Attention Deficit Disorder

Attention Deficit Disorder (ADD) and Attention Deficit Disorder with Hyperactivity (ADHD) occur as a result of neurological dysfunction in the prefrontal cortex of the brain. This is the newest part of our tri-brain system in evolutionary terms. It is the part of our brain that has executive functions. The functions of this brain deal with 1) attention span, 2) perseverance, 3) judgment, 4) organization, 5) impulse control, 6) self-monitoring and supervision, 7) problem solving, 8) critical thinking, 9) forward thinking, 10) learning from experience, 11) ability to feel and express emotions, 12) interaction with the limbic system, and 13) empathy.

Whenever there is a problem with this part of the brain, a number of skills that many human beings take for granted would not be available in any optimal way.

The following are problems that develop when this brain is affected:

1. Short attention span
2. distract- ability
3. lack of perseverance
4. impulse control problems
5. hyperactivity
6. chronic lateness and poor time management
7. disorganization
8. procrastination
9. unavailability of emotions
10. misperceptions
11. poor judgment
12. trouble learning from experience
13. short-term memory loss
14. social and test anxiety

The exact neurological problem with ADD is unknown. However SPECT scans, single photon emission computed tomography, which measures cerebral blood flow and metabolic activity patterns, has noted that when someone with ADD concentrates, their prefrontal lobe activity decreases significantly. This essentially means that under stress and concentration someone with these disorders cannot bring to bear their full cognitive capacity.

It is theorized that our usual ability to screen out and attend to stimuli of our choice is impaired with these individuals. I like to think of it as going to the mall during the summer. It is too bright and there are too many people around, but it is not overwhelming. However, at Christmas time after a couple of hours at the mall people are so over-stimulated that it is hard to find the car. People with ADD feel this way almost all the time.

There are five recommended courses of treatment for someone with ADD or ADHD. Physicians often give an antidepressant such as Wellbutrin, which tends to calm the limbic system and increase dopamine, a neurotransmitter. In my experience, this can be helpful but stimulants, the second course, seem to do a better job. Stimulants given in small doses, so the mood alteration is minimal, act in a paradoxical manner. This means that instead of accelerating a person they help to focus and calm them while still allowing the prefrontal lobe to remain active. They also seem to increase dopamine as well. This neurotransmitter is negatively affected with people suffering from ADD. The third regimen, a combination of an anti-depressant and a stimulant, seems to work best for most people suffering from most forms of ADD. The fourth treatment consists of teaching relaxation, stress-management, organizational, and socializing skills. This should always be included as part of treatment whether or not medication is used.

Another form of treatment is the naturopathic approach. Due to my background I cannot adequately discuss this method, and as yet am not sufficiently familiar with the treatment to be able to measure its efficacy. At the present time, I am working with Dr. Mark Force and with a number of my clients, and he is quite confident about the benefits of this treatment. Dr. Force is a chiropractor and believes that diet, supplements and chiropractic care are very effective

There are numerous misconceptions about Attention Deficit Disorder and a lot of emotional fervor about the diagnosis. It reminds me of the debate over Prozac or over Alcoholism being a disease or a moral defect. It is understandable that people worry about giving young children a mood-altering drug. However, any time medication is considered as an approach, the physician needs to carefully assess both the costs and benefits and the severity of the problem. Most medication difficulties result from mismanagement. When the appropriate amount of medication is used with ADD the benefits are immense and the cost is minimal. A person’s life changes dramatically for the better. It is as if for the first time a person can think clearly and their self-esteem soars.

There is still a tendency in this country to feel that people need to pull themselves up by the bootstraps regardless of the severity of the problem. They are often blamed for their own illness. This happens a lot with ADD.

True ADHD with hyperactivity is rather easy to diagnose. However, only in the last ten years was ADD passive type recognized. This diagnosis is hard to spot and often is characterized by a general spacyness and inability to track. It also used to be common knowledge that children were the only ones to suffer from this disorder and that once they became 14 they grew out of it. What is more common is that in the normal course of experimentation with drugs and alcohol a person with this disorder finds amphetamines and becomes addicted. Almost right drug, wrong dose! Most people do not grow out of the disease. Interestingly enough, even with hard-core Methadrine addicts, if they are put on a small dose of Ritalin they thrive and it does not reactivate the addictive process.

Dr. Daniel G. Amen is the acknowledged leader in the field for the study of Attention Deficit Disorder. He has expanded the classifications of this condition within the last two years from the standard two types of Hyperactive and Inattentive by adding four more distinct types of ADD. He has done this by exhaustive research and has been aided by the SPECT scan, which is a sophisticated brain scanning tool that measures and clearly shows what part of the brain is most active. What is most impressive about his work is that he stresses the need for a multi-treatment approach. This includes attention to diet, exercise, vitamins, supplements, traditional psychotropic drugs, and behavioral techniques.

In “Healing ADD” Dr. Amen lists the six types of ADD as 1) Classic hyperactive, 2) Inattentive, 3) Over focused, 4) Temporal, 5) Limbic, and 6) Ring of Fire. Each of these types has much in common, but also differences in symptoms and treatment.

All of the types of ADD have as their primary feature periodic impairment of the prefrontal cortex of the brain and dopamine involvement. Classic ADD is characterized by both hyperactivity and inattentiveness. It is usually quite easy to treat by a combination of a high protein diet, aerobic exercise, a stimulant such as Adderall or Ritalin, and possibly the supplement of L-Tyrosine. Often an anti-depressant is used as well.

Inattentive ADD lacks the hyperactivity, but people who suffer from it have a difficult time focusing and are often very scattered. As with the classic type the prefrontal cortex is involved. The treatment for inattentive ADD is usually exactly the same as the classic type.

Over focused ADD exhibits the same problems and symptoms of prefrontal cortex as with classic and inattentive ADD, but the difference is that the sufferer of over focused often cannot break away from a thought or behavior. This is because the cingulated area of the brain is overactive and often locks a person into self-destructive, negative, or repetitive behavior. Often a stimulant will cause temper problems. Therefore, it is usually helpful to have the person take an anti-depressant first and only later to add the stimulant. Another possible treatment is to use St. Johns Wort, a natural herbal anti-depressant, but it is important not to use both a traditional and an herbal anti-depressant at the same time. The other forms of treatment such as diet and exercise is the same as the first two types of ADD.

Temporal ADD is still characterized by problems with the prefrontal cortex, but the temporal area of the brain is often affected. This could be from a previous head injury, but not necessarily. All the symptoms remain the same, but often extreme bouts of anger are also included. Treatment is often with a stimulant and an anti-convulsant such as Depecote. All other treatment is the same except the following supplements can be used: GABA, Ginkgo Biloba, or Vitamin E.

Limbic ADD is when the limbic area of the brain is also affected in addition to the prefrontal cortex. This ADD has the symptoms of inattentive ADD, but a significant proportion of depression is also present. A stimulant and a depressant are indicated. Aerobic exercise is needed, but often a complex carbohydrate and protein mixed diet is indicated. The following supplements are used: SAMe or L-tyrosine.

Ring of Fire ADD is a very disorganized and severe form of ADD that is a combination of all the other types. The entire brain is lit up on a SPECT scan. In addition to the standard treatment of a stimulant and an anti-depressant, an anti-psychotic like Respiridal is often called for. Dietary and Exercise treatment is the same as in inattentive type. The following supplements are possibly needed: GABA or Omega-3. Other supplements that have been found helpful with ADD in general are Zinc, Flax seed oil, and Serephos, sophisticated brain scanning tool that measures and clearly shows what part of the brain is most active.

The following is Dr. Amen’s test for ADD:

NAME ____________________________

DATE ____________________________

Please rate yourself on each of the symptoms listed below, using the following scale. If possible, also have someone else rate you (such as a spouse, lover, or parent). This is done to obtain a more complete picture of the situation.

0 Never

1 Rarely

2 Occasionally

3 Frequently

4 Very Frequently

N/A Not Applicable

SELF OTHER

____ ____ 1. Is easily distracted

____ ____ 2. Has difficulty sustaining attention span for most tasks in play, school, or work

____ ____ 3. Has trouble listening when others are talking

____ ____ 4. Has difficulty following through (procrastination) on tasks or instructions

____ ____ 5. Has difficulty keeping an organized area (room, desk, book bag, filing cabinet, locker, etc.)

____ ____ 6. Has trouble with time. For example: is frequently late or hurried, tasks take longer than expected, projects or homework are “last minute” or turned in late

____ ____ 7. Has a tendency to lose things

____ ____ 8. Makes careless mistakes, poor attention to detail

____ ____ 9. Is forgetful

____ ____ 10. Daydreams excessively

____ ____ 11. Complains of being bored

____ ____ 12. Appears apathetic or unmotivated

____ ____ 13. Is tired, sluggish, or slow-moving

____ ____ 14. Is spacey or seems preoccupied

____ ____ 15. Is restless or hyperactive

____ ____ 16. Has trouble sitting still

____ ____ 17. Is fidgety, in constant motion (hands, feet, body)

____ ____ 18. Is noisy, has a hard time being quiet

____ ____ 19. Acts as if “driven by a motor”

____ ____ 20. Talks excessively

____ ____ 21. Is impulsive (doesn’t think through comments or actions before they are said or done

____ ____ 22. Has difficulty waiting his or her turn

____ ____ 23. Interrupts or intrudes on others (butts into conversations or games)

____ ____ 24. Worries excessively or senselessly

____ ____ 25. Is super-organized

____ ____ 26. Is oppositional, argumentative

____ ____ 27. Has a strong tendency to get locked into negative thoughts, has the same thought over and over

____ ____ 28. Has a tendency toward compulsive behavior

____ ____ 29. Has an intense dislike of change

____ ____ 30. Has a tendency to hold grudges

____ ____ 31. Has trouble shifting attention from subject to subject

____ ____ 32. Has difficulties seeing options in situations

____ ____ 33. Has a tendency to hold on to own opinion and not listen to others

____ ____ 34. Has a tendency to get locked into a course of action, whether or not it is good for the person

____ ____ 35. Needs to have things done a certain way or becomes very upset

____ ____ 36. Others complain that he or she worries too much

____ ____ 37. Has periods of quick temper or rages with little provocation

____ ____ 38. Misinterprets comments as negative when they are not

____ ____ 39. Irritability tends to build, then explodes, and then recedes. Is often tired after a rage

____ ____ 40. Has periods of spaciness or confusion

____ ____ 41. Has periods of panic and / or fear for no specific reason

____ ____ 42. Perceives visual changes, such as seeing shadows or objects changing shape

____ ____ 43. Has frequent periods of déjà vu (feelings of being somewhere before even though he or she has never been there)

____ ____ 44. Is sensitive or mildly paranoid

____ ____ 45. Has headaches or abdominal pain of uncertain origin

____ ____ 46. Has a history of a head injury or a family history of violence or explosiveness

____ ____ 47. Has dark thoughts, may involve suicidal or homicidal thoughts

____ ____ 48. Has periods of forgetfulness or memory problems

____ ____ 49. Has a short fuse or periods of extreme irritability

____ ____ 50. Is moody

____ ____ 51. Is negative

____ ____ 52. Has low energy

____ ____ 53. Is frequently irritable

____ ____ 54. Has a tendency to be socially isolated

____ ____ 55. Has frequent feelings of hopelessness, helplessness, or excessive guilt

____ ____ 56. Has lowered interest in things that are usually considered fun

____ ____ 57. Undergoes sleep changes (too much or too little)

____ ____ 58. Has chronic low self-esteem

____ ____ 59. Is angry or aggressive

____ ____ 60. Is sensitive to noise, light, clothes, or touch

____ ____ 61. Undergoes frequent or cyclic mood changes (highs & lows)

____ ____ 62. Is inflexible, rigid in thinking

____ ____ 63. Demands to have his or her way, even when told NO multiple times

____ ____ 64. Has periods of mean, nasty, or insensitive behavior

____ ____ 65. Has periods of increased talkativeness

____ ____ 66. Has periods of increased impulsivity

____ ____ 67. Displays unpredictable behavior

____ ____ 68. Way of thinking is grandiose or “larger than life”

____ ____ 69. Talks fast

____ ____ 70. Feels that thoughts go fast

____ ____ 71. Appears anxious or fearful

To Score The Questionaire:

The scoring key is as follows: If you answered either frequently or very frequently (3 or 4) 6 or more times on questions 1-14 that indicates Inattentive ADD. This is the pivotal score. Unless this score is six or more the rest of the test is negative. However, if you have six or more on this first section and then six or more on any of the following sub- sections then Inattentive ADD and the separate subsection ADD is also positive. The following subsections though are not positive unless Inattentive is present.

Classic ADD is when 6 or more frequently or very frequently answers occur in questions 15 to 23. Over focused are questions 24-36. Temporal-37-49. Limbic-50-58. Ring of Fire-59-71.

2002, Jef Gazley