ADD-ADHD/EFD & Underfunctioning: Einstein at the Patent Office


Swimming Upstream

by Madelyn Griffith-Haynie, CTP, CMC, ACT, MCC, SCAC
ADDendum to the  5-Part  ADD Overview Series

salmon_upstreamQuoting loosely from the  ADD blog authored by Yale’s Dr. Thomas E. Brown, on the website maintained by Psychology Today. . .

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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 . . .

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

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 everyone 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.

[CLICK to hear from a 22 yr. old ADD blogger dx’d at 7]

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]

Remember that you can always check out the sidebar
for a reminder of how links work on this site, they’re subtle ==>

HOVER before clicking – often a box will appear to tell you what to expect

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 101the 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 Nameunless, 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.).

High Distractibility

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:

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

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.

This is what we currently believe, based on what we know:

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 thevanilla” 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 lobesDysfunction of the frontal lobes can lead to problems in the areas of attention, production, impulse control, short-term memory, and/or cognition.

The prefrontal cortex is abundant in a particular classification of neurotransmitters known as catecholamines,

  • 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: Click HERE to read 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 (it will open in a new window/tab – depending on your browser settings – so this page stays right where you left it.)

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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!"

19 Responses to ADD-ADHD/EFD & Underfunctioning: Einstein at the Patent Office

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  8. I don’t know how Guest Posts works, and not sure where to ask you. I’d love to have you guest post on my site, but need your direction. I’m 100% that those who don’t jump over to your site will benefit from your writings. Please explain what I need to do. Thank you so much Madelyn for your time and patience with me. Take care and stay safe, Edie

    Like

    • I’d be honored! Basically, I send you the article and you post it under my “by-line” – introducing it however you’d like, or just sticking it up there.

      I’m already committed to be the April “guest blogger of the month” for the Ethos Community, so I’m not sure how much time I will have to write yet another article between now and my return from the ACO Conference in mid-April (I’m pretty covered up already!) – and I WOULD like to write something TBI specific – so maybe in May?

      xx,
      mgh

      Like

      • Great! It will take me till at least May to get all your instructions for doing this anyway!LOL That’s a fact! First things first, I want you to do it when you can but only if I know you are taking some time to take care of yourself. That might even mean meeting me for lunch or something someday this year! Take care and stay safe, Edie

        Like

        • Whoa! Talking to a voice with a BODY?! (What a concept) – I’d love it. It might take us a year to work out the logistics 😐 – but it sure would be worth it,huh?

          xx,
          mgh

          Like

  9. Thanks for clarifying this Madelyn. I signed up for chat with Dr. Parker, but I hope they send me reminders. I’m new to this, but it sounds like something I’m definitely interested in and could benefit my health and understanding. Education is number one priority in life. Looking forward to this.

    Like

    • I’m sure they WILL – and you’ll do FINE!

      The format is a little odd at first, and a bit tiring if you don’t have a headset or a speakers (for listening, not speaking – at risk of feedback), but you’ll be amazed how quickly you’ll lose your newbie edge!!

      I’m wondering HOW in the world he is going to manage the Q&A if he ends up with a huge crowd (which he just might!). Exciting!

      xx,
      mgh

      Like

      • I can use a headset, but I was thinking my daughter could join in with me and enjoy the educational opportunity. Can I ask another to watch if they are in my presence, or would you encourage using earphone?

        Like

        • I’m not sure how the format he’s using works (new for him and new TO me), but if it’s on the web (aka “webinar” – with visuals – either like on YouTube or like a PowerPoint presentation), she will be able to sit next to you at your computer.

          Then you can BOTH take notes & fill each other in after it’s over — the main benefit there is that if either of you miss something it won’t shut you down worrying about it, so you miss still MORE. (I’ll be there too, remember, so between the three of us we’ll get everything we need!!)

          cp knows there will be “newbies” on the call, so he won’t jump in with “the advanced course in neurobiology” – but sometimes new terms, etc. “stick” better if you hear them *and* write them (even if you misspell them 🙂 )

          Whatever – it will be FINE. Worse case scenario and the tech makes things crazy, we’ll figure it out at the back end, right? You won’t need a mic unless you ask a question – then your headset will be fine when you are speaking (he’ll probably mute you once you ask anyway, I’m guessing).

          xx,
          mgh

          Like

          • Funny you mentioned “backend”. Just wanted to mention I read one of your writing from the bottom up yesterday. Don’t know why but I did!LOL I still got the point. Reading that way may also miss the comment section for most. I look forward to your feedback and clarification it’s such an educational process.

            Reading is difficult for me, but typing is a skill I’ve had since junior high … thank goodness I’ve relied on this skill to compensate for TBI. Things in print can look really good!

            I’m finding on my site, that even on my bad days a little writing is okay because there are so many levels of TBI, from the very basic learning to higher levels of education and those doing research independently to help themselves.

            I like the format of your site and I think I will look for a different Theme so I can change the font size and keep things clearer. Hey, I might as well learn those old typing skills I’m familiar with! Thanks for all your responses.

            Like

            • MY advice? Don’t play with the format – it is FINE – and you *know* it will take more futsing time than you believe it’s going to, right? Spend your energy on your content and your l-i-f-e !!!! (for what it’s worth, the grass is always greener — the first time I landed on YOUR site I had the exact same thought – neat theme, maybe I’ll change — fortunately, something distracted me before I could go much further with that idea 🙂

              Like

  10. Oh how I finally understand the chemistry, or lack thereof with ADD, and similar with TBI. I’ve taken medication that is frequently used for ADD and it’s makes a significant difference in my quality of life. When brain chemicals are off, there are no replacements except the proper chemicals. Albeit, exercise does increase brain chemicals and proper nutrition is vital but don’t hesitate to try medication if prescribed by your physician. It may help with cognition, organization, and all executive functioning.

    It might be the key to quality of life. It was partial key for me with TBI. When my TBI doctor suggested the medication I thought she was nuts. It worked for me! Often it takes a combination of medications. I don’t encourage taking medications except when chemistry is off. I once thought ADD was over diagnosed, but I have learned it’s under diagnosed. It’s probably part of TBI, but again under diagnosed.

    The key to medications here is: Medications must be prescribed by your doctor or nurse practitioner. Do not take another’s medication. Medications need to be closely monitored. Note any changes you have and bring it to the attention of your healthcare provider. If someone you love have concerns about your medications, see if their concerns are valid. They may perceive something you don’t and may be saving your life. Medications may be helpful, but they are harmful to some. It’s difficult finding a balance, and the patient is the best one to help find the proper balance.

    Has anyone found that medications helped? If so how has it changed your life? Have you found medications that seemed harmful? What would you suggest to others?

    Take care and stay safe,
    Edie

    Like

    • I’m not surprised they helped, Edie.

      Stimulants are interesting medications think about them this way: they stimulate the areas of the brain rich in catecholamines (PFC – your executive functioning area), so that the rest of the brain stops trying to pick up the slack (when a brain in overdrive comes back into balance, you might even feel like stims calm you down – probably the source of the accusation that we “tranquilize” kids)

      Effective functioning takes neuron teamwork – BALANCED teamwork. When the filtering and focusing area of the brain is, effectively “off-line” – the rest of the brain gets “busy/noisy” trying to help (as it does when you have damage, btw – which is how stroke or TBI victims EVER recover functioning – new neural networks develop to take over for the damaged areas – but the motor areas and the thinking areas need different things).

      See the problem when the PFC’s “offline”? No filters, MORE to filter. BRAIN CHATTER, distractibility, problems with short-term memory – swimming upstream!

      When the PFC is stimulated to come back on line, the rest of the brain can relax. Filters working better – less to filter. Suddenly, we can get things done – swimming WITH the current!

      Loosely, we believe that stims act as sort of “Trojan Horses” – so that they get taken up instead of the neurotransmitters you WANT hanging out in the synapse (which is the only place they ARE neurotransmitters, btw, the minute they are “reuptaken” into a cell, they are broken down to their component parts).

      If the “catcher” neuron snatches too fast (which is one thing that can happen whenever metabolic timing is screwy), the dopamine or norepinephrine you produce doesn’t hang out long enough to play its part in the neural relay race correctly, so things break down in the PFC.

      BUT – if you don’t produce anywhere near enough of the neurotransmitters to begin with, the stims don’t work as designed. You get side effects, or they just plain don’t work for you.

      That’s why the non-pharm substances, healthy diet, hydration, exercise and PROTEIN IN THE MORNING are so important – they are what your brain needs to make the activation neurotransmitters!

      For SOME people, alternatives alone get the brain working acceptably. Those with “snatchers” instead of catchers, or fewer working production neurons to begin with (and/or complex lives that need A LOT of activation), tend to benefit from meds in ways that seem like a miracle. (like some diabetics can manage with diet alone – some need insulin — and saying “Big Pharma” is pushing insulin is just plain ignorant!)

      Anyway, with TBI, as your brain heals (or new pathways grow), stims may be more than you need after a bit. But they ARE worth trying and DO tend to work just like they do for ADDers once you are out of the hospital and on the healing pathway, so that you can function without such frustration. (check with your doctor — there may be a reason they are not a good idea for YOU – but make sure there’s a reason besides fear and lack of knowledge.)

      BTW – carbs are building blocks for serotonin – NOT what most of us need in the AM, but what most of us eat (a legacy of our agricultural roots, when we worked in the fields all day and needed a steady supply of fuel). Without hard work (or aerobic exercise) to jumpstart activation, they make us sluggish and sleepy – great for the END of the day!

      CPs talk on 3/15 is going to explain how trace minerals, etc. fit into the equation. The link to the page that talks about when & how to sign up is here ==> Doctor answers ADD/ADHD Medication Questions – LIVE

      Like

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