November 3, 2009 ADD Research Paper Attention deficit hyperactivity disorder has traditionally been seen as a behavior disorder characterized by inattention, distractibility, impulsivity, and hyperactivity. These traits are generally the criteria that are used in diagnosing the disorder and many doctors prescribing medications do not truly understand how much more complicated the diagnosis is for ADHD. Thomas E. Brown, PhD, writes in his latest book, Attention-Deficit Disorder: The Unfocused Mind, that an overly simplistic understanding of ADHD still persists among many medical professionals and the general public.
He believes attention is an incredibly complicated, multifaceted function of the human mind and it plays the most important role in how we perceive, remember, think and feel. His research has challenged the older ideas and myths concerning ADHD syndrome and brought to light how complex the disorder is to diagnose and treat. Dr. Brown believes “the myths and misconceptions about ADHD make it even more difficult for the people who suffer from it to be understood and to get adequate treatment. ” He has outlined the key elements in his latest book to support the “new paradigm” to better describe ADHD. Brown, 2008) New research, utilizing brain scan (SPECT) technology is also giving doctors new tools to better diagnose and treat the illness. Daniel G. Amen, M. D. has pioneered the use of brain scan technology with clinical practice to give patients a more specific diagnosis by showing the areas of dysfunction in the brain. The hope is that with a better model for doctors and psychiatrists to follow, better treatment plans can be developed to help people of all ages better handle the symptoms and be educated about behavior modifications which will help them be more successful.
Dr. Brown’s first element describes ADD as essentially a complex disorder of the unconscious self-management system of the brain. The new description focuses less on the hyperactivity and behavior problems and instead describes the real issue, which is the self-management system of the brain itself. Brown has discovered, through his treatment of attention related disorders, the powerful link between attention and multiple aspects of the brains management system. He states that attention is really the name for the integrated operation of the executive functions of brain activity.
To understand ADD and its effects, Dr. Brown has created a model with six clusters representing each important aspect of the brain’s executive function – activation, focus, effort, emotion, memory and action. He describes each cluster as an important piece of the brain’s executive function and he emphasizes, “They depend upon and interact continuously with each other in ever-shifting ways. ” Studies done by Russell Barkley, where he interviewed hundreds of patients, support the same basic model describing ADD as a disorder of the control center of the brain.
Brown sees the six clusters as important functions an individual must use to manage the multiple aspects of everyday life. He concludes that all ADHD persons, regardless of subtype, are suffering from impairments of executive function and it is the essence of their disorder. The second key element emphasized in Dr. Brown’s study was the chronic difficulties with self-regulation of emotion resulting from ADHD. Even though the current criteria for ADD does not list emotional regulation as one of the symptoms, many rating scales (Connors Adult ADHD Rating Scales) describe multiple emotional problems like a “hot temper” and “overreaction”.
The people suffering report inappropriate emotional reactions to frustrations and a low threshold for irritability. The ADD sufferers describe the feeling of emotions flood their minds and take up all the space so that they are so preoccupied with the thoughts that they lose rational perspective about a situation. The immediacy of the emotion can then have too much influence on thought and action, causing them to speak and act in ways that do not take into account others feelings or ideas.
They also describe themselves as “overly sensitive” (Brown) and reacting too sensitively to minor criticism or slight failures. The interaction of emotion and the executive functions of the brain flow in both directions according to Dr. Patricia Quinn. The connection between the two causes further dysfunction when the patient is emotionally charged. The problems associated with the intense frustration and emotion can destroy most of the relationships in the lives of ADHD patients, and must be addressed as criteria for the disorder.
The work is the idea that ADD is not always third key element in Dr. Brown’s apparent until the person encounters the challenges of adolescence and adulthood. It is very apparent when a young child is suffering with severe problems with self-regulation in the early years, because they usually show behaviors that are consistently disruptive, impulsive, or aggressive. These children fit the current criteria that at least some symptoms be obvious by age 7. (Quinn) However, some do not show any signs of impairment until they are in secondary school.
There may be two distinct groups of ADHD adolescents, according to Dr. Grant Martin. The first student is one who has some other type of learning disability along with the ADD. Children who are well motivated and are receiving help for their problems can overcome the concentration issues. However, the increased demands of junior high and high school can overload their coping systems and the result is a huge drop in academic performance. The second type of adolescent diagnosed with attention-deficit may have above average intelligence and come from an involved and motivated family.
In the early years, the child may have been hyperactive, but they had such a strong support system, the problems were not recognized until middle school. Because the student was bright, it took longer for the coping skills to be overwhelmed. In some cases, students might even succeed in high school, but then they experience dramatic failure when they move away to attend college and no longer have the support system of their parents. Dr. Martin explains how the teenager is undergoing many major physical, cognitive, behavioral and emotional changes; however, the normal problems of this phase are magnified for those with ADD.
He explains how it occurs because the features of attention deficit interfere with successfully mastering the developmental tasks of adolescence. The “emerging issues of independence, identity, peer group acceptance, dating, and appearance erupt” creating new sources of stress which the adolescent with ADD and the family have to cope. (Martin) Dr. Brown’s model concludes for many ADD individuals, “The executive function impairments become clearly noticeable only when challenged by the increased demands for self-management encountered in late adolescence and adulthood. (Brown) In his fourth key element, Dr. Brown also tries to discount the idea that ADD is a problem of insufficient willpower. The activation section of the brain controls organizing, prioritizing, and activating to make people work. The individuals with ADD describe putting off all important tasks until it becomes an emergency and only when they are faced with dire consequences, because it is difficult for them to prioritize and stay organized. Many have no ability to determine how long tasks may take and ignore realistic limitations.
Dr. Brown’s research combined with Barkley’s studies show an actual chemical problem with the dynamics in the brain, which prevents the person from taking care of important daily tasks unless they are faced with an immediate threat to stimulate them to respond. The brain imaging studies by Volkow (2002, 2004) have shown the increased activation of the relevant regions of the brain while stimulants are being used, and then the quick drop in activity when they wear off.
The improved functioning of “will power” when medication is used is the best evidence to show that the person is not unmotivated, but does not have the specific chemical ability to move the transmitters in the brain. The summary Brown makes of the situation is that the chemistry of the brain can change instantly in the situation of a perceived threat or reward and the ADD brain needs that stimulation to activate. The fifth element in Dr. Brown’s new theory of ADD suggests that most of the causes of ADD appear to be primarily genetic.
He argues with the ideas of a “blank slate” theory, which suggest that humans are born completely shapeable and fully open to the influences of culture and parenting. Brown does acknowledge the impact childhood experiences have on the individual with ADHD, however, he argues against the theories suggesting ADHD is a consequence of poor parenting or inadequate schooling and nutrition. Strong evidence indicates that ADD is a result of the influence of multiple genes – each of which makes a small contribution to the syndrome. A study done in 2005 by Dr.
Rutter suggests that genes do not act directly on complex behaviors; “they act on proteins that, in turn, affect physiological processes within the body, especially within the brain”. Rutter also notes that huge differences can be seen among individuals in their genetic vulnerability to various influences. Dr. Brown acknowledges that there is a “dynamic” tangled web of ongoing interactive influences between genetic factors and the person’s constantly changing environment. He summarizes that if the genetic factors for ADD were not in place, then environmental issues would not be relevant. The final element Dr.
Brown emphasizes in his book is the idea that ADD is not just one of many psychiatric disorders. He illustrates the notion that “ADD is a foundational disorder that raises the person’s risk of having additional cognitive or emotional disorders through their life” (Brown). Some of the overlapping problems are mood disorders, anxiety, learning disabilities, sleep issues, aggression, and substance abuse. Many studies have been done to support his theory of “co morbidity” and ADD. A person suffering with this syndrome is six times more likely to have another psychiatric or learning disorder.
In a study done on adolescents with ADHD in 2003, the data showed 48% of the teens suffered from depression and another 30% were struggling with anxiety and substance abuse problems. (UMM) Barkley conducted a study of adults and found similar results. Nearly 61% of untreated adults with ADD reported problems with substance abuse, 63% had major depression, and 35% reported anxiety and other social phobia disorders. Many people with ADD have substance abuse problems because they are “self-medicating” to feel better or numb their feelings all together. Schubiner) The trouble is that it gives them relief at first, but self-medicating with cigarettes, alcohol, or drugs leads to many more serious health issues and addiction-related trauma which makes their lives even more difficult. The high incidence of overlapping psychiatric problems support Dr. Brown’s theory which suggests ADHD is commonly found with other disorders. Another well known authority on ADHD, Dr. Daniel Amen, M. D. , has written a book called Making a Good Brain Great.
He states that most problems, such as ADD, anxiety and depression are not single or simple disorders. Dr. Amen writes, “ADD is not one illness, but rather at least six different sets of problems. ” He warns the medical profession of the dangers of treating the same group of symptoms in the same way for each person. He believes if doctors immediately use stimulant medications for everyone who has ADD, then they may make 4 out of 6 people worse. Amen teaches a different approach, where each person has an individualized treatment plan based on the problems in his or her specific brain.
He uses brain scan SPECT technology to actually analyze the brain at work and give physicians and psychiatrists a tool similar to the tools used to diagnose physical illnesses in humans. His ideas are similar to Dr. Brown and he urges physicians not to just treat symptoms, but rather the underlying brain problems causing the difficulties. Dr. Daniel Amen is also the founder and director of a clinic in Newport Beach, California, where he is applying his new theories and the SPECT brain imaging to better understand the human behavior associated with ADD.
Through his clinical work there, he has determined that there are six different types of attention deficit disorder and they each have their own distinctive brain dysfunctions and treatments. Amen and his colleagues’ stress the importance of knowing which type of ADD a person has to determine the best plan of action. He recommends a comprehensive plan involving education, emotional support, medication, exercise, and biofeedback and using a coach for developing school and work strategies.
In his clinic, the treatment plan is based on the type of ADD that is diagnosed; with interviews, behavioral history and the SPECT brain scans. Dr. Amen outlines his entire program in his book, Healing ADD. He believes with a thorough evaluation and a “dynamic” course of action, that the majority of individuals suffering with ADD can lead healthy and successful lives. Amen is hopeful that more physicians and psychiatrists will be receptive to the new information available for diagnosis and treatment in the future.
Attention Deficit Disorder is an extremely complicated syndrome of impairments that affects a significant number of children, teens and adults. According to the first principle in Dr. Amen’s book, “The brain is involved in everything you do. How you think, how you feel, how you act and how you get along with other people has to do with the moment by moment functioning of your brain”. (Amen) The attention process in the brain involves setting priorities, focusing and shifting focus while regulating alertness, effort and the speed and output of thoughts. Volkow) Similarly, Dr. Brown writes, “attention also involves managing frustration and other emotions, recalling facts and using short term memory and self control. ” All of these functions are impaired when the brain is struggling with attention deficit disorder. Society as a whole, as well as the medical profession, must recognize and address the real issues of ADD. Treating the symptoms alone is no longer a solution. The patient must be treated as an individual and every dynamic of this complicated disorder must be examined to determine the best plan of action.
Brown suggests, “Ultimately, clinicians do not treat diagnostic categories or dimensions; they treat individual patients whose symptoms often do not fit neatly in a specific diagnostic description. The competent doctor tries to assess the full range and intensity of the patient’s symptoms, impairment and suffering to develop a specific treatment plan. ” (Brown) The treatment for ADHD must be comprehensive and provided over long periods of time to help those suffering to manage their disorder and lead happy, productive lives.