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Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder (ADD & ADHD)

Summary:
ADD and ADHD are failures of the executive parts of the brain. These conditions are frequently inherited, but the deficiencies can be caused by prenatal injury. Medications effect the neurotransmitters. Remedial chronic management from adults and devices are needed to treat these disorders.

Keywords:
executive brain, inhibition deficit, neurotransmitters, aetiology, chronic treatment
Using a gasoline powered mower, our teenage son had the job of cutting our grass in summer. I'd remind him, "You better mow the lawn today." He'd go to the garage, pull out the mower, and I'd sigh with relief that the job was getting done before the grass grew to be knee high. But then, he'd take the motor apart, put screws and bolts down among the pebbles in our driveway. Oh dear, I'd think, will he find all the parts to put the motor back together? Next he'd bound into the house to get a glass of milk, then he'd circle past the TV, turn on the set and sit down to drink his milk. I'd remind him about mowing the lawn. "Hold your horses," he'd say impatiently. He'd twitch a few dials on the TV, and then out he'd go to reassemble the motor, start the engine and begin mowing our front lawn. He would interrupt the job by stopping to pet our dog. Can you guess? Our son had the symptoms and was diagnosed as attention deficit with hyperactivity (ADHD).

In May, 2009, the Centre for ADD/ADHD Advocacy Canada (CADDAC) held its first conference for parents, teachers, adults with ADHD and their partners, and professionals. Experts spoke about the cases of ADD and ADHD, parenting children or living with a partner with ADHD, and drug therapy for afflicted people. (For CADDAC literature see: www.caddac.ca and www.teachadhd.ca) I attended the conference and read about these disorders.

Dr. Russell A. Barkley, PhD., Clinical Professor of Psychiatry Medical University of South Carolina, described clinical cases of people with ADHD. Typical symptoms are: (1) Reacts impulsively verbally or with motor actions to distractions without being persistent toward goals; (2) Has excess unrelated movement such as fidgeting, walking about, touching; (3) Exhibits frustration and intolerance, is excitable and quick to anger; (4) Is unable to self-manage time, lacks hindsight and foresight. Barkley explained that it's a failure of the executive function of the brain, not an attention deficit. The frontal lobe of the brain, which regulates our ability to pay attention, regulates responses and emotions and allows us to plan actions over time, as well as three other areas of the brain mature two or three years slower in children with ADD or ADHD, and when full-sized those areas of the brain do not function well. These disorders have nothing to do with intelligence. People with ADD and ADHD can learn and retain knowledge, but they can't control their behaviour.

Prevalence - The degree of the disorder varies, but four or five adults out of every hundred in the U.S. have this disorder, said Barkley. Dendy wrote: "Approximately one to three students in every classroom of thirty students has the disorder," and further stated that this diagnosis is prevalent in other developed countries as well: Japan--7.7 percent; Germany--9.6 percent; Canada--3.8 to 9.4 percent; China--6 to 9 percent...(Dendy 10, 11)

Aetiology - "About four times out of five the brain differences in attention disorders are inherited." (Dendy 27) Another 10% to 15% of cases, said Barkley, are related to prenatal injury caused by mothers who drank alcohol or smoked during pregnancy, streptococcal infections or chemotherapy or radiation and serious head injury. Of the 13 or so genes that are linked to ADHD, four are linked to the transmission of signals from one brain cell nerve ending to another. If the neurotransmitters dopamine, norepinephrine and serotonin are inefficient the symptoms of ADD arise. (Dendy 23-28) This disorder is a behavioural inhibition deficit of the central nervous system said Barkley. It can not be cured, but like diabetes it can be diagnosed and treated.

Society's problem - Lawlis (11, 13) cites why children with ADD are a responsibility of society: "35% of students with ADD never finish high school; Individuals with ADD have more hospital visits; Parents of children with ADD divorce three times more often than the general population; 50% to 76% of incarcerated inmates of prisons have some form of ADD; 52% of ADD sufferers abuse drugs at some time; 43% of male ADD students are arrested for a felony before the age of sixteen." "In the United States there are an estimated 17 million children diagnosed with ADD."

Medication - The drugs approved by Health Canada for treatment of ADD and ADHD effect the nerotransmitters dopamine, norepinephrine and serotonin. A person with a low level of dopamine is inattentive and distractible; a person with a high level of norepinephrine is impulsive and highly aggressive; a person with a low level of serotonin is irritable and dissatisfied. The approved drugs increase or decrease the effects of these brain chemicals. (Dendy 101-102) Although Blakely recommends using medication to treat people with inherited ADD and ADHD, Lawlis and other specialists have reservations.

Barkley says that treatment of each afflicted person requires a remedial strategy of chronic treatment. Adults must assist children with ADD or ADHD: Use lists, signs and other clues, placed at the point of performance; use timers, clocks, counters, hand or gesture signals as time reminders; break up tasks into many small steps; encourage self-motivation with frequent praise and tangible rewards such as a point system for completed tasks to earn privileges; employ as many manual, visual, and oral activities in teaching as possible and include motor activity; give positive directions, repeat instructions and teach the child to use his inner voice to remind himself of his goal; avoid blaming the child or yourself, instead focus on success.

References -

Dendy, Chris A. Zeigler, M.S. (2006). Teenagers with ADD and ADHD 2nd Ed. Woodbine House Inc. Bethesda. MD.

Lawlis, Frank, Dr. (2004). The ADD Answer. Penguin Group, N.Y., N.Y, Toronto, etc.
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