People with ADHD almost always have unrecognized talents
Teachers need to seek out strengths
Properly diagnosed, ADHD can be an asset…like a verigated brain
There are two clusters of symptoms: 9 of inattention; 9 of hyperactivity
In the next DSM, they will probably be two different disorders
Children were considered bad, weak or stupid
Rec or RX: try harder. They were the battered children through history.
Major paradigm shift from the moral framework to medical framework.
Most people recognize that the brain is tissue. Words like bad, weak or stupid are moral judgments. When we began to look at the brain as an organ, a shift occurred…it’s not God or the devil.
In 1937 we took the leap from reform schools to hospitals. Dr. Bradley in Providence RI gave a stimulant to hyperactive children and observed that they became better focused.
From the 40’s through the 70’s, we saw great changes in child rearing to a much more and gentler child centered parenting style.
And there were advances each decade:
First Dx was minimal brain dysfunction, which indicated that the problem was in the brain rather than in the soul or spirit.
In the 70’s, researchers realized that ADHD didn’t disappear in puberty. The Dx was expanded in 1978 to include MBD in adults. Then, Virginia Douglas, a PhD, noticed the invisible attentional component and the disorder was renamed attention deficit disorder.
This isn’t a good name either, because these people can attend quite well, just not to what is going on in the room. They go elsewhere.
In the 80’s, we began to look at girls and women. The ratio went from 10-1, boys to girls,, to now 3-1 if not 1-1. Females tend to be under diagnosed because they are inattentive type while boys tend to be hyperactivity type.
In the 90’s, the MRI, PET and spec scan emerged as great research tools demonstrating that the brains of ADHD persons are different. Alan Scentian published pet scan studies in which two groups of people with the use of radioactive glucose used by the brain for energy (scan shows brain activity in color) demonstrated that the frontal lobes of ADHD people are smaller, so we know that there are biological differences.
It is believed that ADHD people have reward deficiency syndrome: they have a more difficult time finding pleasure and are more likely to have addictions.
An aside: an audience member asked about Tom Hartman, who wrote about ADHD as
Hunters in a Farmer’s world, which posits that the ADHD brain is simply a genetic brain trait from an earlier time in history when men had to be hyper-vigilant, quick acting, liking action. Ned loves to hear him debate with the ADHD authority Russell Barkley.
Ned says the fear is the great learning disability. When we experience fear, we can’t learn anything.
Another aside: Ned says MRI etc should not be a tool of diagnosis, but rather research. The only way to diagnose is by history: the behavior of an individual as reported by family members, teachers etc.
Causation: clearly genetic, based on twin studies OR acquired by brain insult, trauma or a virus; lead poisoning or environmental toxins.
Are we seeing a rise in cases? No, just better dx and maybe an increase in environmental allergens.
What else can look like ADD? There is a distracted or dissociated stage of PTSD which looks like ADD. Chronic anxiety can produce similar symptoms.
Does Ritalin stunt growth? Nom but reduces appetite.
Add persons are mostly left handed or mixed dominance. A history of early ear infections, and thyroid problems as well as being adopted associated with between 30-70% of cases.
| Basic DSM: 2 clusters of 9 symptoms each-9 hyperactive; 9 impulsive. |
| Impaired functioning present in multiple settings. |
| No such thing as adult onset; just adult diagnosis |
The only real learning disability is fear. Children with ADD and LD often feel misunderstood and develop fear of teachers.
The way to diagnose is an art. There is no proof; no test. The history the study is the most important.
3. MRI is not diagnostic, just a good research tool. Dan Amen uses spec scanning. He’s the only one using it and he overstates the value of the tool. If it were really worth it, don’t you think that Harvard and Yale would be using it?
4. It is not valid to give meds as a test. Some people with ADD do not respond to meds (about 20-25%); some people will respond favorably to the meds and not have ADD. It is suggestive, but not definitive. Computer tests are not definitive.
Differential: ADD and modern life.
ADD induced by culture which induces symptoms creates a pseudo ADD. Factors include a technological society shifted the economy from a knowledge based economy. We all feel left behind. Faster is better; slow is painful. These factors create restlessness and impulsivity. We have disconnected from personal relationships. There are few family rituals, talking over the fence. We are all feeling alienated.
A super speeded up electronic age + disconnectedness= distractibility, restlessness and impulsivity. Don’t mess up on the dx. The pseudo ADD needs to disconnect from electronics and reconnect with people. How do you tell the two apart? Look at individual in many settings. Question: how will information overload affect our children?
Coexisting with ADD:
Aspergers? No.
Dyslexia, dyscalcula, depression and reactive depression, GAD, OCD, Social phobias-toxic worriers/ substance abuse, bi polar, juvenile bi polar/ explosive prolonged tantrums YES
There is a high correlation between ADD and eating disorders; high stimulation is organizing life around it.
Borderline disorder in kids now considered bi polar in teens.
How to tell ADD apart from conduct disorder or oppositional defiant disorder? A matter of volition. Add is involuntary and spontaneous; other two are premeditated.
Ritalin is a methyl amphetamine along with Concerta; Adderall, Dexadrine are amphetamines. When meds work, mental focus increases. If you don’t want a stimulant, try Wellbutrin, Xyban or Stratera, a new drug for which the jury is still out. If coexisting anxiety and depression try Zoloft.
