The phone is ringing again at the posh day spa where Betsy Patterson ushers in an elegant new client. A customer is calling to schedule an eyebrow wax, but Betsy can't fit her in; the 41-year-old esthetician and masseuse is fully booked for the next week. "Tell her I'm sorry" Betsy asks the receptionist. Then, self-assuredly, she leads the way back to her high-tech facial treatment room.

Watching this confident professional analyze her client's vexing skin problems, it's hard to believe there was ever a time when Betsy herself didn't fit in. This irony is not lost on the vibrant, dark-haired beauty who twenty years ago was a divorced, unemployed high school dropout forced to move back home with her parents after her second child was born.

"I didn't develop the patterns of behavior it took to be an adult," Betsy recalls during a brief break between clients. "I'd go out and buy an expensive car and make the first payment, but that was it. My Dad would always have to pay the rest."

The ADHD that made Betsy's high school years so miserable made her early adulthood a daily disaster. "My twenties was a period of going from job to job," she says. "I was always getting fired or screwing up."

Some of the screw ups scared her. Once, while employed at a nursing home, she confused two patients medications. "I had thought I might want to be a nurse," she says. "But I realized then that it was never going to happen." A job in finance ended in a similar disaster. "My boss said to me 'You have thirty days to straighten up.' But I told him, You might as well just go ahead and fire me now because it's not going to get any better." So he did.

Eventually things did get better for Betsy, a transformation she credits in part to having to care for her two young sons. "The one thing I knew how to do well was to be a great mother," she says. "I probably never would have grown up if I hadn't felt such a responsibility for them."

That sense of responsibility grew even greater when her second son was diagnosed with ADHD. Then in her mid-thirties, Betsy obtained her esthetician's license and sent herself to massage school. Today, she's busily employed, supporting her family, and finally content." I found something I really love to do that I'm good at, she says. The part I love most is the daily contact with people."

A Question of Maturity
Betsy's story is typical of many young adults with ADHD. The maturation process is slower for young adults with ADD and it's not linear, says Kathleen Nadeau, Ph.D., Director of Chesapeake Psychological Services of Maryland and co-author of, Understanding Girls With ADD. There's a lot of up and down, back and forth. It's slow, but that doesn't mean they're never going to get there. Sometimes they don't until they're 35 or 40 years old. Which was certainly the case for Betsy. "I don't think I really reached adulthood until I was forty" she admits. But Betsy didn't realize that the reason my be partly neurobiological.

The brain's frontal lobes, which are involved in ADHD, continue to mature until we reach age 35. In practical terms, this means that people with ADHD can expect some lessening of their symptoms over time. Many will not match the emotional maturity of a 21-year-old until their late 30's. So while most people graduating from college take time to adjust to adult life, people with ADD need more time, more family support, and more professional help.

MORE TIME
Parents can't solve their adult children's problems, but their actions can hurt or help. Comparing newly graduated ADDers to higher achieving peers and siblings hurts. Patience helps.

Parents really need to alter their expectations, says Nadeau, who sees dozens of young adults in her practice. Lots of what I'm doing at work is really parent education. Parents are comparing their ADD kids to peers who are going to graduate school, doing internships, and getting high-paying jobs. I try to help parents understand that there are some things that people with ADHD are bad at and they always will be. They need support, not criticism.

At the same time, ADD graduates themselves need to take more time. Don't be in such a crazy hurry to settle down, says Nadeau, who advises recent graduates to spend a year or two living far from home on their own. She suggests they take menial jobs to support themselves temporarily before making a commitment to a significant career. They need to develop independent living skills first, says Nadeau, Paying the rent, registering the car, things like that. They can't transition to self sufficiency and a demanding job successfully at the same time. And living far away gets parents out of the rescue mode.

Nadeau tells of one client who took off for Alaska to find herself. "Her parents were furious," Nadeau recalls. We're prone to want our kids to be clones of us. But during that time she worked her way up to a marketing job, and within a few years she had worked her way back to an executive job with a high powered marketing firm in her home town.

Sometimes you have to let ADHD kids follow their whim, she says.

MORE PARENTAL SUPPORT
Parents can expect their twenty-something ADD kids to move back home from time to time, and should not regard it as a disaster. Like Betsy, young adults with ADD often need to regroup. There's a lot of back and forth, from an apartment situation that doesn't work out with a room mate, back to the parents' home, back to an apartment, back home. You have to be willing to support them during this period but with clear limits. These limits should include:

Rent: Tell them it's fine to move home, but that after three months they'll have to start paying rent.

Telephones: They must agree to install their own phone line so the family avoids teenage arguments over using it.

Belongings: They must be responsible for personal laundry, cleaning, and housework.

Meals: They are responsible for their own meals, but are welcome to join the family as long as adequate notice is given.

Expenditures: They must pay all their own bills. The biggest mistake I've seen parents make is paying off their kids' charge cards, says Nadeau. Young adults need to learn to put the brakes on themselves or suffer the consequences.

In short, parents should nudge but not push, support but not coddle. The maturation process for people with ADD proceeds in fits and starts. It's a process, says Nadeau. You have to help them move toward self sufficiency. It's not going to happen overnight.

MORE PROFESSIONAL HELP
People with ADD absolutely have more trouble with the school-to-work transition, says Sonya Goodwin-Layton, an ADD counselor in Louisville, Kentucky. They don't yet have enough self-reliance, self-discipline, ability to pay attention, time management skills, capacity to break down complex tasks, or focus to meet deadlines.

Layton finds the typical ADDer's need for constant stimulation leads to frequent job changes, which looks bad on a resume. That's one reason it's especially important to choose a career and job with extra care. Indeed, many of the time honored ways of finding employment-- Mom is friendly with the boss, or the neighbor down the street owns the company B can be disastrous for people with ADD, leading to disenchantment, failure, and excessive job hopping.