Another View of Attention Deficit Disorde | ADHD Information

From Jef Gazley, M.S.

Your Turn - What do you think?

Attention Deficit Disorder (ADD) and Attention Deficit Disorder with Hyperactivity (ADHD) occur as a result of neurological dysfunction in the prefrontal cortex of the brain. This is the newest part of our tri-brain system in evolutionary terms. It is the part of our brain that performs executive functions. The functions of this brain deal with 1) attention span, 2) perseverance, 3) judgment, 4) organization, 5) impulse control, 6) self-monitoring and supervision, 7) problem solving, 8) critical thinking, 9) forward thinking, 10) learning from experience, 11) ability to feel and express emotions, 12) interaction with the limbic system, and 13) empathy.

Whenever there is a problem with this part of the brain, a number of skills that many human beings take for granted would not be available in any optimal way. The following are problems that develop when the prefrontal cortex is affected. 1) Short attention span, 2) distractibility, 3) lack of perseverance, 4) impulse control problems, 5) hyperactivity, 6) chronic lateness and poor time management, 7) disorganization, 8) procrastination, 9) unavailability of emotions, 10) misperceptions, 11) poor judgment, 12) trouble learning from experience, 13) short-term memory loss, and 14) social and test anxiety.

The exact neurological problem with ADD is unknown at this time. However SPECT scans, single photon emission computed tomography, which measures cerebral blood flow and metabolic activity patterns, has noted that when someone with ADD concentrates, their prefrontal lobe activity decreases significantly. This essentially means that under stress and concentration someone with these disorders cannot bring to bear their full cognitive capacity.

It is theorized that our usual ability to screen out and attend to stimuli of our choice is impaired with these individuals. I like to think of it as going to the mall during the summer. It is too bright and there are too many people around, but it is not overwhelming. However, at Christmas time after a couple of hours at the mall people are so over-stimulated that it is hard to find the car. People with ADD feel this way almost all the time.

There are five recommended courses of treatment for someone with ADD or ADHD. Physicians often give an antidepressant such as Wellbutrin and Strattera, which tends to calm the limbic system and increase dopamine, a neurotransmitter. In my experience, this can be helpful but stimulants, the second course, seem to do a better job. Stimulants given in small doses, so the mood alteration is minimal, act in a paradoxical manner. This means that instead of accelerating a person they help to focus and calm them while still allowing the prefrontal lobe to remain active. They also seem to increase dopamine. This neurotransmitter is negatively affected with people suffering from ADD. The third regimen, a combination of an anti-depressant and a stimulant, seems to work best for most people suffering from most forms of ADD. The fourth treatment consists of teaching relaxation, stress-management, organizational, and socializing skills. This should always be included as part of treatment whether or not medication is used.

Another form of treatment is the naturopathic approach. Due to my background I cannot adequately discuss this method, and as yet am not sufficiently familiar with the treatment to be able to measure its efficacy. At the present time, supplements, vitamins and chiropractic care seem to be effective as an adjunct to stimulants.

There are numerous misconceptions about Attention Deficit Disorder and a lot of emotional fervor about the diagnosis. It reminds me of the debate over Prozac several years ago or whether or not Alcoholism is a disease or a moral defect. It is understandable that people worry about giving young children a mood-altering drug. However, any time medication is considered as an approach, the physician needs to carefully assess both the costs the benefits and the severity of the problem. Most medication difficulties with ADD result from mismanagement. When the appropriate amount of medication is used with ADD the benefits are immense and the cost is minimal. A person’s life changes dramatically for the better. It is as if for the first time a person can think clearly and their self-esteem soars.


There is still a tendency in this country to feel that people need to pull themselves up by the bootstraps regardless of the severity of the problem. They are often blamed for their own illness. This happens a lot with ADD.

True ADHD with hyperactivity is rather easy to diagnose. However, only in the last ten years was ADD inattentive type recognized. This diagnosis is hard to spot and often is characterized by a general spacyness and inability to track conversations. It also used to be common knowledge that children were the only ones to suffer from this disorder and that once they became 14 they grew out of it. What is more common is that in the normal course of experimentation with drugs and alcohol a person with this disorder finds amphetamines and becomes addicted to them. Almost the right drug, wrong dose! Most people do not grow out of the disease. Interestingly enough, even with hard-core Methadrine addicts, if they are put on a small dose of Adderall they thrive and it does not reactivate the addictive process.

Dr. Daniel G. Amen is the acknowledged leader in the field for the study of Attention Deficit Disorder. He has expanded the classifications of this condition within the last two years from the standard two types of Hyperactive and Inattentive by adding four more distinct types of ADD. He has done this by exhaustive research and has been aided by the SPECT scan, which is a sophisticated brain scanning tool that measures and clearly shows what part of the brain is most active. What is most impressive about his work is that he stresses the need for a multi-treatment approach. This includes attention to diet, exercise, vitamins, supplements, traditional psychotropic drugs, and behavioral techniques.

In “Healing ADD” Dr. Amen lists the six types of ADD as 1) Classic hyperactive, 2) Inattentive, 3) Over focused, 4) Temporal, 5) Limbic, and 6) Ring of Fire. Each of these types has much in common, but also differences in symptoms and treatment.

All of the types of ADD have as their primary feature periodic impairment of the prefrontal cortex of the brain and dopamine involvement. Classic ADD is characterized by both hyperactivity and inattentiveness. It is usually quite easy to treat by a combination of a high protein diet, aerobic exercise, a stimulant such as Adderall or Ritalin, and possibly the supplement of L-Tyrosine. Often an anti-depressant is used as well.

Inattentive ADD lacks the hyperactivity, but people who suffer from it have a difficult time focusing and are often very scattered. As with the classic type the prefrontal cortex is involved. The treatment for inattentive ADD is usually exactly the same as the classic type.

Overfocused ADD exhibits the same problems and symptoms of prefrontal cortex as with classic and inattentive ADD, but the difference is that the sufferer of over focused often cannot break away from a thought or behavior. This is because the cingulate system of the brain is overactive and often locks a person into self-destructive, negative, or repetitive behavior. Often a stimulant will cause temper problems if used alone. Therefore, it is usually helpful to have the person take an anti-depressant first and only later to add the stimulant. Another possible treatment is to use St. Johns Wort, a natural herbal anti-depressant, but it is important not to use both a traditional and an herbal anti-depressant at the same time. The other forms of treatment such as diet and exercise is the same as the first two types of ADD.

Temporal ADD is still characterized by problems with the prefrontal cortex, but the temporal area of the brain is often affected. This could be from a previous head injury, but not necessarily. All the symptoms remain the same, but often extreme bouts of anger are also included. The treatment for this type is usually a stimulant and an anti-convulsant such as Depecote. All other treatment is the same except the following supplements can be used: GABA, Ginkgo Biloba, or Vitamin E.

Limbic ADD is when the limbic area of the brain is also affected in addition to the prefrontal cortex. This type of ADD has the symptoms of inattentive ADD, but a significant amount of depression is also present. A stimulant and an anti-depressant are indicated. Aerobic exercise is needed, but often a complex carbohydrate and protein mixed diet is indicated. The following supplements are used: SAMe or L-tyrosine.

Ring of Fire ADD is a very disorganized and severe form of ADD that is a combination of all the other types. The entire brain is lit up on a SPECT scan. In addition to the standard treatment of a stimulant and an anti-depressant, an anti-psychotic like Respiridal is often called for. Dietary and exercise treatment is the same as in inattentive type. The following supplements are possibly needed: GABA or Omega-3. Other supplements that have been found helpful with ADD in general are Zinc, Flax seed oil, and Serephos.

Your Turn - What do you think?



http://mentalhealth.about.com/cs/familyresources/a/gazleya dd404.htm I saw a scan of what a add brain looks like vs non add.It can effect any part. The one I saw had many parts effected. In our sons case the part is the left posterial area. It also said his is intermintent in his case. This meaning not all the time. This is why I say he most likely is wrongly dx. I know nutrition are a sucess in mosr cases cause at one time that all there was to use. I grew up on health care products. We only saw Dr.'s for half to's like a check up, illness and my epilepsy. Supplements are also for preventive care not a cure. Foods have no nutrition unless organic. Soils are depleted and the US is one of the big ones. Just ask ant dieatician they will request supplements also. My dad and I saw one. He told us at the class at age 30 we should all use enzymes cause this is when we all start loosing them.  RN oldtimer38706.3138425926

[QUOTE=GlenW]enzymes are the biggest marketing scam since the Atkins' diet.  Most enzymes dissolve in the stomach acids long before they can be of use.  The way to make enzymes in a healthy person (or sick for that matter) is to have a healthy varied diet.  The body makes enzymes inside - to try and use them from outside sources is a sham.  Just thought I'd make that clear as I hear enzyme bounced around too much and knowing what they are it seemed good to clear that up.[/QUOTE]

They are effective with my digestive problems however I don't take them anymore. Other then that I don't know if they have a use. I agree that most of them are not good for much. Not sure what they have to do with ADD anyway.

btodd,

I think it's pretty interesting.  I read this somewhere before.  Something else to look up is Executive Functioning Disorders.   

enzymes are the biggest marketing scam since the Atkins' diet.  Most enzymes dissolve in the stomach acids long before they can be of use.  The way to make enzymes in a healthy person (or sick for that matter) is to have a healthy varied diet.  The body makes enzymes inside - to try and use them from outside sources is a sham.  Just thought I'd make that clear as I hear enzyme bounced around too much and knowing what they are it seemed good to clear that up.

[QUOTE=oldtimer] Just ask ant dieatician they will request supplements also. My dad and I saw one. He told us at the class at age 30 we should all use enzymes cause this is when we all start loosing them.  RN [/QUOTE]

What type of enzymes are you referring to?

 

I really like the analogy of going shopping at Christmas time. 

I'm glad that counseling is now generally recommended.  When I was originally diagnosed - when I was in my twenties, some professionals actually seemed to get angry with me when I suggested that I could benefit from counseling. 

Later, I got the counseling.  While things aren't perfect, it definetely helped me.