ADD...What every parent should know..

What is ADD?

Attention Deficit Disorder, or ADD/ADHD, is a psychological term currently applied to anyone who meets the DSM IV diagnostic criteria for impulsivity, hyperactivity and/or inattention. The diagnostic criteria are subjective and include behavior which might be caused by a wide variety of factors, ranging from brain defects to allergies to giftedness. ADD, as currently defined, is a highly subjective description, not a specific disease.

Confusion and controversy is caused by the tendency of some mental health professionals to assume that everyone diagnosed with ADD has some mysterious, irreversible brain defect. This assumption has its roots in the very first group of severely ADD people ever studied, who suffered from encephalitis, or a swelling of the brain. We also have learned that birth defects and brain injury from toxic chemicals such as lead often cause ADD. However, over the last several decades the ADD diagnostic criteria have been so broadened as to include many people with no brain defects at all. Experts in the fields of temperament and creativity have objected that perfectly healthy people are being classified as disordered. Huge numbers of these new types of people being added to the diagnostic pot have changed the way ADD is viewed in some circles, including people like Thom Hartmann, who popularized the idea of ADDers being "Hunters in a Farmer's World". On the other hand, many argue that such people aren't ADD in the first place. Both may be correct. This website was started with the first viewpoint in mind (hence the title), but as time passes I find myself more likely to just say that many so-called ADD people are simply not ADD in the classic sense.

Misconceptions about ADD:

• Many people assume ADDers cannot pay attention. This is completely false. In fact, ADDers are known to "hyperfocus" on anything which captures their attention, to the point where it is difficult to get their attention. It is true, however, that a higher degree of interest is necessary before the ADDer can pay attention. ADDers do not tune-out or daydream on purpose or to be rude. Some people have likened it to having an on-off switch in the brain. Interest is needed to activate or "turn on" the brain, after which the ADDer can pay attention. If there is no interest, then the brain is "off" and the ADDer is likely to do something to try and get it back on. This can include sensation seeking, daydreaming, or becoming immersed in something the ADDer finds very interesting. It can also include disruptive behavior. This might be nature's way of making sure that some people are always on the lookout for something new and interesting - these are our explorers and discoverers. Ritalin and other stimulants appear to work by artificially stimulating the brain, allowing the ADDer to tolerate a duller setting than they could otherwise function well in (e.g. schools).

• Someone can be ADD and not be hyperactive. Some ADDers, especially girls, are quiet daydreamers.

• Oppositional behavior is often confused with ADD. ADD in itself does NOT directly cause oppositional behavior. It can, however, indirectly result in anger and oppositional behavior if the ADDer is chronically mistreated, for example, by parents and teachers who continually blame the child for not "performing" like other children. Such children may give up trying to please their parents and instead misbehave out of frustration and anger. Otherwise, ADD kids are often described as enthusiastic and affectionate by understanding parents. In addition, some people reacting to foods may become hostile as well as hyperactive while they are reacting to the food.

• You cannot tell if someone is ADD by their response to stimulants. Most people perform better and feel better when given stimulants, including those who are not ADD. That's why so many people drink coffee.

Types of ADD:

There are two major types of ADD at this time (this aspect of ADD keeps evolving): ADD with hyperactivity (the traditional type of ADD) and ADD without hyperactivity ("inattentive" type). Here are the DSM IV diagnostic criteria in a condensed form:

Inattention (must meet six of the following to a degree that is "maladaptive"):

• Often fails to give close attention to details or makes mistakes in schoolwork;
• difficulty sustaining attention in tasks;
• seems not to listen;
• fails to follow instructions or finish work;
• unorganized;
• difficulties with schoolwork or homework;
• loses things like school assignments, books, tools, etc.;
• easily distracted;
• forgetful about daily activities.

ADD with Hyperactivity (must meet six of the following to a degree that is "maladaptive"):

• fidgety in a squirmy sense;
• doesn't stay seated;
• runs or climbs excessively (or feelings of restlessness in older children);
• difficulty playing quietly;
• often "on the go" or acts if "driven by a motor";
• often talks excessively;
• blurts out answers to questions;
• difficulty waiting in lines or waiting turns;
• often interrupts or intrudes on others.

How is ADD diagnosed?

ADD should be diagnosed by a psychologist or psychiatrist who is knowledgeable about ADD as well as giftedness and creativity. Avoid diagnosis by a pediatrician, since pediatricians as a group are far more likely to simply prescribe medications without properly assessing the child. Psychiatrists and neurologists are far more likely to prescribe medications before acquiring a total picture of the patient.

Adults, especially those with the non-hyperactive form of ADD, may have trouble finding a practitioner knowledgeable in ADD, since until recently ADD was considered a childhood condition. Women with ADD are often told they suffer from depression and are prescribed antidepressants which do not work.

Ask the practitioner what his or her ADD assessment entails. A good assessment typically runs several hours and will include tests for IQ and creativity. Avoid anyone who simply asks a few question and then prescribes medication to "see what happens." Most people do better and feel better on stimulants, even those without ADD, so this is a very bad approach for a professional to follow.


How is ADD treated?

Physicians often recommend that ADHD or AD/HD be treated asymptomatically with stimulant medication, special education and counseling. Although these approaches sometimes yield positive benefits, they may mask the problems rather than get to their underlying causes.
In addition, many common drugs for ADD (such as ritalin, methylphenidate, cylert), which have the same Class 2 classification as cocaine and morphine, can have some negative side effects that relate to appetite, sleep and growth. Placing a normal student who has difficulty paying attention in a special class and counseling could undermine rather than boost his self esteem.

A sensible, multi-disciplinary, developmental approach treats underlying causes rather than the symptoms which are secondary.

VISION THERAPY improves visual skills that allow a person to pay attention. These skill areas include visual tracking, fixation, focus change, binocular fusion and visualization. When all of these are well developed, children and adults can sustain attention, read and write without careless errors, give meaning to what they hear and see, and rely less on movement to stay alert.

OCCUPATIONAL THERAPY for children with sensory integration dysfunction enhances their ability to process lower level senses related to alertness, body movement and position, and touch. This allows them to pay more attention to the higher level senses of hearing and vision.

TREATMENT OF ALLERGIES to pollens, molds, dust, foods and/or chemicals by eliminating or neutralizing them has also been shown to alleviate the identical symptoms, and without side effects.

The public needs to understand that some behavioral optometrists, physicians, educators, mental health professionals, occupational therapists, and allergists are all addressing the same symptoms and behaviors. The difference is that medication, special education, and counseling can mask these symptoms and behaviors, while vision therapy, occupational therapy and/or treatment of allergies may alleviate the underlying causes and thus eliminate the symptoms long-term.

When making a choice about treatment for Attention Deficit Disorder (ADD), Attention Deficit Hyperactivity Disorder (ADHD, AD/HD) or Attention-Deficit Hyperactivity Disorder (ADHD, AD/HD):

• Consult a behavioral optometrist for a developmental vision evaluation
• Have a child evaluated by an occupational therapist with expertise in sensory processing problems.
• Consult an allergist regarding possible reactions to foods or airborne particles.