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By Suzanne Day
What it is
What would our world be without Thomas Edison, Winston Churchill, and Mozart? These individuals have been labelled retrospectively A.D.D. (Attention Deficit Disorder). They learned to benefit others with their creativity, energy, spontaneity, and the ability to focus intensively (hyperfocus). These qualities often characterize the A.D.D. population as well as the negative behaviours: inefficient selective and sustained attention, distractibility, impulsivity, and sometimes hyperactivity. People with A.D.D. are a very heterogeneous group: they manifest the symptoms in different combinations and to different degrees.
The main characteristics
Inattention: difficulty attending to and sustaining the attention when required to do so. This behaviour is often accompanied by a tendency to loose things, difficulty planning in order to accomplish a task, dilike homework, and a tendency to make careless mistakes.
Hyperactivity: difficulty inhibiting behaviour. They need to often move parts of their body: squirm on their chair, fiddle with their hands, their legs swing when required to sit. They are often driven like a motor.
Impulsivity: these people have difficulty thinking through before doing something. They often speak without thinking of the consequences, and regret it later. It seems that they need to act in order to think it through.
Evaluation by professionals would lead to a diagnosis of Attention Deficit Disorder with qualification either of inattentive type, or the hyperactive type, or the combined type (of all three). Using quantitative electroencephalogram (QEEG), Dr. Joel Lubar from the University of Tennessee has demonstrated that when a person with ADD needs to concentrate on an intellectual task, there is a decrease of brain wave activity in their frontal lobes and prefrontal cortex. PET studies that evaluate the glucose metabolism in the brain and the SPECT studies that analyse the brain blood flow have confirmed the same conclusions.
Possible causes of AD/HD
The research is showing that dopamine (a neurotransmitter) availability in the basal ganglia (deep structures in the brain) appears to be one of the most common explanations for these problems. The basal ganglia connects with the limbic system (emotion center) and the prefrontal cortex (executive functions). Heavy metals like mercury and lead in the brain cells may be interfering with the efficiency of this circuit. Head trauma (even minor) and birth trauma (use of forceps or lack of oxygen) seem to be other causes of dysfunction. The genetic contribution outweighs the influence of the environment and medical history. In other words mom or/and dad usually carry some of these weaknesses.
What it is not
A person with A.D.D. is not necessarily lacking attention but often pays more attention to certain topics. Focussing intensively on their own area of interest comes as an extreme to their attitude of being easily bored by what other people find important.
The attention problem is not the only symptom. Apart from being easily distractible, impulsive, and hyperactive, the A.D.D. is often academically underachieving which interferes with the child’s actualization of his potential. Although these children present creativity beyond their years, they are often immature or take longer to be recognized as matured adults.
The person’s character is not necessarily "lazy" (although some may become). The overproduction of slow brain waves when the child is trying to resolve a problem is producing a "tund out" mode mind set that requires more energy. With time some A.D.D. may choose to avoid the frustration and develop a "giving up" attitude but in my experience so many of these children are "trying hard".
Facts about AD/HD.
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5 to 7 % of the population is thought to have A.D.D. while only 2 % receive treatment.
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Children usually do not grow out of A.D.D. Unrecognized and unmanaged, people with A.D.D. are at risk for developing debilitating social problems:
35% never finish school
30% may have problems with the law
75% have interpersonal problems and academic problems
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Parents of A.D.D. children divorce three times more often than the general population.
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Many people never outgrow A.D.D. and have symptoms interfering during their whole life.
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How to know if your child have AD/HD
Formal assessments would provide more information on the type of attention difficulty and the severity. An evaluation should be done by A.D.D. specialists using not only questionnaires such as the Conners Rating Scale, but also a continuous performance test done with a computer program that measures the ability for the child to sustain and select his attention span for repetitive tasks. The quantitative EEG (QEEG) provides more "objective" data on the quantity of slow brain waves (responsible for the "tune out" mind set) in relation to faster brain waves (responsible for a problem solving mind set required to do school work). Unfortunately this tool is not yet widely available by professional. Suzanne Day is certified by the BCIA and offers this service.
What parents can do
Labelling a child is a mixed blessing. It allows the parents and educators to start an intervention plan. Without a professional label the parents feel guilty about how their child behaves and the child often receives other inaccurate labels such as lazy, bad, or dumb. However, too often everything the child does is blamed on the label and other reasons for his learning difficulty are overlooked. Parents need to try to limit the time the child has to wear a label by working with pertinent strategies and interventions.
Interventions for AD/HD
Unfortunately, drugs such as Ritalin, Adderall, Concerta are the main treatment recommended to parents. The drug companies have huge financial interest invested in organizations like CHADD and in the medical and educational professions. Too often the parents are not informed of the way that these powerful psychotropic drugs work nor of some of their dangerous side effects. Parents who are aware of the limitations of the drug intervention and desire to be informed should know about the growing evidence of nutrition treatment for attention problems (see article on this subject). They need to be aware of the other interventions available, such as neurodevelopmental activities and neurofeedback training (see other articles). The attention deficit problem is complex and presents different facets that need to be addressed one by one: the physical component, the intellectual component, the emotional, and the spiritual components. Even those promoting medication as safe, warn that the drug should never be the only intervention used with ADD children. I recognize the place of the pharmaceutical intervention when all other efforts have failed.
Parents should take time to fill in the list of characteristics in the check list section of this web site. If they suspect problems, an assessment may be necessary not only to identify the inefficiencies but more importantly, to receive professional advice on how to improve the attention span and coaching to carry through the needed interventions.
Copyright 2005 Suzanne Day, Neuropsychologist member of l’Ordre des psychologues du Québec
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