Messy purse girls: adult females and ADHD.

Most people don't realize that some people expend tremendous energy merely to be normal. --Albert Camus I'm the smartest dumb person I know. I'm one of those messy purse girls. --Cynthia Cynthia's Story Cynthia is a 35-year-old married woman recently diagnosed with attention deficit hyperactivity disorder (ADHD) while seeking counseling for depression following a miscarriage. "There's so much in my head, so many ideas, but they're a jumbled mess. I can't seem to turn them into anything productive. I'm constantly losing things. I have trouble remembering to do the laundry, remembering to pay the bills, balancing my checkbook, taking my son to baseball practice. My house is a trail through books and piles of just about everything else. When my husband comes home from work, I have nothing tangible to answer the question, 'What have you been doing all day?' And of course, my purse is always such a mess, and I wonder if that reflects my state of mind. I wish I could be one of those neat purse girls." Cynthia's parents divorced when she was 7. To help Cynthia and her younger brother, Henry, adjust to the divorce, their parents took them to a psychiatrist. After several visits, the psychiatrist observed that Cynthia was having a harder time adjusting to the divorce than her brother and recommended that she continue on a one-to-one basis. Cynthia took the WAIS-C, which revealed she had an above-average intelligence, but there was considerable discrepancy between her verbal and spatial scores. Cynthia says it was in seventh grade when "everything fell apart." She remembers having trouble getting up in the mornings, missing school, having no friends, and experiencing conflict with her mother. "I know I was difficult to raise. I was willful and obstinate. My mother and I were in constant conflict. She hounded me about my weight, my messy room, my talking on the telephone too much. She pushed me to study piano, violin, and voice. I hated it at the time, but it's true, I had no initiative. I needed pushing." In high school, despite frequent absences, Cynthia made straight As, was in the National Honor Society, played the lead in school musicals, and was on the dance team. She says she's never really felt happy and reports seeing several different psychiatrists over the years. All diagnosed her with depression and anxiety, comorbid conditions associated with undiagnosed ADHD. Attention Deficit Hyperactivity Disorder ADHD is an early onset, neurobiological disorder involving inattention, impulsivity, and hyperactivity. Until recently, experts believed it was a childhood disorder that remitted in adolescence and adulthood. Although the hyperactivity that leads to behavioral problems does tend to abate during adolescence, recent studies indicate that the inattention and impulsivity continue into adulthood, making adult ADHD a valid diagnosis. In 1902, Dr. George Frederic Still, a British pediatrician, recognized the disorder we now refer to as ADHD (Hallowell & Ratey, 1994). Dr. Still described children who were hyperkinetic, unruly, and hard to control, and suggested that the disorder was either biological or the result of perinatal injury. Over the next few decades, the disorder was referred to as hyperkinetic syndrome, minimal brain dysfunction, physiologic hyperactivity--all terms that describe it as a problem associated with overactivity, impulsivity, and motor function. The Diagnostic and Statistical Manual of Mental Disorders (DSM-II) (American Psychological Association [APA], 1968) referred to it as "Hyperkinetic Reaction of Childhood," again stressing the motor component. DSM-III (APA, 1980) bifurcated the disorder: ADD with hyperactivity and ADD without hyperactivity. The DSM-III-R (APA, 1987), however, returned to a one-dimensional paradigm, lumping together varying degrees of hyperactivity and impulsivity. …