active, slow-learning boys and under-diagnosed in inattentive but quiet girls. A high percentage of people with ADD also have a learning disorder, and complete neuropsychological or educational-psychological evaluation should be considered for anyone diagnosed with ADD.
Stimulant medications (e.g. Ritalin, Adderall, and Dexedrine) remain the primary therapy for ADD. They are thought to decrease neurologic "white noise" from competing centers of the brain, facilitating focus and concentration on central tasks. They are now available in a variety of short- and long-acting preparations. Some are being marketed directly to consumers, on TV, and in magazines, with sometimes confusing results.
All of these medications are controlled substances. Their efficacy is in no way diagnostic of ADD. They very effectively counter fatigue and facilitate focus whether you have ADD or not. Stimulants are used routinely in the military, for instance, on prolonged missions. On college campuses, they are frequently traded among friends as "study aids." In fact, at Bowdoin, nearly one in five students surveyed has reported doing so during the previous year. The shorter-acting stimulants are also not uncommonly abused for recreational purposes.
Headache, abdominal pain, appetite suppression, insomnia, and nervous tics are all common side effects of stimulants. Taken orally, in prescribed doses, stimulants are safe and effective medications. Rarely, in people with predispositions to seizure disorders or cardiac problems, they can be dangerous, even fatal. This is especially true when they are ground up and snorted.
Many "natural" products have also been promoted to control symptoms of ADD, including essential fatty acids, phosphatidylserine, ginkgo, DMAE, and Ephedra. None have been scientifically proven to be effective. And remember: "natural" does not at all necessarily mean safe.
So J.L., if your trouble concentrating is only very recent, it's unlikely that ADD is the cause. Ritalin might help you get through a long night of studying or paper-writing, but that doesn't mean you have ADD. And it should go without saying that taking someone else's prescription medication is not a good idea, above all when the medication is a controlled substance. Come into the Health Center for an evaluation. We'll be happy to help figure this out!
Be well!
Jeff Benson, M.D.
Dudley Coe Health Center