Attention Deficit Disorders

What is ADD/ADHD?  ADHD stands for attention deficit hyperactivity disorder.  With ADHD the individual has trouble staying focused on matters that are not of strong interest to them.  Patients with ADHD may also become hyperactive, which is a distraction to those around them.  This inability to focus can lead to numerous problems for persons with ADD or ADHD, including poor performance in school and the work place.  The performance issues often lead to depression and drug use, which can eventually lead to trouble with the law. Treatment of people with these disorders is therefore very important, and fortunately, a treatment strategy using both medicine and psychotherapy is very successful.

What are common misconceptions about ADHD. People with ADHD don’t lack complete attention.  In fact, they are extremely attentive to tasks that are new and existing.  Often, they are our leaders, inventors, and pioneers.  They are people with vision who can think outside the box.  However, they do lack attention in situations that require prolonged attention to detail and repetitive actions.  So some individuals with ADHD are successful and are thought of as bold multi-taskers and pioneers, while others, who find the disorder damaging or debilitating, may be thought of as reckless, impulsive, or easily distracted.

What causes ADHD? Forget poor parenting, family problems, school issues, too much TV, or diet. These factors are not involved.  Research indicates that the disorders are caused by biological factors that affect neurotransmitter activity in the brain.  A strong genetic basis exists with these individuals.  For instance, if one person in a family is diagnosed with the disorder, the likelihood of other family members having the disorder is 25-35 %, compared to only 4-6 % in the general population.

A leading theory attributes ADHD to dysfunctional prefrontal cortical brain cells that control executive functioning, filter (both in and out) internal and external stimuli, and prioritize the need for action and the level of urgency.

What damage can ADHD do? A typical scenario follows:

You are typing an important report that is needed today. The phone rings, you answer, and an email alert pops up on your computer.  You read the email, and it prompts you to call someone so you can meet in a few minutes, even though the subject is not high priority.  You leave for the meeting without finishing the report.  (In this case, your prefrontal cortex has failed to filter out the non-urgent issues, that is, the email and meeting, and it has failed to filter in the important issue, completing your report.)  Tomorrow is no different for you, and the pattern continues.  Eventually, you lose your job and you feel angry. Sadness sets in and gives way to thoughts such as “I’m a failure,” or “I will never have a steady job,” or “No one likes me.”  You become depressed.  You seek shelter from these self-defeating thoughts in drugs and alcohol.  Such self medicating takes hold of you and becomes a compulsive habit. The mission to obtain drugs at any cost eventually subjects you to the criminal justice system.

ADHD commonly leads to mood and anxiety disorders in adolescents and adults. Ignoring the need for treatment can be extremely detrimental at the personal, career, social, familial, and community levels

What treatments are available for ADHD?  Clinical experience teaches that the most effective method of treatment for ADHD is a combination of medicine (if warranted) to regulate brain activity and counseling or psychotherapy to learn coping skills and adaptive behaviors. Medication, prescribed by a physician, often helps to normalize brain activity in the prefrontal cortex. Stimulant medications such as Ritalin, Dexedrine, Adderall, Adderall XR, Concerta, Vyvanse, and Focalin XR are usually effective, and as well as a variety of other drugs that are available to the physician in managing these disorders. Both behavior therapy and cognitive therapy help patients in modifying behavior and in dealing with the emotional impact of ADHD. Many adults respond to the aid of an ADHD coach who helps increase productivity by working on the person’s organizational skills and higher level executive functioning tasks such as planning, prioritizing, goal-setting and impulsivity.

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