ADD-ADHD & Underfunctioning: Einstein at the Patent Office
Sunday, February 17, 2013 16 Comments
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by Madelyn Griffith-Haynie, CTP, CMC, ACT, MCC, SCAC
ADDendum to the 5-Part ADD Overview Series
Back when it was believed that anyone with ADD would outgrow those problems by the time they were about 14 years old, ADD was seen as simple hyperactivity, not as a problem with attention and EF (executive functions).
Longer term studies have shown that for about 70-80% of those with ADD, attentional symptoms tend to persist into adulthood.
This is true even in those individuals where former problems with [gross motor] hyperactivity can no longer be observed.
This more recent research indicates that, while there ARE about 30-80% of the ADDult population who do not continue to struggle with ADD to the degree seen in childhood, they are over-represented in the literature.
Since they are functioning better than 70-80% of us, they are ABLE to run their own lives with enough time left to blog, write books and articles, develop websites and blogs, and organize and speak to podcast audiences – while the rest of us work twice as hard for half as much, as ADD expert author Dr. Edward Hallowell continues to say.
Despite what you hear and read, a great many of us really are still struggling. We are living lives that may look good enough from the outside, but probably nowhere near what they could be, given what we have to do to keep outward appearances in place.
What if Einstein had kept his nice little patent office life?
Successful? hmmmm . . .
BETTER is not good enough!
While it is true that a great many diagnosed ADDults seem to manage better as they age, I am about to make the case that MOST ADDults, diagnosed or undiagnosed, continue to under-function for many, many years past puberty.
That, in turn, hamstrings their levels of achievement in ways that
“advantage-matched” non-ADDers do not experience.
- The majority of so-called “neurotypicals” have the additional
advantage of getting to swim with the current.
- ADDers are forced by a “neurotypical-dominant” society
to swim against it for much of the rest of our lives.
Yet the “finish times” of both groups are measured against one another in the Olympics of life as if both groups were swimming the same race.
Attempts at Leveling the Playing Field
Properly titrated medication can level the Executive Functioning playing field somewhat, but I want to remind us all that the Head Start Program was instituted because of the strong belief in the clear relationship between a strong start and life success.
ONLY those ADDers who are identified early in childhood,
with assistive technology in place from diagnosis,
GET that strong start.
MOST ADDers struggle for years before diagnosis,
EVEN those who are lucky enough to be diagnosed in childhood.
The apparent lessening of symptoms as adulthood approaches (coupled with the scare-tactics and ridicule of nay-sayers like the derisive Sir Ken Robinson) means that MANY ADDers do not even consider getting formally diagnosed until life struggles reach a point when they are no longer willing or ABLE to continue to soldier on.
Even once these floundering individuals reach the point of action toward diagnosis, far too many doctors are reluctant to diagnose and/or medicate ADDults who clearly need both, which delays successful treatment further.
And I think that’s a crying shame!
My attempts to educate are my only weapon in this war against shame, so GOOD FOR YOU for getting yourself educated!!! Before I go on, let’s take a look at what Brown has to say about why the struggle seems to lessen with age.
While I don’t disagree with his suggestions AT ALL, I do have a few addendums and qualifiers that might reframe them a bit. [my comments in red]
Three reasons may contribute to such [apparent] improvement:
1. For many with ADD, junior high, high school and the first few years of university are the most difficult.
This is because these are the years when one is required to cope with the widest range of academic tasks with the least opportunity to escape from the ones you’re not that good in (or particularly interested in studying – which can riddle an academic transcript with black-holes that can swallow-up future educational objectives)
When [and IF] one gets further along in education or employment it is often possible to specialize in work that is more interesting and which one can do reasonably well, without carrying so much of a burden of more challenging tasks. (assuming one has the education to qualify for those more interesting jobs & can lay off the self-medicating long enough to pass the drug test)
2. Imaging studies have shown that the course of brain development in adolescents with ADD is very similar to that of their age mates, except in a few specific regions of brain that are essential for executive functions.
Individuals with ADD tend to catch up in development of these delayed regions of brain crucial for executive functions about 3 to 5 years behind their peers.
This may account for some students who do poorly in high school and early college, then return to more advanced education a few years later and are very successful. (assuming, of course, they have not already concluded that they don’t have what it takes to be successful in an academic environment)
3. A third factor that helps many with ADD to improve their impaired executive functioning is treatment with appropriate medication.
For about 80% of those with ADD, executive function can be improved significantly with a carefully managed regimen of medication approved for treatment of ADD.
Medications cannot cure ADD, but, just as eyeglasses can improve vision when worn, for most individuals, regardless of IQ level, medication treatment for ADD can significantly improve executive functioning when it is appropriately used.
More information about ADD, executive function impairments, and this research on children, adolescents and adults with ADD (with a special focus on high IQ) can be found on Dr. Brown’s website
For those who read easily: Don’t forget that 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- links on THIS page have been set to open in a new window or tab, so you don’t have to go hunting for the rest of THIS article)
NOW, WHY do ADDers underfunction?
An Overview of ADD
Reviewing SOME of the information contained in ADD Overview 101, the first article of the ADD Overview Series, lets start by exploring the meaning of the diagnosis.
The term Attention Deficit Disorder refers to a family of disorders marked by attentional impairment, distractibility, disorganization and, often but not always, impulsivity, motor hyperactivity, conduct problems and low frustration tolerance.
As explained in ADD-What’s in a Name, unless, I am directly quoting material from others, the only time I will use “ADD/HD” is when I am specifically directing your attention to one of the hyperactive components of attentional dysregulation.
• Gross Motor Hyperactivity (no brakes)
• Fine Motor Hyperactivity (fidgeting)
• Cognitive Hyperactivity (a brain in overdrive)
I have heard and observed in my work over the last 25 years, that even when an ADDer is not considered “hyperactive” in the observable manner described by Hyperactivity Types one and two, the majority experience the third type: a brain in overdrive.
It makes it difficult to do a lot of things when “the committee in your head” is bouncing around thoughts, ideas and reminders without a [neurochemical] referee.
Without that mediator, staying tracked and focused – “paying attention” – is not a factor of will-power any more than attempting to eavesdrop on one conversation at a crowded, noisy cocktail party is a factor of import or resolve.
DESPITE what too many ADD-illiterate blogs and poorly researched articles in the popular press would have you believe, ADD is considered by many hundreds of expert scientists, researchers and brain-related specialists to be a medically valid diagnosis that identifies a neurochemical, neurodevelopmental disorder.
They are all in agreement that ADD is, essentially, a genetically inherited chemical-communication “glitch” resulting in atypical neural development.
- In other words, without effective intervention, this atypical brain development leads to impairments in the ongoing development of the brain – 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.
Basically, in a person with an ADD 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.
With executive functioning disorders, 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, a suddenly remembered to-do or funny joke, 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, cognitive ambush, 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:
IMPORTANT INFO: The “Attention” portion of the name of Attention Deficit 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 specifically to intentional, discriminatory focusing – the process and dynamics of “attending.”
“The Dynamics Of Attending“ refers specifically 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 characteristics and Executive Functioning Disorders. ADDers and many with TBI (traumatic brain injury) typically have trouble with at least one, often all three — in addition to the linking and retrieval stages of the learning process.
Where does it come from?
While TBI is a result of damage to the areas that impact intentional focus (and more), ADD develops as a result of the combined input of nature and nurture: from your genetic inheritance influenced by your life experiences and environment.
Although we still don’t know precisely why, researchers continue to study the link between ADD and brain chemistry, especially related to the parts of the brain that regulate attention and impulse control.
Neurons, the brain cells we know most about right now, communicate using chemical messengers known as neurotransmitters.
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.
As I’ve said before:
No messengers, no message!
Faulty messengers, faulty messages.
Faulty messages, kludgy behavior!
(ADD affect, 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 ADDers.
Theories about Why
Thom Brown coined the term “ADD-syndrome” to describe the entire spectrum of problems (“deficits”) that accompany ADD. 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 certain areas that are necessary in the process of communication between areas of the brain controlling the executive functions.
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 –with differing causes and effects, responding to different treatments.
Regardless of causation, they all involve the reality that the ADD-flavored brain style works differently from the “vanilla” brain style in certain measurable areas, with varying displays of disorder by individual.
This is not a “new” idea, btw
Way back in 1971, in his book Minimal Brain Dysfunction in Children, Dr. Paul Wender, “the Dean of ADD,” suggested 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 dopamine and norepinephrine, and included implications for serotonin.
It just so happens that these particular neurotransmitters are particularly important for adequate functioning of that highly-specialized area of the brain behind your forehead, the frontal lobe, in particular, the prefrontal cortex.
The “regulation responsibility” 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
As I’ve explained, these tasks and abilities are usually referred to, collectively, as the executive function 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 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 exactly where the ADD “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 functions 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.
- Take a wild guess at which parts of the brain are “balanced” by stimulant medications!
SO NOW WHAT?
Now that you have another overview to serve as a general explanation for some of what’s going on with ADD, click some of the related content posts (scroll down), 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?)
UPDATE: check out my reply to Edie’s comment below for a non-“scientific” overview of how stimulant medication does what it does, and what YOU can do to help — with meds or without!
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Articles in the ADD Overview series:
A few other related articles here on ADDandSoMuchMore
- Don’t Drink the Kool-Aid (includes the story of my own late-life dx)
- ADD: What’s in a Name
- The Procrastination Puzzle & the ADD Brain-style
- When You are New to ADD (Intro & links to “starter” articles on ADDandSoMuchMore)
- The Top Ten Stupid Comments by [supposed] ADD Professionals
- ABOUT Impulsivity
- Nine Challenges: What Are They?
- What ARE Executive Functions?
- Differential Diagnosis
- Brain Waves, Scans and ATTENTION
- ADD Meds Info for Moms Part I: Titration Troubles
For more info offsite:
- The Mysteries of ADD and High IQ (Thom Brown’s info on psychologytoday.com)
- Parents, getting your child diagnosed may change their life for the better!
(from a 22 yr. old ADD blogger dx’d at 7 — read my comments on his post too!)
- Confessions Of A Mum Packing Meds (theglobalmail.org) – a must read for parents!
- 70 percent increase in ADHD among black children, study finds (thegrio.com)
- Life Management Skills for Adult ADHD (everydayhealth.com)
- It’s Playtime! Choosing Toys and Games for Kids With ADD/ADHD (everydayhealth.com)
- ADD – Causes and Diet (dominicspoweryoga.com)
- An ADHD Primer (everydayhealth.com) good video on the site – but not TOTALLY accurate;
statistics on text are % “diagnosed” NOT % who have ADD btw – BIG difference!