because the frontal processes that work closely with the emotional system of the brain are not functional. So they get mad at little things and their anger is exaggerated. The punishment does not fit the crime. There is no tolerance. There is no hook to get them back. When things are overwhelming they leave and that is that. They don’t care about the consequences or the impact of their behavior on those around them. They are not aware of their behavior nor able to process what it will mean in the future. 5.3 The ADHD Brain is Different Research has shown that the ADHD brain is different from that of non- ADHD brains. The presence of this disorder has been found to be highly associated with what is called structural changes in the brain. This means that the sizes of certain brain structures are different from what has been seen in individuals without this disorder. Changes are in certain areas of the brain and can result in the presence of learning disabilities, dyslexia in particular. These specific areas are smaller in size, which has been thought to mean that there are fewer cells, thus fewer connections and a decreased ability for think- ing. Areas targeted are the parietal area, parts of the frontal processes, and a watershed area where the primary lobes meet, entitled the angular gyrus. The presence of brain abnormalities also supports the notion that this disorder is more severe in nature. 5.4 General Problem Areas for the ADHD Individual 5.4.1 Time Sense is a Problem With ADHD there is a skewed time sense. They cannot see that what they do now will impact the future of others and/or themselves at a later date. There is no delay of gratification due to disabled frontal processes and so they want it now. There is no time sense to allow any sort of wait. They therefore can’t wait in lines and so on. This is the individual likely to cause a problem if wait- ing in a line for a long period of time. They blow up and explode. Due to a complete lack of time sense they can be late for appointments or miscalculate how long things will take. They justify tardiness, for example, by saying that the show won’t start until they get there, or everyone will just have to wait. They are attempting to make sense of their experience for themselves. © 1999 by CRC Press LLC 0-8493-????-?/97/$0.00+$.50 © 1997 by CRC Press LLC 6 Comorbid, Associated Physical Disorders 6.1 Differential Diagnosis The Importance of Having an attentional disorder or ADD alone is usually not the case. If you think about the idea of disturbing the biochemical balance in the brain and creating an imbalance, then it would stand to reason that such an imbalance could result in other disorders besides ADD. ADD, being a biochemical imbalance, involves two neurotransmitters or brain messengers, dopamine and norepinephrine. The job of these two brain messengers is arousal and alertness. They arouse and alert the brain structures in specific areas so those areas function as they should. Given the decreased amount or capac- ity of these neurotransmitters, and that they specifically impact the parietal and frontal processes, it would stand to reason that those areas do not func- tion as they should. Once you disturb the brain’s biochemical balance with ADD, further difficulties will ensue. Neurotransmitters are like dominoes. Some excite and some inhibit, but they all constantly impact each other. Once this system has interference, other systems have interference. Further, the neurotransmitters dopamine, norepinephrine, and serotonin are the same neurotransmitters involved in just about any existing emotional or psychological disorder. It makes sense that the imbalance would not just create ADD but other disorders as well. This is exactly what occurs. More often than not, ADD is not seen by itself but with a whole host of other disorders. Therefore, the diagnosis of ADD is often just the beginning, but certainly not the whole story. There are other diagnoses that accompany this disorder, both physical and emotional. This chapter addresses physical disorders that are commonly seen and some that are rarely seen in conjunction with the attentional disorders. Some dis- orders will look like ADD but in fact are the result of another disorder instead. Symptoms overlap and can easily confuse the diagnosis of the true disorder. There are often accompanying, unexplained behaviors that cannot be understood merely from the standpoint of ADD. The presence of these disorders can make the ADD person look demented or out of balance. Instead of seeing this behavior as due to the presence of some other disor- © 1999 by CRC Press LLC . 1999 by CRC Press LLC 0-8 49 3- ? ?? ?-? /97/$0.00+$.50 © 1997 by CRC Press LLC 6 Comorbid, Associated Physical Disorders 6.1 Differential Diagnosis The Importance of Having an attentional disorder or. dyslexia in particular. These specific areas are smaller in size, which has been thought to mean that there are fewer cells, thus fewer connections and a decreased ability for think- ing. Areas. to process what it will mean in the future. 5 .3 The ADHD Brain is Different Research has shown that the ADHD brain is different from that of non- ADHD brains. The presence of this disorder has