Attention Deficit Disorder: Practical Coping Methods Barbara C. Fisher, Ph.D. and Ross A. Beckley, Ph.D. © 1999 by CRC Press LLC Preface This book has been rewritten no fewer than five times in an effort to keep abreast of current information. It is a compilation of personal/professional experiences, notes, anecdotes, research and hopes that have been stored and shared over the past decade. New research is occurring constantly and this disorder, which has been historically looked upon as a disorder of child- hood, is now being widely accepted as one that spans the lifetime. It is a dis- order that one is born with, and it does not end with childhood, instead, symptoms develop and change commensurate with the developmental cycles of adolescence, adulthood, middle age and advanced age. This book is meant for parents, children, teachers and ADD adults who are tired of searching and are ready for answers to their many questions about this very diverse and complicated disorder. Our goal is to demystify the vast amount of information that has been gener- ated and to present this rather confusing disorder in a manner that is both understandable and applicable by providing what we have learned that is helpful in addressing this disorder in the individual’s everyday life. This books addresses the questions of why Ritalin does and doesn’t work, why ADD is not just a childhood disorder, why ADHD is being over-diagnosed and why so often the person diagnosed and treated with medication is not cured and the story is far from over. The presence of ADD has broken up marriages, prevented many from attending college, fulfilling their potential, or following the career path that they truly desire. It has made people feel stupid and incompetent. With new perspectives, changes can occur, and people can create the life they want and deserve; they can fulfill their dreams. ADD is a disorder with far-reach- ing consequences, however, it is also a disorder that can be treated and spe- cific symptoms can be managed. We prefer to think of ADD as a challenge that can be met with good physical health, nutrition, specific coping mecha- nisms, medication, and, most of all, education and understanding. A good diagnosis identifying all of the various disorders that can complicate the sit- uation is absolutely imperative. What we provide to the reader in this book in the way of knowledge about ADD has been field-tested in a variety of settings—households, schools, clinics, businesses, colleges, hospitals, and classrooms. © 1999 by CRC Press LLC 0-8493-????-?/97/$0.00+$.50 © 1997 by CRC Press LLC 1 What is Attention Deficit Disorder? 1.1 What Attention Deficit Disorder (ADD) Was Once Thought to Be Historically, when Attention Deficit Disorder (ADD) was discussed, we were referring to Attention Deficit Disorder with Hyperactivity (ADHD). At that time there was no awareness of ADD without hyperactivity. It was thought that ADD was a psychological or behavioral problem viewed as a disorder of childhood. The symptoms were hyperactivity, overactiveness, and attention deficiency, hence the term ADD. The theory was that the disorder was the consequence of a system in the brain not being mature — perhaps due to early birth or damage to the brain. That underdeveloped system in the brain was thought to be the Reticular Activating System (RAS), which is involved in general arousal and alertness. In that underdeveloped or immature state, the result was overactive or hyperactive behavior on the part of the child. As this system developed, the symptoms of ADHD and its hyperactive or overactive component would dis- appear. It was believed that because the system was immature it produced the overactivate and inappropriate behavior characteristic of hyperactivity, a motor-driven activity. Therefore, ADD was not understood as a disorder involving the thought pro- cesses but as a disorder linked to behavior with symptoms such as a child who “ran but did not walk” and was continually distracted, not focused, or could not attend to task. These children were seen as behavioral problems as they did not respond to directions, but did as they pleased without obeying the rules and regulations of the family household. The attention disorder was viewed as ADHD; a rather disruptive behavioral problem that was expected to go away once the child reached the later stages of adolescence and the RAS matured and began to function as it should, and no longer produced overactive behavior. The problem was that ADD and the systems seen did not make sense. Some- times the behavior would be there and sometimes it would not. There seemed to be no rhyme or reason. It was difficult to diagnose unless the disorder was © 1999 by CRC Press LLC 0-8493-????-?/97/$0.00+$.50 © 1997 by CRC Press LLC 2 The Two Subtypes of ADD: ADD Without Hyperactivity and ADHD 2.1 Understanding the Brain and the Differences Between ADD and ADHD ADHD is often over-diagnosed. ADD (without Hyperactivity) is often under- diagnosed. The result is a lot of confusion and the disorders’ being called the “yuppie condition” and not being looked at as medical disorders. In our clinical practice we have found it extremely critical to be able to sep- arate out the two disorders. The two represent very different issues for treat- ment and very different relationships with family members and other significant individuals in a person’s life. There are different expectations related to each disorder based on different abilities and different ways each disorder has an impact on thinking and performance. Diagnosis and separa- tion of ADD with hyperactivity from ADD without hyperactivity allows for treatment that is designed specifically to address the problems related to each individual disorder. The ADHD individual may lie, display manipulative and secretive behav- iors, and resemble more of the behavioral profile characteristic of delin- quency, addictive personality, and oppositional defiant disorder. These behaviors arise not from an attempt to defend and protect oneself as in the case with ADD without hyperactivity, but as part of the manifestations of the disorder itself. Aggressive individuals may be seen with this disorder, espe- cially when it is severe in nature and the impulsivity may be truly there and also involve another neurotransmitter, serotonin, in addition to the dopam- ine imbalance. ADHD tends to involve the RAS, the frontal areas of the brain, and, primarily, dopamine. It is more associated with learning disabilities for reading, writing and spelling due to the inability to learn as related to prob- lems of the frontal processes. © 1999 by CRC Press LLC . LLC 1 What is Attention Deficit Disorder? 1. 1 What Attention Deficit Disorder (ADD) Was Once Thought to Be Historically, when Attention Deficit Disorder (ADD) was discussed, we were referring to Attention. field-tested in a variety of settings—households, schools, clinics, businesses, colleges, hospitals, and classrooms. © 19 99 by CRC Press LLC 0-8 49 3-? ?? ?-? /97/$0.00+$.50 © 19 97 by CRC Press LLC 1 What. Attention Deficit Disorder: Practical Coping Methods Barbara C. Fisher, Ph.D. and Ross A. Beckley, Ph.D. © 19 99 by CRC Press LLC Preface This book has