It is now 20 years since Attention Deficit Disorder first appeared in the 1990 version of the psychiatric diagnostic manual. In these two decades, much has been learned and much has stayed the same in our understanding and treatment of ADD. ADD is still defined by variability in three characteristics: attention, hyperactivity, and impulsivity. Agreement is beyond reach on the many different forms of ADD —although there is recognition that not all ADD is alike. What has changed is a vast new understanding of brain’s contribution to these characteristics and how these characteristics appear in daily life, as well as how to live and work with them.

Originally ADD was seen as a problem of hyperactive young boys, and it was thought that these boys outgrew ADD by adulthood. We now know that about 80% of boys and girls with ADD continue to warrant the diagnosis into adulthood—that’s approximately 4% of the adult population! Some aspects of ADD do slow down over time, primarily the feature of hyperactivity. With the brain’s final stage of maturation in the early to mid-twenties, hyperactivity often eases in to a quieter kind of restlessness rather than the full scale hyperkinesis that first got the attention of parents, teachers, and researches so many years ago.

We now know too that ADD is not a problem of poor parenting or a sugar packed diet. Although a good diet can help in the management of ADD symptoms. ADD runs in families which leads us to the understanding that ADD has a neurological basis. A child with ADD has at least a 30% chance of having a parent with ADD. Twin studies conducted in Australia of over 2000 twins revealed that if one twin had ADD, there was a 91% chance that the other twin had it too.

ADD is now the most researched of all medical conditions. One important study recently took a look at all the treatments available for ADD. Medication, behavioral interventions, traditional therapies, and of course, the control group, no treatment, were compared. Medication and behavioral interventions combined had by far the most beneficial impact on ADD symptoms. Medication options have advanced enormously in the past twenty years. Medications are not just short-acting, side-effect packed pills but carefully measured, individually adjusted treatments that can be a major help in ADD management.

Behavioral interventions are tried and true, big impact, low cost means for managing ADD symptoms. Behavioral interventions are available for just about all of the daily tasks of living that are often difficult for an ADDer but not necessarily part of the official diagnosis--getting to work on time, finding keys, completing projects by deadline, answering email, paying bills, remembering birthdays, and the like to name a few. Maximum flexibility is available to the ADD consumer as well. Depending on personal style, individual, group, in person, by phone, and in writing behavioral treatment means are available.

It will be an amazing to see where our ADD understanding and treatment is in another 20 years. But for now, there is plenty of power in what we know and what we can do with what we have.

guest blogger M. Susan Roberts is the co-author of Living with ADD: A Workbook for Adults with Attention Deficit Disorder.