ADHD

ADHD boy in class

Did You Know That…  Astronaut Scott Kelly, currently on the lecture circuit, says that he has ADHD.  He described it at the Marin Speaker Series in February 2018 (Marin County, California).  It is true that he was a child before ADHD was considered as a diagnosis for problems in school, but he feels certain that if he were a child today he would be diagnosed as having ADD or ADHD.  He also discussed his ADHD in an interview with the Santa Barbara Independent, a news, arts, and alternative newspaper published every Thursday in Santa Barbara (California).  He said that every year he promised himself that he would pay attention in class and finish his homework.  It never happened.  He could not get it done.  Then he was inspired by the book about astronauts, The Right Stuff, and used this as his motivation to learn new habits of study, school, and work to become an astronaut.  He succeeded, of course, and, among other achievements, spent a year on the International Space Station.

Articles related to ADHD:

Are People with ADHD Defined by Being Overly Active?

While it might seem that a person with Attention Deficit Hyperactivity Disorder must be overly active or “hyperactive”, this is not always true.  It is true that many children and adults with ADHD are really overly physically active.  That said, there are also many that are not very active.  Individuals with ADHD who are calmer are the same as the hyperactive ones in that they also find it hard to focus their thinking on one thought for very long.  This is the “attention deficit” part, a deficit in being able to focus attention over time.  Without the hyperactivity, these individuals sit quietly, daydreaming, their mind wondering from one thought to another.  Girls and women are more likely to have this calmer type.  Clearly this situation creates problems in school in younger years and at work as their careers start.  Because they are sitting quietly and are not being disruptive, they don’t come to anyone’s notice.  But because they are daydreaming and not focused, it’s much harder to learn appropriately or accomplish at their aptitude level.

Beneficial Children and Adults

Individuals with ADHD are mostly fine, valuable children, adolescents, and adults.  Too often people with ADHD are not portrayed in a good light.  They can be a great asset to most situations.  They are bright people, typically easy to work with, and prefer to be problem solvers not problem creators.  That said, some individuals with the ADHD diagnosis can be clinically more complicated in diagnosis, treatment, and behavior.  More on that below.

The Value-Added of ADHD in Historic Context

There is a theory about how communities came to value this behavioral type.  Imagine yourself in prehistoric times when communities were local tribes of several families.  This is how all the world’s civilization started, in little clusters here and there around the world.  In this setting, the behavioral traits of ADHD makes them the communities’ hunter/gatherer, hunting for food sources for us all.  Because of their quickness, vigilance, and high energy, they were more able to gather high-quality animal and fish protein.  Over the eons this better protein/lipid-rich diet supplied what was needed for human brain growth.  As settlements became intellectually more capable people realized that they could grow their own food, too, and not just depend on the hunt.  These later seed and crop planters and farmers provided a more consistent and secure food supply.  The march to the pinnacle started with the hunters.

Those with ADHD As A Community Brain Trust

A few years ago one of us here at the NeuroSci R&D Consultancy was standing around with a group of scientists at the annual meeting of the Society of Neuroscience.  This small group had randomly come together in an open hallway as one or another of us were walking down the hall and ran into each other.  There were 7 or 8 of us who stopped and chatted for about 5 minutes.  The others in this informal discussion circle were some of the most brilliant and productive neuroscientists in the United States.  One in the group made a joke about an East Coast colleague being so active and productive in research and publishing that, “It’s as though he has ADHD!”  Another in the circle spoke up, “So what, I have ADHD.”  Then another chimed in, then another.  In this circle of about 8 of these brilliant neuroscientists, 5 or 6 each said he had ADHD.  Each was clearly proud of it and happy with the great gift of cognition and energy that it provided.

How the Brain Is Wired

Inattention

ADHD is a brain-based disorder.  It is not imaginary and not changeable with stern parenting or strict education.  It is how a person’s brain is wired, hard-wired, often for life.  Some people with ADHD have the “inattentive” type while others have the “hyperactive/impulsive” type.  Inattention means that your mind drifts and allows you to wander off the task in front of you.  It’s difficult to pay attention over time to a narrow, limited focus of interest.

Hyperactive

The “hyperactive/impulsive” type is the ADHD type that most people think of when they think of ADHD.  Hyperactive in this sense means on the move continuously, not staying still.  Or so the person with ADHD might appear to parents, friends, spouses, and relatives who do not have ADHD.  The social situation in which this individual finds himself matters only if he cannot freely move around.  If hindered he, or she, become really uncomfortable and might become disruptive.  In the classroom or business meeting these individuals talk out of turn.  Children “fidget” even when they are asked to sit still.  If he cannot move much he might start tapping his fingers or the toes of his shoes.  Anything that helps “get the wiggles out.”  They’re restless.  Continuously.

Impulsive

The impulsivity part of ADHD might be considered humorous if it did not so often lead to problems.  The quickness of ADHD means that at times these individuals’ bodies move and act before the executive circuits of their brain, their mind, has even thought about it.  The dilemma can be illustrated with the old military sequence of shooting a weapon at a target: ready, aim, fire.  The person with ADHD-style impulsivity might well fire before any thought takes place, then he thinks about it and gets ready and aims.  One can see the risk of harm.  The summersault can start and complete before the child thinks about the mud puddle just ahead.  Another aspect of this is interrupting others when they are talking.  Or bursting into a social group uninvited.  And making snap decisions, even important ones with long-term consequences, without much thought.

As These 3 Aspects of ADHD Sort Out Among Individuals…

As we sort these 3 clinical features among people who have ADHD, it gives us 3 types:

  • A combined inattention and hyperactivity-impulsivity type
  • A mostly inattentive type
  • A mostly hyperactive-impulsive type

ADHD Remains a Medical Puzzle

Though medical science and research is moving closer to an explanation and cause for ADHD, the puzzle is not yet solved.  And because no one has nailed down the true cause, there is a “laundry list” of factors that experts in this field conjecture might cause it.  Those experts who believe in one or another cause devise the reasons why they think their view is the correct one.

Here are a few examples

  • family history and inherited genes
  • a mother’s cigarette smoking, alcohol use, or drug use during pregnancy
  • a mother’s exposure to harmful environmental toxins during pregnancy
  • a direct toxic exposure of the person with ADHD, like high lead levels at a young age
  • low birth weight
  • brain injury during birth or while growing up

Then Reality Steps In…

The ADHD described at the start of this page is just typical, garden-variety, uncomplicated ADHD.  The clinical reality is that ADHD as a condition and as a diagnosis it can become complicated.  In addition to ADHD, children can have learning disabilities, anxiety disorders, conduct problems, depressed mood states, and the poor judgement to use harmful drugs and/or alcohol.  Mix any one, or two, or three of these situations with ADHD and that person really struggles in life.  A good psychiatrist or other health care professional who believes in the person with a clinically complicated situation around ADHD can be a powerful ally and support to assist the child, adolescent, or adult to work through everything and come out winning.

ADHD Treatment

Treating ADHD is covered more extensively on the page https://www.neuroscirandd.com/adhd-treatment/.

Here’s a brief overview.

To put it right out in front, a person with moderate ADHD, or ADHD that is more severe than moderate, needs medication.  There is no way around it.  Many people hope to avoid using medication.  Parents often try to avoid medication use for their children.  In avoiding medication they leave their child at risk.  It might be that person with mild ADHD could work it out, make it through life and not use medication, and still win.  But even so, why?  Why purposefully spend a life at 80% when one can spend their life at 95% with little extra cost and effort?

Here’s Why

In the ancient black-and-white television days of the 1950s there was a popular series, The Adventures of Robin Hood.  In one episode their large, strong, muscular guy, Little John (played by Archie Duncan), is carrying a box.  He struggles.  He can’t keep carrying it.  He just can’t do it.  Little John can’t understand this “weakness” because the box is not that big and he can carry anything.  He’s the “Lou Ferrigno” of their band of thieves.  He thinks there must be some wicked black magic in the box that’s making him weak.  When they open the box, it holds a stone block for minting the King’s gold coins.  That’s why he couldn’t keep carrying it.  It was one huge piece of solid rock.  The point of the story is this.  Anyone can put a 10-pound backpack on their back and hike all day.  Put on a 150-pound backpack and most of us would collapse in a few steps.  Without medication, you’re asking a person with ADHD to carry around a 75-pound (or heavier) backpack all the time.  They are going to struggle and at times fall.  With medication, that backpack shrinks to 10-pounds like the rest of us can carry.

What the Medication Does

The medications are supposed to lessen hyperactivity if one is overly active, lower impulsivity, improve attention span, and help the person to focus.  If all this works they are more successful in school, earn more and are promoted at work, and are more engaging and enjoyable at home with family.

Which Medication?

Methylphenidate, the amphetamines, and other “stimulant” medications work best for most people.  At the right dose, these medications increase the activity of the neural circuitry for the executive function part of the brain.  The person can think more clearly and keep everything under better control.  These medications turn down the volume knob on the brain circuits that push for endless activity and impulsivity.  For most people they are safe to use with a health care provider following along.

There are other medications that sometimes work when the stimulants don’t work or cause problem side effects.  These medications are not stimulants.  These non-stimulants take longer to start working than the stimulants.

A Person with ADHD Needs More Than Just a Tablet or Capsule

To Illustrate the Point with Diabetes

Take diabetes, for example.  Type I diabetes, for which the person needs insulin.  If a teenager develops Type I diabetes, how well would he do if you gave him a vial of insulin and a syringe with a needle and said, “There you are.”  No instructions.  No explanations.  The situation would not go well.  There are entire medical clinics set up for diabetes education.

Educating the Person on their ADHD

As made clear in the diabetes example above, just tossing a medication dose toward a person who needs medication is never a good idea.  Someone with ADHD needs to learn what this brain-based medical condition is all about.  The education and support come in the form of therapy.  The combination of the right medication and best-fit therapy is the most powerful way to lessen the impact of ADHD.  This arrangement provides a guide through the ADHD and ADHD treatment jungle.  There are many types of therapy.  Maybe behavior therapy or interpersonal therapy.  Family therapy or marital therapy (for parents or for adults) might be helpful.  Training on specific skills or situations (stress management, test taking in school, dating relationships) could improve success.  Another helpful set of skills one can learn is parenting skills training (raising a child with ADHD, while eventually rewarding, is a fast-moving challenge day-to-day).

 And Now for a Bit of Medical History – If we watch how people with ADHD behave one can understand those theorists who harken back to prehistoric times and the hunter/gatherer concept.  Quick runners, attention rapidly shifting (focus, shift, focus, shift), act almost before or before thinking.  If you want someone who can catch a wild boar for the family dinner maybe this is the person you want.  Speculation aside (it is fun, though), identifying ADHD as a medical syndrome might have begun with Melchior Adam Weikard, followed later by Sir Alexander Crichton in late 1700s.  Others mark the origin with the clinical observations and writings of Sir George Still, a British pediatrician.  In 1902 he described, “an abnormal defect of moral control in children.”  He observed that children thus affected could not control their behavior a way that a typical child could, but that these affected children were still intelligent.  The next bridge to better care came from Dr. Charles Bradley.  A new medication, the amphetamine Benzedrine, had been FDA approved in 1936.  He noticed, to his surprise, that when it was given to school children their behavior and performance in school improved.  At the time, unfortunately, his findings were ignored.  While the first edition of the DSM (Diagnostic and Statistical Manual) in 1952 did not mention this disorder in children, DSM-II, in 1968, introduced the diagnosis Hyperkinetic Impulse Disorder.  Finally, ADHD had been formally recognized as a medical disorder.  In 1980 it was renamed in DSM-III as Attention Deficit Disorder (ADD).  The term ADHD was introduced in 1987 in DSM-III-R, the Revised Third Edition.

Helpful links:

National Institutes of Health, National Institute of Mental Health

https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

Center for Disease Control and Prevention (CDC) – United States

https://www.cdc.gov/ncbddd/adhd/index.html

Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)

https://chadd.org/

The Mayo Clinic

https://www.mayoclinic.org/diseases-conditions/adhd/symptoms-causes/syc-20350889

American Psychiatric Association

https://www.psychiatry.org/patients-families/adhd/what-is-adhd