ADD/EFD Overview 101

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I use “ADD” to include AD/HD, ADHD etc. Check out What’s in a Name for why.

ADD/EFD BASICS: A Brief Overview

by Madelyn Griffith-Haynie, CTP, CMC, ACT, MCC, SCAC
First article in a 5-Part  Series

Brain graphic surrounded by the following terms in various colors: disinhibition, hyperactivity, forgetfulness, inattention, distractedness, disorganization

If you are one of the many ADD/EFDers who struggles to stay focused when you read . . .

You may find that the beginning of this article is a little more slow going than most of the articles on this site — unfamiliar technical terms are always a bear!  

If you can possibly read through it, the information will be worth your effort — if only to have a bit of science to throw back at those opinionated nay-sayers who pooh-pooh the existence of ADD or EFD as valid diagnoses.

It will also help you hold your own in response to hearing or reading some idiot popping off with sound-bite logic-that-isn’t, like: “ADD is not caused by a Ritalin deficiency.”

The information “builds on itself” – the reading gets easier as you go — and I do my best to explain terms in “plain English” — well, plain-ISH, anyway!!

The rest of the articles in this series aren’t “tech-talky” – so if you CAN’T get through THIS one, don’t let it keep you from clicking through to the others.

Click HERE for the next article in this series

For those who read easily: There are tons of links to additional information on this post (dark gray, remember, so they’re not distracting while you’re trying to read what’s here) – scroll your mouse over the page and the links will almost jump out at you.  Hover for a moment before clicking and a bit of info will appear. (BTW- ALL links on THIS page will open in a NEW window or tab)

NOW, what’s up with ADD/EFD, anyway

 check the right column for how links work on THIS site.


What is ADD/EFD?

The term Attention Deficit Disorderonly one of the Executive Functioning Disorders, refers to a family of disorders marked by attentional impairment, distractibility, disorganization and, often, impulsivity, motor hyperactivity, conduct problems and low frustration tolerance.

ADD/EFD is considered by many hundreds of scientists, researchers and brain-related specialists to be a medically valid diagnosis that identifies a neurochemical, neurodevelopmental disorder — essentially, a genetically inherited chemical-communication “glitch” resulting in atypical neural (brain) development.

  • In other words, without effective intervention, this atypical brain development leads to impairments in the ongoing development of the brain or CNS (central nervous system) –particularly in areas responsible for what are called the brain’s executive functions.
  • In addition to all types of critical thinking (the foundation for sound judgment), how well our executive functions support us determines our success with the ongoing, day-to-day tasks of life: planning, prioritizing, organizing, delaying gratification (impulse control), and working within the boundaries of time.

On I use ADD to include AD/HD or ADHD (respectively, the DSM-IV and DSM-5 “official” names for the disorder their time around), as well as all its other names. As explained in ADD-What’s in a Name, unless, I am directly quoting material from others, the only time I will use “AD/HD” is when I am specifically directing your attention to one of the hyperactive components of attentional dysregulation.

The Three Types of Hyperactivity

•   Gross Motor Hyperactivity (no brakes)
•   Fine Motor Hyperactivity (fidgeting)
•   Cognitive Hyperactivity (a brain in overdrive)

So, what’s up with ADD/EFD?

Basically, in a person with an ADD/EFD diagnosis, the brain’s filtering & focusing areas are not operating well, so its “juggling ability” is limited by the number of “attentional balls” it is forced to juggle already

There is difficulty sorting out incoming stimuli – prioritizing focus as well as “back-grounding” ambient or persistent stimulation (refrigerator hum, street noise, clutter, scratchy clothing tags, flickering florescent lighting, itchy bug-bites, drippy allergy noses, etc.).

When the brain’s automatic filtering mechanisms are impaired, the strongest stimuli capture an individual’s conscious awareness  (color, movement, sound, tactile or kinesthetic feedback, and so on).

What is considered “strongest” is a matter of individual perception, brain by brain, but the resulting lack of consistency in functioning, generally appears to an observer in one of the following ways:

a)  motor hyperactivity (gross or fine-motor — sometimes combined with impulsivity)
b)  hypo-activity (daydreaming or “spaciness”)
c)  mixed by stimulus and circumstance (both involuntary)

The “Attention” portion of the name of the disorder refers to a concept that is broader in scope than what we normally consider when we  say that someone is or is not “paying attention.”  It refers primarily to intentional, discriminatory focusing –  the process and dynamics of “attending.”

The Dynamics Of Attendingspecifically refers to a three part process:

1.  Focusing on the intended stimulus
2.  Sustaining the focus
3.  Shifting focus at will

Adequate control of each of the three dynamics are necessary parts of the registration phase of the memory process and in the development of adequate learning systems.

Problems with any or all dynamics are at the very heart of the ADD/EFD characteristics.
ADD/EFDers typically have trouble with at least one, often all three — in addition to the linking and retrieval stages of the learning process.

Can you hear me NOW?

ADD/EFD develops as a result of the combined input of nature and nurture: from your genetic inheritance influenced by your life experiences and environment.

Researchers continue to study the link between ADD/EFD and brain chemistry, especially related to the major players in parts of the brain that regulate attention and impulse control.

The brain cells we know most about right now communicate using chemical messengers known as neurotransmitters.

These chemical messengers are produced within the brain cells themselves, in neuron “manufacturing plants” called mitochondria.

Neurotransmitter “messengers” are then released into the neurological “hallway” between cells known as the synapse.

If anything interferes with the “typical” production of neurotransmitters, brain-cell to brain-cell communication breaks down, as well as communication from brain cells to other kinds of cells in other parts of the body.

No messengers, no message!  Faulty messengers, faulty messages.
Faulty messages, kludgy behavior!
(ADD/EFD, anyone?) 

A breakdown in “normal” (neurotypical) neurotransmitter function is what they mean when they say that there is a metabolic abnormality in the brains of ADD/EFDers.

Theories about Why

Functional Brain Scans have pinpointed impaired functioning in those areas of the brain which are used when people pay attention or keep still, and in response to intellectual challenge

You will run across this impaired functioning described scientifically as “frontal global deactivation” or “under-functioning of the premotor cortex and the superior pre-frontal cortex . . . sometimes coupled with increased activity in the left frontal and temporal lobes,” the area also associated with tic disorder), with varying displays of disorder by individual.

Which is a complicated way to say that ADD/EFD is possibly a collection of several syndromes, with differing causes and effects, responding to different treatments — but all involving the fact that the ADD/EFD brain works differently from the “non-ADD/EFD brain” in  certain measurable areas.

Dr. Thomas E. Brown coined the term “ADD-syndrome” to describe the entire spectrum of problems (“deficits”) that accompany what I most often refer to as ADD/EFD these days.  The development of ADD-syndrome seems to be initiated by a hereditary chemical failure in the parts of the brain that “fine tune” attention.

Ineffective “tuning” results in over or underproduction of neurotransmitters, some of which serve as a human “white noise machine ” — chemical filters that automatically block irrelevant stimuli — and/or are necessary players in the process of communication between areas of the brain necessary for certain executive functions.

Let’s hear it from the Dean

Way back in 1971, in his book Minimal Brain Dysfunction in Children,  Dr. Paul Wender“the Dean of ADD,” proposed the hypothesis that a metabolic abnormality in a particular classification of neurotransmitters – monoamines – accounted for some of the symptoms in  children with attentional deficits.  In particular, he targeted the monoamines dopamine and norepinephrine, and included implications for serotonin.

It just so happens that these particular neurotransmitters are particularly important for adequate functioning of the highly-specialized area of the brain behind your forehead, the frontal lobe, especially for the prefrontal cortex.

The “regulation responsibilty” of the frontal lobe is

  • to handle sequentially received information
  • to integrate current experiences with the past
  • to monitor present behavior
  • to inhibit inappropriate responses
  • to organize and plan for future goals

These tasks and abilities are usually referred to, collectively, as the Executive Functioning role of the frontal lobes.

Dysfunction of the frontal lobes can lead to problems in the areas of attention, production, impulse control, and/or cognition.

The prefrontal cortex is abundant in catecholamines, a particular type of neurotransmitter.

  • The dopamine tracts form pathways between the motor centers (movement) and the limbic center (emotions) to the frontal structures (executive functions).
  • The prefrontal cortex also receives norepinephrine input from the lower brain structures (more primitive, “knee-jerk” functions).
  • Consequently the presence and regulation of dopamine and norepinephrine in the prefrontal areas may well be crucial to proper functioning of the frontal lobes.
    (Oops! That is just exactly where the ADD/EFD “glitch” seems to be too — no WONDER we’re struggling!)

Regardless of the source of the imbalance, the result is the same: problems with the executive function because the pre-frontal cortex isn’t able to do it’s job – it is unable to disinhibit inappropriate responses (faulty brakes).

  • Which parts of the job it falls down on seems to be a function of a lack of neurotransmitter balance.  
  • We see different behaviors and reactions, depending on whether the source is an undersupply of one neurotransmitter or an oversupply of another.


ABOUT the Primary Symptoms of Catecholamine Imbalance
(and one monoamine)

The primary symptom of an undersupply of bioavailable dopamine appears to be disinhibition (under-arousal/inattentive).

Dopamine undersupply can be compensated for by treatment with stimulants or clonidine.

My belief is that the lack of sufficient bioavailable dopamine leads to problems with the ability to direct focus: intentional focus ability (the first Dynamic of Attention)

The primary symptoms of an oversupply of bioavailable norepinephrine appears to be disinhibited hyperactivity/aggression/anxiety (the lack of ability to control these states).

Too much norepinephrine can also be regulated with stimulants.

Patients who are over aroused and hypervigilant may be more responsive to alpha-2-noradrenergic agonist drugs such as clonidine.

My belief is that too much norepinephrine leads to problems with the ability to sustain intentional focus (the second Dynamic of Attention).

The primary symptoms of an oversupply of bioavailable epinephrine appears to be disinhibited behavioral control (rage/tantrums/violent behavior).

It is frequently treated with Tegretol, Depakote or Inderal.

My belief is that too much epinephrine negatively impacts the ability to shift focus at will (the third Dynamic of Attention).

The primary symptoms of an undersupply of bioavailable serotonin,
our monoamine, appears to be depression, rumination, mini-panic states, or obsessive/compulsive behaviors.

Serotonin undersupply can be compensated for by treatment with a particular medication that was originally developed specifically for depression: Selective Serotonin Reuptake Inhibitors (SSRIs).

Although the role of serotonin in ADD/EFD has not been scientifically established biochemically

My belief is that it will eventually be accepted that adequate serotonin is also essential to be able to shift focus at will (the third Dynamic of Attention).

  • It is not uncommon for ADDers to be prescribed a sub-clinical dose of an SSRI* to help with “distractibility.” (*Zoloft, or its generic, sertraline, quite often, because it doesn’t interfere with Dopamine utilization)
  • What IS distractibility if it’s NOT difficulty of the third Dynamic of Attention: shifting focus at will? 

ADD/EFDers also report (anecdotally) – and I myself have experienced – that the emotional testiness, irritation or anger that generally accompanies continued distractions or interruptions is practically eliminated with a small dose of sertraline.

WHY?  Because we are able to go back to whatever we were doing without the usual hobbit-trail experience that otherwise follows whenever we are pulled off-task.


Now that you have an overview to serve as a general explanation for some of what’s going on with ADD/EFD, stay tuned for the posts where I will give you some specific things to look at, and to add to your list of symptoms that you take to your appointments with your doctors (you DO write things down and take a list to your doctor’s appointments, right?)

Thanks to Patricia O. Quinn, M.D. a developmental pediatrician in Washington, D.C. with the Georgetown University Medical Center for her notes and seminar delivered in May, 1996 at the 2nd ADDA conference in Pittsburgh, which was the genesis of my original material including the catecholamine information above, edited and excerpted for this post.  Check her out – she’s an expert on ADD in Women and Girls.

As always,
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Articles in the ADD/EFD Overview series:

A few other related articles here on ADDandSoMuchMore

For more info offsite:

BY THE WAY: Since is an Evergreen site, I revisit all my content periodically to update links — when you link back, like, follow or comment, you STAY on the page. When you do not, you run a high risk of getting replaced by a site with a more generous come-from.




About Madelyn Griffith-Haynie, MCC, SCAC
Award-winning ADD Coach Training Field founder; ADD Coaching field co-founder; [life] Coaching pioneer -- Neurodiversity Advocate, Coach, Mentor & Poster Girl -- Multi-Certified -- 25 years working with EFD [Executive Functioning disorders] and struggles in hundreds of people from all walks of life. I developed and delivered the world's first ADD-specific coach training curriculum: multi-year, brain-based, and ICF Certification tracked. In addition to my expertise in ADD/EF Systems Development Coaching, I am known for training and mentoring globally well-informed ADD Coach LEADERS with the vision to innovate, many of the most visible, knowledgeable and successful ADD Coaches in the field today (several of whom now deliver highly visible ADD coach trainings themselves). For almost a decade, I personally sponsored and facilitated seven monthly, virtual and global, no-charge support and information groups The ADD Hours™ - including The ADD Expert Speakers Series, hosting well-known ADD Professionals who were generous with their information and expertise, joining me in my belief that "It takes a village to educate a world." I am committed to being a thorn in the side of ADD-ignorance in service of changing the way neurodiversity is thought about and treated - seeing "a world that works for everyone" in my lifetime. Get in touch when you're ready to have a life that works BECAUSE of who you are, building on strengths to step off that frustrating treadmill "when 'wanting to' just doesn't get it DONE!"

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  10. Ken says:

    I came to to this website while reading a sports article which had a advertisement on Neuroflexyn. When I saw Add, add/HD on your website I studied the symptoms. I’m 53 taking Vyvance for ADHD and have been suffering my whole life with many of the symptoms under add,add/HD. I started taking Vyvance at 49 while attending marriage counseling, which many of our problems for my part I believe were and still are caused by many of those adhd should I say qualities. After many years of unfinished responsibilities, constant interrupting, just getting by. I didn’t complete college lost a job of 24 years by basically not focusing. I have to start over every day forgetting about what I didn’t do yesterday, but I’m lucky to be able to do that and look at positives over negatives. I’m fighting to improve myself for me ,my kids and family and friends. Consequently you loose confidence of ability and question everything you do. I want to move forward to success in marriage, as a dad and other things but I keep running into the same obstacles and starting over. You have to complete things achieve things love and communicate. My communication skills are getting worse , lost friends disconnected with family and friends all because of my inability to focus listen and believe in myself from many of the characteristics of ADHD. It may he therapeutic to type this out. I want to understand this and look ahead not back and get out of my head. There is a lot out there which I want to feel share and enjoy. Maybe there is something to get out of this and to realize I’m not the only person struggling with this.

    Liked by 1 person

    • I’ll be back. If you see only this – come back for more. xx, mgh
      NOPE! You are most certainly NOT the only person struggling with this – and I DO believe that connecting with others with the same struggles is more than therapeutic — it lets us all have an experience of “tribe.”

      I was not dx’d until I was almost 40 – and I am STILL having to overcome ADD/EFD obstacles EVERY SINGLE DAY. As you will read all over this blog, knowing exactly what you are facing is step one, building your work-arounds is step two, and the rest of it is the hardest – developing new habits to be able to DO what you know.

      Take a look at this link:

      And jump through the links on this one:

      And keep coming back! Thanks a bunch for taking the time to comment.
      PS. I just started my Neuroflexyn trial – and will be reporting my experience here, so do come back to read how it affected ME (with the reminder that no two of us are alike!)


  11. Miranda says:

    I think the admin of this web site is really working hard in favor of his website, because here every information is quality based


  12. 2NoYGDGMm says:

    Surely did not recognize that. Learnt 1 thing new today! Thanks for that.


  13. This is the most cogent overview of ADD that I can remember reading. I will share this with clients and students as appropriate.
    I thought I knew a lot about ADD since it runs in my family — but this post contains information I don’t recall seeing: 3 types of hyperactivity, dynamics of attending, etc.

    Now I have read Thom Hartmann’s stuff — but that was 10 years ago.

    Thanks for having this information so accessible.


    • PS I just posted a link to this post on my facebook fan page at I will tweet about it too –useful stuff.


    • From YOU, that is high praise indeed! Thank you. I try not to make the articles on this site “overly” technical, but that’s a fine line to walk with a background overview.

      I strongly believe that understanding the neurochemistry to at least THIS level really helps to get a handle on WHY certain things that many do easily might be difficult for anyone in the Attentional Spectrum Disorders group. THEY ARE TOO “trying hard enough” — but, just like a third grader trying harder to squint her way into visual focus so she can read what’s on the blackboard, its probably not going to work without a bit of “focus help.”

      The two “newbies” to you are my compilation specifically – although I can’t claim to have “invented” the info in the categories. The information is certainly “out there” – but I may have been one of the earliest to categorize it 1-2-3. Much of my content about the “implications” of an ADD diagnosis and my ADD Coaching techniques to work around Challenges builds on these concepts, so I needed the shorthand.

      side comment – Thom is a favorite of mine as well – he and his wife Louise were part of OFI’s ACT-10 (teaching more than learning, natch! – but all trainers had to be part of a class). Focus Your Energy was one of the five required texts from Day-1 (original out of print, but content can be found in part three of Thom Hartmann’s Complete Guide to ADD). ALL of his books are helpful, and particularly wonderful resources for those who struggle with reading. His Healing ADD (distinct from Amen’s book by the same title) is a synthesis of NLP underlying concepts with Thom’s ADD info – with a forward by Bandler himself.


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