We all have that one “high-spirited” friend and/or family member we peg as having ADD/ADHD, but if you don’t, Dennis in Dennis the Menace is a good quick reference to what it can look like…
While some of us embrace the term in a friendly and positive manner, those who truly have to deal with ADD/ADHD it may be more of a nightmare at times. Many people have concerns about the implications of a diagnosis as well as those of being medicated. Furthermore, we often hear about the “epidemic” of “over diagnosis” of this condition.
So, what exactly is ADD/ADHD?
Is it really an illness? Is medication really necessary? How does it arise and how do we grow out of it? This article will briefly explore some of these topics as explained by Dr. Martin Lawrence, MD, Associate Professor in the Department of Psychiatry & Behavioural Neuroscience at McMaster University, at an extraordinary conference. I hope you find it as informative as I did!
What is an adult ADD and ADHD?
ADD/ADHD is actually the most inheritable of all psychiatric conditions—meaning that if your mother or father had it, you’re very likely to have inherited that trait. About 4% of the population are thought to have ADD/ADHD, and about one in ten receive any form of treatment.
To understand ADD/ADHD we first must talk about brain development and a bit about evolution. The human brain is highly complex and highly evolved, but even then it has parts as old as its oldest ancestors. One such part of the brain is called the “amygdala”, which roughly sit in the front part of your brain just behind the eyes. These regions are responsible for recognizing new surroundings and for generating emotions, especially fear and anxiety. In evolutionary terms anything that was “new” was a threat and wanted to kill you. This very primitive part of the brain (the “fear generator”) is normally regulated by another part of the brain: the frontal cortex. The frontal cortex acts as the “adult” brain telling the amygdalae to “snap out of it!” In people without ADHD this process happens smoothly; those with ADD/ADDD have a hard time doing so.
What does this have to do with ADD/ADHD?
Well, children are highly emotional beings, and they do not readily recognize consequences. They cry, they laugh, they “tell it how it is” (e.g. “grandpa, why do you smell so bad?” or “you are so ugly” or “I don’t like your food”). They are uninhibited. This is because their “adult brain” (i.e. frontal cortex) isn’t fully developed yet, and thus does not regulate the amygdalae very well. Furthermore, we know that children are highly attracted to their surroundings (big things, bright things, fun things!). As we get older, we learn to regulate our behaviour by means of the “adult brain”.
What are the causes?
What happens with those with ADD/ADHD is that the prefrontal cortex (“adult brain”) is lagging a bit in terms of its—behaviour regulation—development. This does not mean the child (or the adult) is developmentally delayed, but it does mean that emotion and behaviour regulation is not at the level that it should be—the delay is usually about 2 years or so behind as compared to peers of the same age.
What are the symptoms?
There are specific criteria that physicians and other experts use in order to provide a diagnosis. Those are readily available online as well. I would like to bring your attention two a couple of concepts not usually talked about. We normally think of ADD/ADHD as not having attention, or shifting attention really quickly. While it is a cornerstone, it is not exactly the whole story.
ADD/ADHD people have the following two problems:
- problems with initiating a task;
- problems with stopping a task (they don’t know when it’s time to move on—and this is also true of emotions!!!).
If they’re not interesting in something, it is almost impossible to initiate it because they’re not interested in it. Conversely, if they are interested in the activity, they will be hyper focused and will have trouble stopping. Not surprisingly, ADD/ADHD individuals are big procrastinators who do everything the night before.
The other concept worth mentioning—and this links back to the primitive brain and child development—is that, much like when they were children, ADD/ADHD people see time in two forms: 1) Now; 2) Not now.
The implications of this are vast. For example, the non-ADD/ADHD person, may have a lot of laundry to finish. This is a task not many people enjoy doing, but must get done. This person will think about the implications of not doing laundry (i.e. no clean clothes). This person is also thinking about the future (e.g. no clean clothes for work would look really bad). The ADD/ADHD person is not concerned about the future because it is not “now”. They’re most likely wondering about how to maximize their time doing everything else that’s more interesting other than the menial task of laundry.
While this is a rather simplistic, “black and white” approach, it helps to illustrate some of cognitive processes taking place inside an ADD/ADHD person’s head—and believe me, I would know! Furthermore to the problems of initiating and/or stopping an activity and the now vs. not now, we discussed how ADD/ADHD people have problems with emotional regulation. We explained that emotions are generated by the amygdalae and regulated by the prefrontal cortex (adult brain), which is usually lagging a few years in terms of behavioral development:
Emotional regulation in ADD/ADHD:
- emotions are started by poorly regulated by prefrontal cortex
- emotions floods the brains and takes 100% of your brain
- emotion are triggered and they immediate act on it
- emotions tend to dominate; you don’t think before you filter them
- can easily be mislabeled as borderline personality disorder
- emotions generated cannot be counterbalanced, so they’re expressed
This would explain why those with ADD/ADHD tend to show irritability, low self esteem, anxiety, depression, substance abuse, inability to maintain a job for long periods of time. Emotions run their priorities (as we saw in the laundry example).
What can be done to help?
Most kids have—to a certain extent—some degree of ADD/ADHD because as their brains are developing they show lack of emotional and impulsivity control. Children tend to fit the ADHD criteria, whereas adults fit the ADD one—hyperactivity is usually “grown out”. Treatment can be a combination of medication and “skills” (i.e. professional attention from a psychiatrist, clinical psychologist, etc.). This condition does not have to be treated if it’s not causing any problems. If it’s mild we can learn the skills with a “coach”. For more information about medication options please speak with a physician.
Natural supplements do not substitute seeking professional guidance. While you may be poised to take vitamins and “brain food”, there is very limited scientific evidence that this may help—perhaps with the exception of omega-3s, which may play a role in certain psychiatric conditions (e.g. depression, which can be a comorbidity in ADD), but seek the guidance of a qualified health professional first.
With that said, natural approaches can also take the form of physical activity (which floods the brain with good feelings), and mindfulness techniques that bring awareness can be helpful. Being aware of one’s emotions, and of one’s priorities is important. (e.g. if getting that annoying essay done is giving you grief, challenge yourself well in advance to write one paragraph every day, then treat yourself with something that will positively reinforce that good behaviour). As you can appreciate, this is a very complex topic that managed to condense into a few paragraphs, but I truly hope it was informative!