Watching for Speed Bumps on the Way to an A.D.H.D. Diagnosis

In school, she would procrastinate and then pull desperate all-nighters to study for an exam. She’d become hyperfocused on a project and let everything else fall by the wayside. Maintaining relationships was tricky.“I would concentrate intensely on a friend and then move on,” she said. She commuted to college one year simply because she had missed the deadline to apply for housing.

“I managed to achieve a lot, but it was difficult,” said Ms. Goldberg, a mother of three who lives near Philadelphia.“I sensed something was wrong, but others would always talk me out of it.”

Finally, in her late 40s, Ms. Goldberg was given a diagnosis ofattention deficit hyperactivity disorder, a condition caused by signaling problems in the brain. The primary symptoms are impulsiveness, inattention,restlessnessand poor self-regulation. Children with the condition tend to be hyperactive, but adults who have it often just seem distracted and disorganized.

Undiagnosed, A.D.H.D. can wreak havoc on relationships, finances and one’s self-esteem. Adults with the disorder are twice as likely as those without it to be divorced, for instance, and four times as likely to have car accidents. It’s no surprise that they also tend to have poor credit ratings.

“A.D.H.D. is a very debilitating mental disorder,” said Russell Barkley, a clinical professor ofpsychiatryat the Medical University of South Carolina.“It can produce more severe impairment, and in more domains of life, than depression or anxiety.”

More than 5 percent of adults have A.D.H.D., according to a recent study by Dr. Barkley. But just 10 percent of those adults have a formal diagnosis.

It’s an expensive problem for many consumers. Adults with the condition, particularly women, are frequently given a diagnosis of depression, anxiety orbipolar disorderinstead— or their symptoms are dismissed, as Ms. Goldberg’s were.

Ms. Goldberg said of her eventual diagnosis:“It was so freeing. I realized,‘I’m not stupid— I have a mental disorder.’ ”

Just getting the correct diagnosis can be costly.“Many clinicians do not know how to spot the signs,” said Ari Tuckman, a psychologist in West Chester, Pa., and author of a book about A.D.H.D.,“More Attention, Less Deficit” (Specialty Press, 2009).

Clinicians may arrive at the diagnosis with a snap judgment, or they may send patients for lengthy and expensive neuropsychological evaluations. Both approaches tend to miss the main symptoms— and therefore waste the patient’s time and money.

If you think that you may have A.D.H.D., or that a friend or family member may, the first thing to do is get a proper diagnosis. Here’s how to get tested and what to avoid.

Step 1:Test yourself.

Cost:Free.

If you’re not quite sure if you or a family member has the disorder, start by printing out theAdult A.D.H.D. Self-Report Scaleand answering the 18-question assessment. It was developed by a team ofpsychiatristsin conjunction with the World Health Organization, and it is used by many clinicians to diagnose A.D.H.D.

The test is simple and has a straightforward scoring system. Use the results only as a guide to gauge your symptoms or a family member’s; it should not serve as a final diagnosis.

Bear in mind that A.D.H.D. is not something you suddenly develop as an adult; you are born with it.“If you tell me,‘My life was fine until I was 24,’ you don’t have this disorder,” said Dr. Barkley.

Avoid:Snap diagnoses.

Diagnosing this disorder takes time. A quick assessment, even by your favorite doctor or therapist, can miss important signs.

“I can’t guess how many clients I have had who have seen otherpsychologists, psychiatrists and primary care physicians who missed their A.D.H.D., even though it was burning like a bonfire,” said Dr. Tuckman.“It’s possible to make a diagnosis by using a rating scale and a 10-minute discussion, but it’s also far too easy to make an inaccurate diagnosis or miss a diagnosis.”

Step 2:Find an experienced clinician.

Cost:$200 to $500.

Make an appointment, or more than one, with a psychiatrist, psychologist or neurologist who has expertise in diagnosing A.D.H.D. Ask your doctor or a psychotherapist for a recommendation, or contact a local chapter of the organizationChildren and Adults With Attention Deficit/Hyperactivity Disorder(informally known as Chadd) and inquire about local professionals.

Dr. Barkley also suggests calling a nearby medical school or university psychiatry program and asking whether there is a doctor on staff who specializes in adult A.D.H.D.

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First Mention— M.R.I., 1974

On Feb. 9, 1974, The New York Times reported in its Patents of the Week column that Dr. Raymond V. Damadian, a physician and biophysicist at Downstate Medical Center in Brooklyn, had patented a method for distinguishing normal from cancerous tissue by what was then called nuclear magnetic resonance.

The apparatus was“still under development,” the article said, and it mentioned several other patents recorded that week, including one for a new kind of no-iron all-cotton fitted bedsheet.

On Oct. 12, 1975, The Times described one of world’s most powerful N.M.R. spectrometers, built at Stanford University. The article said nothing about its potential use in medical diagnoses.

On July 21, 1977, Dr. Damadian was in the news again. He had announced a new technique for detectingcancer, using a one-and-a-half-ton, 10-foot-high device equipped with what he called“the world’s largest magnet.” His news release apparently exaggerated a bit, and Dr. Damadian later retracted a contention that his technique had already been used to discover cancerous tissue in a living patient.

By late 1978 other imaging techniques— positron emission tomography (PET scans), computed tomography (CT or CAT scans) andultrasound— were already being used in humans, and on Nov. 14, the lead article in the first issue of Science Times described the new procedures. Mention of nuclear magnetic resonance was relegated to the last two paragraphs, where it was called“one of the newest methods of imaging, and probably furthest from clinical application.”

But in the early 1980s magnetic scans were being performed on humans, andhospitalshad begun buying the devices. As the machines became more widely used, the word“nuclear” in the name frightened some patients with its suggestion that nuclear radiation was involved. An article on March 17, 1985, explained that now most doctors were calling both the procedure and the machines“magnetic resonance imaging,” or M.R.I. It was the first time The Times used the term that is universally accepted today.

On Oct. 7, 2003, The Times reported that Paul C. Lauterbur and Sir Peter Mansfield had won theNobel Prizein Physiology or Medicine for“discoveries of imaging with magnetic resonance,” in the citation’s words, that“have played a seminal role in the development of one of the most useful imaging modalities in medicine today.” Dr. Damadian took out full-page newspaper ads to complain that he had been unfairly denied the prize.

NICHOLAS BAKALAR

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Leeks in White Wine - Recipes for Health

6 medium leeks, about 2 1/2 pounds, white and light green parts only

Salt

2 tablespoons extra-virgin olive oil

1 cup dry white wine, like pinot grigio or sauvignon blanc

Freshly ground pepper to taste

4 large garlic cloves, minced

2 tablespoons chopped flat-leaf parsley, mint or dill (or a combination)

1.Cut the ends and the dark green leaves off the leeks, and then cut them in half lengthwise. Place in a bowl of cold water for 10 minutes, then run them under the faucet to remove any sand that may be lingering in between the layers. Cut into 2-inch pieces.

2.Bring a large pot of water to a boil, salt generously and add the leeks. Parboil for two minutes and drain.

3.Spoon the olive oil into a wide, lidded skillet, and place the leeks in the skillet in an even layer. Pour in the wine, and add salt and freshly ground pepper to taste, and the garlic. Bring to a boil, cover and reduce the heat to low. Simmer for 30 to 45 minutes, until the leeks are very tender but still intact and most of the liquid has evaporated.

4.Remove from the heat, and allow the leeks to cool in the juices left in the pan. Transfer to a serving dish. Taste and adjust seasonings. Sprinkle on the fresh herbs and serve.

Yield:Serves four to six.

Advance preparation:The leeks will keep for a day or two in the refrigerator. Reheat or bring to room temperature before serving.

Nutritional information per serving (four servings):278calories; 1 gramsaturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 0 milligramscholesterol; 42 gramscarbohydrates; 5 gramsdietary fiber; 61 milligrams sodium (does not include salt to taste); 5 grams protein

Nutritional information per serving (six servings):185 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 3 grams monounsaturated fat; 0 milligrams cholesterol; 28 grams carbohydrates; 3 grams dietary fiber; 41 milligrams sodium (does not include salt to taste); 3 grams protein

Martha Rose Shulmanis the author of"The Very Best of Recipes for Health."

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Transplant Recipients of Julio Garcia’s Organs Gather in Thanks

“That’s my heart,” she said.“It’s still beating for me.”

Although she had just met Mr. Lourenco, she had known his heart for a long time. It had belonged to her husband, Julio, who died from abrain hemorrhagein March 2010, at the age of 38. Mrs. Garcia donated her husband’s organs, and the family’s loss led to a second chance for Mr. Lourenco, 57.

But he was not the only one. Seven or eight other people who urgently needed transplants also received organs from Mr. Garcia, an unusually large number. (The average from organ donors is about three.) Even more unusual, his family and a group of recipients met on Wednesday in a highly emotional gathering at the Manhattan headquarters of theNew York Organ Donor Network, which coordinated the transplants.

The story of the Garcias and the people whose lives were saved by one man’s donated organs provides a close look at the charged world of transplants and organ donation, where people on the transplant list know they may die waiting, and the families of brain-dead patients are asked, at perhaps the most painful time in their lives, to look beyond their own grief and allow a loved one’s organs to be removed to help strangers.

There are nowhere near enough donor organs for all the people who need transplants. Nearly 111,000 are on waiting lists in the United States, but last year, only 28,663 transplants were performed, according to theUnited Network for Organ Sharing, which oversees the transplant system nationwide. This year, 6,000 to 7,000 people are expected to die waiting.

Last week, Mrs. Garcia and her children, 5, 11 and 18, who all live in Stamford, Conn., met four of the recipients of her husband’s organs for the first time. A fifth recipient also attended, one of two people withrenal failure, both members of the Garcias’ church, whom Mrs. Garcia chose to receive kidneys.

Mrs. Garcia addressed a room packed with recipients, families, doctors, nurses, her minister and his family and network employees. She spoke briefly through an interpreter. She said her husband had had a big heart and would be very proud“to give life after death.” No one would ever forget him, she said.

Elaine R. Berg, president of the donor network, said:“These meetings don’t happen that frequently. I’ve been here 11 years, and if it’s once a year that’s a lot. I’ve never met five recipients from one donor. It’s highly unusual.”

In many cases recipients or donor families, or both, choose to remain anonymous, Ms. Berg said. Recipients may send thank-you letters through the network, but they and donors do not often choose to meet.

“It’s pretty intimidating and pretty emotional,” Ms. Berg said.“Some people cannot bear it.”

But she said that meeting the recipients can bring solace to donor families.

Mr. Garcia was so young and strong that his corneas and six organs were healthy enough to transplant: his heart, one lung, his pancreas, both kidneys and his liver, which was divided to save two people, an adult and a child.

In photographs, Julio Garcia was handsome, with a mischievous smile. His wife said he loved to joke and laugh. But he was also deeply religious, and as a pastor at their evangelical church in Stamford he did a lot of preaching and marriage counseling. He earned his living as a carpenter. Both he and his wife, originally from Guatemala, became naturalized citizens.

For many years, he had suffered periodically from severe headaches, but he had been told they were migraines. The headaches were unusually bad during the week or so before March 17, a Wednesday. That day, his head hurting, he told his children he loved them and went to work.

He called his wife that afternoon, saying the pain was terrible and he was going numb all over. She wanted to call an ambulance, but he asked her to pick him up instead. She drove him to a hospital in Stamford. A major hemorrhage andswellingwere putting pressure on his brain. Doctors tried to relieve the pressure, and then transferred Mr. Garcia to NewYork-Presbyterian/Weill Cornell hospital in Manhattan.

By the time he arrived there on Wednesday night, he was in a deepcoma, needed a ventilator to breathe and had extremely lowblood pressure— all signs of a large hemorrhage affecting the brain stem, according to Dr. Axel Rosengart, the director of neurocritical care. Doctors stabilized him and tried again to reduce the pressure on his brain, but scans showed extensive, irreversible damage, Dr. Rosengart said.

Dr. Rosengart said he was not certain but suspected that the bleeding was caused by an arteriovenous malformation, a blood vessel abnormality that Mr. Garcia may have had from birth.

By Thursday, Dr. Rosengart said, he began to warn the family that Mr. Garcia was heading toward brain death. Later that day, the diagnosis was made twice, by two different physicians, in accord with state law. A patient with brain death is legally dead. At that point, there were two priorities, Dr. Rosengart said:“the family and their emotional survival, and preserving the organs.”

Brain-dead patients can become medically unstable, and intensive treatment is often needed to prevent their organs from failing.

Dr. Rosengart and a social worker from the New York Organ Donor Network asked Mrs. Garcia about organ donation.

At first, Mrs. Garcia recalled, she could not accept the diagnosis of brain death. Still hoping a miracle would save her husband, she asked them to wait.

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Dabrali Jimenez contributed reporting.

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Using Biomechanics to Improve Surgical Instruments

Physcient is, in fact, a medical technology company. But its décor speaks to the exceptional careers of its co-founders, Hugh Crenshaw and Charles Pell. They both got their start studying biomechanics— how creatures fly, swim and crawl. Mr. Pell built models of muscles and fish heads. Dr. Crenshaw earned his Ph.D. figuring out how single-celled creatures swim. And over the past 20 years they’ve profitably translated their understanding of biomechanics into inventions, from robotic submarines to pill sorters.

Now they’re turning their attention to the world of surgery. The instruments that surgeons use today, they argue, were invented before biomechanics became a mature science. They work against the physics of the body, instead of with it.“The technologies remain remarkably unchanged,” said Dr. Crenshaw.“Maybe we can do better.”

Dr. Crenshaw and Mr. Pell are starting with a kindler, gentler rib spreader. Surgeons often treat the broken ribs and other painful side effects ofopen heart surgeryas inevitable. But Dr. Crenshaw and Mr. Pell have invented a new kind of rib spreader that takes into account how bones can bend, rather than break. Their preclinical studies on pigs suggest that it causes far less damage.

If it turns out to work as they hope, the inventors will turn their attention to other tools of the trade.“The entire surgical tray is going to be transformed,” said Mr. Pell.

As a boy, Mr. Pell was, in his words,“a congenital geek.” He spent his free time building rockets, cars and wave machines. He went to art school and earned a master’s degree in sculpture, but his sculptures were more like robots than marble busts. After graduate school, Mr. Pell headed for California, where he ended up director of research and development at a company that built robotic dinosaurs for museum exhibits. He continued to come up with strange designs, like a water-filled arch that fish could swim inside to travel from one pond to another.

To figure out if a fish could physically survive the journey through a water bridge, Mr. Pell called up Stephen Wainwright, a pioneer in biomechanics at Duke University.“He said,‘Who are you, and why are you doing this?’ ” recalled Mr. Pell. Despite his initial misgivings, Dr. Wainwright ended the conversation by offering to fly Mr. Pell to Duke for a visit. Not long afterward, Mr. Pell became the director of the BioDesign Studio at Duke.

At the studio Mr. Pell helped Dr. Wainwright and his colleagues build models to test their ideas about biomechanics, creating models of spinal cords, muscles, jaws and dozens of other animal parts.“These models can physically surprise you,” said Mr. Pell.“They can show you things that you didn’t think of before you built them.”

One of Mr. Pell’s biggest surprises came when he tried to make a simple model of a swimming fish. He built a rubber tube with a rounded front and then stuck a rod a quarter of the way down its length. When he put the tube in water and turned the rod back and forth between his fingers, it generated a wave with its tail. While making a new version of that tube, Mr. Pell accidentally nicked the tail end. That new shape, he discovered, caused the water to flow in a different pattern around the tube, creating thrust.

Mr. Pell, Dr. Wainwright and their colleagues got a patent for the design and started a company called Nekton to develop products from it. First, they turned it into a commercially successful bathtub toy. But when the Navy discovered Mr. Pell and his colleagues could get fishlike thrust from something without any moving parts, they encouraged him to get into the business of building underwater robots. Mr. Pell and his colleague at Nekton ended up making a highly maneuverable yardlong robot called the Pilot Fish.

“We started out as a toy company; we ended up as a defense contractor,” said Mr. Pell.

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A New Gauge Helps to See What’s Beyond Happiness

Martin Seligman now thinks so, which may seem like an odd position for the founder of the positivepsychologymovement. As president of the American Pyschological Association in the late 1990s, he criticized his colleagues for focusing relentlessly on mental illness and other problems. He prodded them to study life’s joys, and wrote a best seller in 2002 titled“Authentic Happiness.”

But now he regrets that title. As the investigation of happiness proceeded, Dr. Seligman began seeing certain limitations of the concept. Why did couples go on having children even though the data clearly showed that parents are less happy than childless couples? Why did billionaires desperately seek more money even when there was nothing they wanted to do with it?

And why did some people keep joylessly playing bridge? Dr. Seligman, an avid player himself, kept noticing them at tournaments. They never smiled, not even when they won. They didn’t play to make money or make friends.

They didn’t savor that feeling of total engagement in a task thatpsychologistscall flow. They didn’t take aesthetic satisfaction in playing a hand cleverly and“winning pretty.” They were quite willing to win ugly, sometimes even when that meant cheating.

“They wanted to win for its own sake, even if it brought no positive emotion,” says Dr. Seligman, a professor of psychology at the University of Pennsylvania.“They were like hedge fund managers who just want to accumulate money and toys for their own sake. Watching them play, seeing them cheat, it kept hitting me that accomplishment is a human desiderata in itself.”

This feeling of accomplishment contributes to what the ancient Greeks called eudaimonia, which roughly translates to“well-being” or“flourishing,” a concept that Dr. Seligman has borrowed for the title of his new book,“Flourish.”He has also created his own acronym, Perma, for what he defines as the five crucial elements of well-being, each pursued for its own sake: positive emotion, engagement (the feeling of being lost in a task), relationships, meaning and accomplishment.

“Well-being cannot exist just in your own head,” he writes.“Well-being is a combination of feeling good as well as actually having meaning, good relationships and accomplishment.”

The positive psychology movement has inspired efforts around the world to survey people’s state of mind, like a new project in Britain to measure what David Cameron, the prime minister, calls GWB, for general well-being. Dr. Seligman says he’s glad to see governmentsmeasuring more than just the G.D.P., but he’s concerned that these surveys mainly ask people about their“life satisfaction.”

In theory, life satisfaction might include the various elements of well-being. But in practice, Dr. Seligman says, people’s answers to that question are largely— more than 70 percent— determined by how they’re feeling at the moment of the survey, not how they judge their lives over all.

“Life satisfaction essentially measures cheerful moods, so it is not entitled to a central place in any theory that aims to be more than a happiology,” he writes in“Flourish.” By that standard, he notes, a government could improve its numbers just by handing out the kind of euphoriant drugs that Aldous Huxley described in“Brave New World.”

So what should be measured instead? The best gauge so far of flourishing, Dr. Seligman says, comes from a study of 23 European countries by Felicia Huppert and Timothy So of the University of Cambridge. Besides asking respondents about their moods, the researchers asked about their relationships with others and their sense that they were accomplishing something worthwhile.

Denmark and Switzerland ranked highest in Europe, with more than a quarter of their citizens meeting the definition of flourishing. Near the bottom, with fewer than 10 percent flourishing, were France, Hungary, Portugal and Russia.

There’s no direct comparison available with the United States, although some other researchers say that Americans would do fairly well because of their sense of accomplishment. The economist Arthur Brooks notes that 51 percent of Americans say they’re very satisfied with their jobs, which is a higher percentage than in any European country except Denmark, Switzerland and Austria.

In his 2008 book,“Gross National Happiness,” Dr. Brooks argues that what’s crucial to well-being is not how cheerful you feel, not how much money you make, but rather the meaning you find in life and your sense of“earned success”— the belief that you have created value in your life or others’ lives.

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Haiti - Ambitious Vaccine Plan for Newborns

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