ADD

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.

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.

Background and History:  ADD was first identified and studied in the early 1900's, although it wasn't called ADD back then.   After World War I, researchers noted that children who had contracted encephalitis displayed a high incidence of hyperactivity, impulsivity, and conduct disorders.  And in the 1940's, some soldiers who had experienced brain injuries were found to have behavioral disorders.1   It seemed clear that brain damage could cause hyperactivity.  Other forms of brain insult have since been identified as causes of hyperactivity, including exposure to lead and other environmental toxins, as well as fetal exposure to drugs and alcohol.

Once brain damage was identified as a cause of hyperactivity in certain patients, researchers assumed that all hyperactivity was caused by brain damage, even when no brain damage could be identified.  That's why ADD was once called "minimal brain dysfunction."  This is an important point to understand.  It is because of this early association of brain injury and hyperactivity that ADD traits are still assumed by many to reflect a brain disorder.  Researchers made a giant leap in logic: Because brain injury can lead to hyperactivity, they believed that all hyperactivity was caused by brain injury.  We now know this is not true.   In fact, hyperactivity is also associated with giftedness, but obviously we cannot say that all hyperactive children are gifted any more than we can say all hyperactive children have suffered brain injury.

More recent studies have shown that ADD is largely genetic.  That is, it runs in families.  This has lead some ADD researchers, notably Russell Barkley, to assume that our population is experiencing large scale random genetic mutations, a rather ridiculous notion for anyone familiar with population genetics.   Anytime more than one percent of the population carries a gene, geneticists rule out random mutations under the belief that the gene has been actively selected for.  For example, the gene-based disease sickle cell anemia has been found to help a population by providing resistance to malaria.

In the 1990's a growing number of ADD experts began to view ADD not so much as a disorder, but instead a natural condition which leaves ADDers at a disadvantage in some common modern settings, and many positive attributes became associated with ADD, such as creativity, enthusiasm and entrepreneurial tendencies.  This is probably due in part to the ever expanding world of ADDers.  A few decades ago only the most dysfunctional hyperactive kids were identified as "disordered" and these kids were more likely to suffer from actual brain injury. Today, the diagnostic criteria are so broad that millions of children in the U.S. are getting the label.  Any underachiever who doesn't seem to pay attention in school or who has trouble handing in finished homework is fair game for a diagnosis.  I spoke to one teenager who was diagnosed ADD even though her grade point average had never been below a 3.85 (taking Ritalin allowed her to achieve a 4.0).    I also spoke to a psychiatrist who routinely prescribed Ritalin to "C" students in an effort to improve their grade point average.

How common is ADD?

The figure for ADD is typically given as 3-5 percent of the population.  The real figure is unknown and estimates vary between 1 and 20 percent or even more.  This is largely because the diagnostic criteria are so subjective: What is considered "clinically significant impairment" to one person might seem more like normal childhood behavior to someone else.  For example, in one English survey, only 0.09 percent of the children were found to be ADD.   But in an Israeli study, 28 percent of children were rated hyperactive by their teachers.  And in one U.S. study, teachers rated 50 percent of boys as restless, 43 percent of boys as having "short attention spans" and 43 percent of boys as "inattentive to what others say."

Diagnoses and medication rates can vary greatly within the U.S.  Gretchen Lefever, a pediatric psychologist who became concerned when she was suddenly inundated with ADD referrals, studied 30,000 grade-school students in two Virginia school districts.  Her findings, which were published in "The American Journal of Public Health", showed that 17% of white boys in the region were given medication for ADD while at school.  Other rates were 9% for African-American boys, 7% for white girls, and 3% for African-American girls.

What Are The Causes of Attention Deficit Disorder (ADD)?

 

The real causes of attention deficit disorder are unknown, but it is likely that many factors play a role in ADD and ADHD. None of those factors include specific parenting skills, so parents shouldn’t blame themselves for this problem.

Experts hope that someday, understanding the causes of attention deficit disorder, there will be effective treatments.

Possible Causes of Attention Deficit Disorder include:

Genetics
Evidence is building towards genetic causes of attention deficit disorder, rather than elements of the home environment. Researchers are currently investigating many different genes, particularly ones that are involved with the brain chemical dopamine, since people with ADD seem to have lower levels of dopamine in the brain.

Children who carry a particular version of this gene, seem to have thinner brain tissue in the areas of the brain that are associated with attention. However, research has shown that the difference is not permanent. As children with ADD grow up, the brain tissue in those areas get thicker and most of the symptoms of ADD disappear.

Brain Injury.

Being exposed to toxins or physical injury, either before or after birth, can be one of the causes of attention deficit disorder in a very small percentage of cases. According to experts, a brain injury can cause ADD-like symptoms in people who previously seemed unaffected.

Nutrition
According to experts, refined sugars can be the cause of a range of abnormal behaviors, but there’s no link to ADD/ADHD. Research shows that lack of omega3 can cause ADD, since this fat is important for brain development and function. Also other components of the diet can be the causes of attention deficit disorder.