ADD/ADHD | What Is Attention Deficit Hyperactivity Disorder?

What we know as ADHD,

attention

deficit

hyperactivity

disorder

(or some people still call it "ADD") has been recognized by some doctors since 1902. But from 1902 to 1980, it was about little kids that they couldn't sit still, they couldn't shut up and they were driving everyone crazy. They were just behavioral problems. The name of the

disorder

was changed several times. There were different formulations. But it was all about behavioral problems. Since 1980, when they first changed the name of the disorder to include the words "

attention

deficit

," we have realized that this is not so much a behavioral problem but rather a problem with the brain's management system. : its executive functions. .

And we also learned that there are many people who have ADHD who have never had major behavioral problems. And that, even for those who have it, is usually the least of it. It is attention problems that tend to cause the most problems for people, especially as they get a little older and more is expected of them to be able to manage themselves. One thing that is important to be clear from the beginning is that ADHD has nothing to do with how smart a person is. There are some people who have this and who are super, super, super smart.

Others, high average, medium average, low average, slow. This is why I treat people who are like university professors, doctors, lawyers and business bigwigs. Many people who are normal people. Some people have trouble doing the basics. You could have any level of IQ and still have ADHD. It has nothing to do with how smart you are. The other thing to know is that this is a problem (a set of problems) that includes a wide range of characteristics, and

what

I would like to do today is describe to you some of the characteristics of

what

we call ADHD, give some examples of them, and then we'll talk a little bit about what we know about what's involved in the brain in the course of ADHD.

One thing that's important is that people... One of the main things that people with ADHD complain about is difficulty staying attentive. That when they listen or read or work on something, they catch part of it, but then it fades away, and then they come back, and then they fall asleep, and it fades away again, and then... We come back. They have difficulty staying attentive. It is similar, in some ways, to the problem you have with a mobile phone when you are in an area where you don't have good reception. You can catch part of it and then the message keeps appearing and disappearing.

The other thing is that they often have trouble getting distracted. Like anyone else, they see and hear things happening around them. They have thoughts going through their head. But most people, if they have something to focus on, they can put it aside and focus on what they have to do. People with ADHD find it very difficult to do that. They'll be sitting in the classroom trying to hear what's going on, or maybe they'll be in a meeting or sitting around trying to read or write something, and someone drops a pencil, and they have to check and look, where did it go? the pencil?

Then they will return to concentrating on their task for a couple of minutes. Then they think about some television show they watched the night before. And then they get back on task for a minute, then think about some conversation they had with someone two hours ago. And then they go back to their task for a few minutes, and then they look out the window like anyone else does from time to time, but they'll probably sit and watch the squirrel climb the tree a little longer. than someone else and be watching the traffic and the cloud formation, the guy who is mowing the lawn.

Then they get back on task for a few minutes and will be thinking about what they are going to do when this is over and how soon it will be over anyway. I have things to do. And what am I going to have for dinner tonight? And I wonder what's on TV tonight? All of these things come in all at the same time, and it's almost like you're trying to watch TV and you have four different stations coming in at the same time on one channel, and it becomes a little difficult to separate the signal from the noise.

But the disconcerting thing about this, which really makes it very difficult for people to understand, is that for people who have ADHD, it's like this almost all the time, but not always. Everyone I've seen who has ADD (and that's a lot of people) has some things they can do without having trouble paying attention or concentrating. Let me give you an example. I saw a sixteen year old boy; He was the goalie for his school's ice hockey team. And it just happened that the day his parents brought him to see me was the day after his team had just won the state ice hockey championship, so at first they were bragging a little about how great he was. at the tournament. the day before.

And apparently he was a very good goalkeeper. They said that when he was there playing hockey, he didn't miss anything. He knew where the puck was every second of a fast game. Totally on top of that. The type of goalkeeper that every team wants. Smart boy. Tested very high in the top range. He wanted to get good grades. He hoped to go to medical school. But he always had problems with his teachers. And what they would tell him is, you know, every once in a while you'll say something that shows how smart you are. We'll be talking about something.

You will come up with some commentary that is actually very insightful and quite impressive. But most of the time you go out to lunch. You're looking out the window. You're looking at the ceiling. It seems like you're half asleep half the time. You don't even know what page we are on. And the question they kept asking him was, "If you can pay attention so well when you're playing hockey, why can't you pay attention when you're sitting in class?" Here is another example. Many times parents bring kids in for me to see and say, "You know," the teacher says this kid can't pay attention "for more than five minutes." We know that is not true. "We've seen her play video games." And she can sit and play those video games "for three hours straight and not move." And the teacher said that she is easily distracted. "That's stupid.

When she's playing those games," she's fixated on that screen like a laser, "and the only way to get her attention is to jump in her face or turn off the TV." Again, it's like you can do it here. Why can't you do it there? Now, it's not always about sports or video games. There are some people with ADD who are not good at those things. They might like art, and they're drawing and drawing and really getting into it. Someone else, when he was little, was creating engineering marvels with LEGO blocks. And then when they're older, they take car engines apart and put them back together or design computer networks.

But everyone I've seen who has ADHD has some things they can do without having trouble paying attention, even though they have a lot of trouble paying attention in almost everything else. And if you ask them about it, you say, "What's wrong with this? How come you can do it here and you can't do it here and here and here?" Usually what they'll say is, "It's easy." something that interests me, I can pay attention to it. If not, I can't." And most people hear that and say, "Yeah, right. Congratulations. That's true for anyone. "Anyone is going to pay more attention to something that interests them than to something that doesn't interest them." Which is true.

But here is the difference. People who don't have ADHD: If they have something to do and they know they have to do it and that it's important, they can usually force themselves to pay attention, even if it's pretty boring. , simply because they know they have to. People with ADD find it incredibly difficult to pay attention unless the task is something they find really interesting, not because someone told them it should be interesting. , but simply because it is interesting to them for whatever reason or if they feel that they have a gun to their head and that something very unpleasant is going to happen very quickly if they do not deal with this here and now.

In those two conditions, there is no problem. They can concentrate very well. In anything else, they find it very difficult to concentrate. But the problem is that this is not something that is under voluntary control. Makes it sound like it's a willpower problem. "If you can do it here, why can't you do it here, here and here?" But it is not a problem of willpower. It's a problem with the way the brain is wired. All of the characteristics of ADHD, which I am going to describe here, are things that everyone struggles with sometimes. It's just that people with ADD have a lot more problems.

So in that sense, ADHD isn't an all-or-nothing thing like pregnancy, where you're either pregnant or you're not pregnant. There is nothing in between. It's more like a depression, where everyone gets discouraged from time to time. But just because someone feels unhappy for a couple of days doesn't mean we're going to diagnose them as clinically depressed. It's only when those depressive symptoms are persistent and widespread and causing them a lot of problems that we say, "Yes, that's depression. We should do something about it." So all the characteristics of ADHD are problems that everyone has sometimes. It's just that people who have ADD have a much harder time most of the time.

And the problem is that it is not under voluntary control. It's not something you can do with willpower. But let me tell you some of the other things we see in people with ADHD. One is that they often have trouble getting organized and getting to work. For many, it is difficult to organize their things (their backpack, their desks, their notebooks, their filing system, their living space), a bigger mess than most people most of the time, unless someone else help them deal with it. Other people don't have a problem with their stuff. They have many problems with their time and their work.

And what they'll tell you is, "If I have a bunch of things to do" at the same time, it's very hard for me to look at it and say, "'Okay, that should be the first thing. That should be the second thing.'" That should be third.'" But even when they have their priorities straight, which they often don't, they tend to have a lot of difficulty getting started. Another thing you'll often hear from people with ADHD is that they will say that they have a lot of difficulty regulating your sleep and your alertness and to be able to maintain the effort to get things done in a reasonable amount of time.

Many people complain that they have trouble falling asleep, and what they will tell you is, "I often stay up much later. "than I really want or should because I've discovered that "if I try to go to bed before I'm really exhausted, "I just can't close my head. I keep thinking about things. "And that's why I stay up late reading, watching TV, "surfing the net or whatever until I'm exhausted. "Then I fall asleep fine. But the problem is that I tend to "sleep like a dead person, and I have a hard time" waking up in the morning.

And if I don't have "someone around to help me recover" when I get out of bed "in the morning, there's a good chance I'll be late for whatever I'm supposed to do or possibly sleep through the whole process. I keep pushing the snooze button or I just turn off the watch completely." During the day they are usually fine as long as they are standing, moving or talking a lot. But if they have to sit still for a long time to listen, read, or do paperwork, their eyelids start to get a little heavy. Another thing that often happens as a problem with people with ADHD is that they have trouble sticking with a task, which they may start out reasonably well, but then find it difficult to sustain the effort to finish it in a reasonable time.

I had a college track star, a runner, who came into my office one day and said, "My mind is a great sprinter, but it's a lousy distance runner." He said, "If the task I have to do is something that 'you can do in one quick part, you just do as much as possible' and then you're done, I'm fine. But if it's 'something that you can't do in one quick part' , "it's a longer-term project, if you have to fragment-" keep working on it day after day, which I have "more problems with." And my approach to that "is either we hurry up, make a splash and get things done, 'or why don't we put this aside and wait until it becomes an emergency?'" Sometimes everyone has problems. with deadlines.

People with ADD, it's almost like they can't get started until it becomes an emergency. Another thing that people with ADHD often have trouble with is writing. I'm not talking about handwriting, now. I mean taking ideas and putting them into sentences and paragraphs. Because what people often say is, "I have a lot of ideas about what I should write for this essay I'm supposed to write" or for this term paper, but It takes me half an eternity to be able to put the sentences and paragraphs together so that they make sense. change it or it's just disorganized.

They have difficulty organizing their thoughts and being able to pronounce words in a reasonable way. Another part of this: It's not part of the official diagnostic criteria for ADHD, but it's certainly something that many people with ADHD worry about and worry about.complain—is that they often have difficulties managing their emotions, but I need to give you some examples, because it is not the same for everyone. I once saw a salesman who came in and said. , "You know, yesterday afternoon I was at the restaurant "having lunch. I'm in a very good mood, sitting there "eating my sandwich.

The guy at the table behind me" eats his sandwich. He is chewing too hard. It's making bites, bites, bites." He said, "There was something about that noise" that was driving me crazy. It was like "a computer virus had gotten into my head" and swallowed up all the space, "and that It was the only thing I could think about, it was that noise. "I'm sitting there with my fists clenched, seriously thinking 'about getting up and slapping this guy in the mouth because he was chewing so obnoxiously hard.'" He said, "I didn't do it." I didn't want to get arrested.

But if I had been at home, I would have been yelling at someone or I would have left the room." "Then it was strange," because after a few minutes it was still making the same noise, but then it didn't bother me anymore. He said, "Things like that bother me." There's a lot of things that happen where there's a little bit of frustration, the kind of thing that most people on a frustration scale would say, "Which goes from zero to 10, I'd say, that's a zero or a one, maybe." a two at most. For me," he said, "it can be like a seven, an eight or a nine." He said, "Sometimes I make a big deal about it." A lot of times I don't say anything.

But I feel this surge "of anger when I feel like hitting someone or breaking something. And then it's usually over." But he said, "It's not always like that." He said, "The day before, I was in the office. I'm walking down the hall. A friend of mine who works" in the other department comes around the corner. "He walks towards me reading some newspapers" as he walks. And it had been a long time since he had seen him. "So as we got closer, I stopped and said, 'Hey, what's up? How are you?' I thought we could stop and chat for a minute.

And he looks up, waves, hangs his head and keeps walking." He said, "Now most people would write him off in a minute and realize he was in a hurry. He has to go to a meeting or something. We'll talk later." He said: "Not me. It happened at lunchtime. I didn't do anything for the rest of the day. I spent the whole afternoon "thinking, 'Did I do something to upset him?' "Or maybe I did something to offend someone" in his apartment and everyone is mad at me. "Or maybe I'm the kind of person that no one likes," and no one would tell me that.

But I couldn't get it out of my head." Other people, it's not like that. They get an idea in their head of something they want to do or something they want to get or something they want to buy, and all of a sudden, that desire takes on an urgency. so strong that the feeling is: I have to have it now. And it almost doesn't matter how expensive it is or how inconvenient it will be for them or for someone else, or whether they are using time and money now for this thing that they know they need for something else. tomorrow that's more important.

There's just a relentless drive, and they'll keep it up until they get it or they hit a brick wall. They're not very happy, because usually by then they're onto something else they want. , it's not like that, but they worry a lot, like a woman was talking about how she was driving on the highway. She's in the left lane. She said, "I'm in the left lane." left, an 18-wheeler" to my right. We're going about 65 miles per hour, "and this truck starts to stop a little bit." She didn't move into my lane, but it made me think about "how big her truck was and how small my car was." "And pretty soon I'm wondering, 'What would happen if he didn't see me and he stopped,' and crushed me against the Jersey barrier? "And soon I'm not just thinking about that anymore.

I'm watching a very vivid movie in my head, imagining exactly what it would look like if that truck came and crashed into my car, crushing it, Sharp pieces of metal were sticking into me, I'm bleeding out, the car is being swept away. "along the Jersey barrier, the truck buckles, "the cars and trucks behind us hit us repeatedly, "there is a huge traffic jam, it takes a long time" for the rescue team to come out and get me out of the car. "At that point, I had already bled to death. They have to call "my family and tell them I'm dead." And all this "while trying to drive the car at 65 miles per hour down the highway." She said, "Things like that happen to me" all the time.

There will be some little thing and I think, "what if this happened?" And everything goes well, and I think, "what if this happened or what if that happened?" And very soon I won't be thinking only about it anymore. I'm in it." Now, it's not like someone with ADD will have all of these things. But many will have one or a combination of a couple of them. But what they have in common is that computer virus in their head, that's the emotion. , whether it's hurt feelings or being upset about something or, "I have to have it now" or "What if?", it comes and just eats up all the space in your head, and it's very hard for you to put it into perspective, to let it go. in the back of their mind and get on with what they have to do.

Another thing that is very important for people with ADHD is their working memory. Ask people who have ADHD, "How's your memory?" They will often tell you, "I have the best memory of my family." I can remember things that no one else can remember. And they give you an example about a movie they saw 10 years ago. And they can tell you every detail of the entire story of the movie they saw once 10 years ago and haven't seen. since then. Or someone else will say, “Yeah, I went” to the Super Bowl five years ago. I can still describe to you almost every play they made during that game.

Or someone else will say, "I have 450 songs in my head, all the music, all the lyrics, all the verses that were popular in the '70s." But even though they may be very good at remembering some things like that from a long time ago, If you ask them about something that happened just a couple of minutes ago or yesterday, they often can't tell you. The problem with ADHD memory is not with long-term storage memory it is. What you depend on When you go to the other room to get something and you stand there scratching your head wondering why you came here or you are working on a project you go downstairs to get something you need for the project, you see something else that is interesting. or something that needs to be done.

Soon you are elbow-deep in project number two, having completely forgotten that you were in the middle of project number one above and it was something important to do. The students complain: They will be in class. asks the question. They will raise their hands. They have a good answer for it. The teacher calls someone else first. You have to wait while this other kid tells his trick. Then the teacher comes back and says, "Yeah, what were you going to say?" It's like I have no idea. Not only have I forgotten what she was going to say, but what was the question again?

Or they will read something and understand it perfectly the moment they read it. They read a few more pages, stop for a second, and realize that their eyes have scanned every word and they have no idea what they just read. Or, this really bothers them, they will study for a test the night before. They will go over it and ask you if you have it. They walk into class the next day thinking they're going to get a good grade on this, and suddenly, most of what they knew the night before has evaporated. They can't get it out of their heads when they need to.

But then, a few hours, a few days later, something jogs their memory and it all happens again. It's not that they didn't have it. It's just that they couldn't get it back when they needed it. Or you are getting ready to go somewhere. You think of five things you should take with you. Half an hour later, you're walking out the door. You have one of them. I don't remember the other four to save your life. It's where you have to keep one thing in mind while doing another. That's the kind of memory problem that people with ADHD complain about.

Another part of this is action management. You know, it's true that there are some people who, even as adults, are very restless and anxious. It's like they always have to have some moving part. And there are some who jump into things very quickly, even as adults. And there are certainly a lot of kids who have this kind of thing. But the fact is that many people with ADHD have difficulty braking when they need to slow down and accelerating when they need to speed up. They often have difficulty controlling their actions. Sometimes they speak out of turn and do not consider what the effects of speaking and saying what they say will be.

Or they jump into something without thinking: "What will happen if I do this?" But all these things I'm talking about: problems with memory, problems with difficulty controlling actions, problems with regulating emotions, problems with regulating alertness and sleep, problems with the ability to concentrate and shift focus when necessary. All of these things make up the range of difficulties that people with ADHD complain about. And remember, these are all things that everyone struggles with sometimes. The thing is that people with ADD have many more problems with them. So the question is not: does it ever happen, but to what extent does it happen?

How much does it interfere with the person's ability to do the things he needs to do in her daily life? Now how does it happen? Why do some people have so much more difficulty with these things than others? Evidence shows that it appears to be mostly hereditary. Of every four people diagnosed with ADHD, one of them has a mother or father who suffers from it, whether they know it or not. They never used to diagnose this very well. Even today it is greatly missed. The other three, if they don't have a parent who does, usually have a grandfather, uncle, aunt, cousin, brother or sister.

One of your relatives will have it. Although it is often not recognized. There are some people who have this and it can be seen from early childhood. There are others where you don't see much in the first few years of schooling, but then when they start moving into high school and they don't have that teacher who can help them keep things organized, now suddenly they have to keep track of what happens in several different classes and of the assignments for different courses and moving from one class to another. They have much more difficulty managing it. There are some whose parents are so effective at building scaffolding around them that they don't even see the problem until they reach high school, where their parents aren't very aware of what they need to do, or they may move away. home and they go to university or get involved in some job where their parents can't help them, and you start to see that they have a lot of problems organizing themselves and doing what they have to do.

That's why we don't always see this in early childhood. Sometimes it doesn't really appear until adolescence or early adulthood. But the fact is that those are usually the most difficult times, I would say probably for most, middle school, high school, the first years of college or entering the workforce. These are the times when most people with ADHD have the most difficulty. Because those are the times when you have the greatest variety of tasks you have to do with the least opportunity to escape from the ones you're not so good at. If you're lucky, as you progress, you'll be able to focus more on the things you're good at and let someone else do other things you're not so good at.

And some people function quite well that way. But the fact is that these are problems that can cause a lot of difficulties, not only in school, but also in the way people get along with other members of their family, in the way they manage their social relationships, and in the how they manage their jobs. And what we have to do is be able to design a way to help them work with their strengths and solve their difficulties. But I think in order to fully appreciate this, it's important to understand what's going on in the brain that underlies these difficulties, which I just described.

The brain weighs about two and a half pounds. About this big. There you have 100 billion neurons. Those are the cells that make up most of the brain tissue. It's hard for most people to imagine a number as large as 100 billion, but here's a way to do it. Think of the pixels on a television screen. Imagine a 17-inch television screen or monitor screen for your computer. On that screen, you would have about 200,000 pixels. Now imagine if we then went to the Freedom Tower in New York. It is almost 100 stories high. And take 17-inch monitor screens and put them next to each other, bottom up, up on one side, all the way around, so that this whole building is completely covered with 17-inch TVs, and turn them all on, and add all those pixels on all those screens in that whole huge building.

Then you would have enough pixels, if you added them all up, to show how many neurons a person has in their brain. Now, these neurons... they are very, very small. You have to look at them under a microscope. But they come in different sizes and shapes, but they all work on a system of branches and twigs, somethinglike this. And if you isolate any one of them, you will find that there are more than 1,000 places where it connects and interacts with those around it. But the surprising thing is that the entire system works on low voltage electrical impulses and is not connected to anyone.

This is true for people with ADHD. It's true for everyone else. They are not connected directly. Let me show you what it looks like. If you can imagine these tiny connections that are so small that you need a microscope to see them. They look like a couple of mushroom heads put together. And then there's a space between them that's thinner than a piece of tissue paper. So when there's something coming from the brain, electrical impulses traveling here, it has to jump this gap like a spark plug. And there are little receiver buttons on the other side that you have to connect to.

And if it comes strong enough... ccckkkoo. You move on to the next connection and from there you continue to where you need to go. If not, just fail here. But the other thing we have here is that there are little bubbles on the sides. This is where they come from. This is where chemicals are made. The brain produces 50 different chemicals to help transmit messages back and forth. And there are two of them that control most of the things I've been describing in ADHD. So what happens when that electrical impulse arrives is that microdots of that chemical are released.

That's what crosses the gap and gets to these receivers. It works like a spark plug. And then if it hits the right threshold, it moves on. And then on this side, there are some little cells that work like little vacuum cleaners that run all week long and suck up the chemicals and recharge the system. Otherwise it would be open all the time. We think that what happens with people who have ADHD is that their brains produce these chemicals the same way anyone else's brain does. But they just don't release or recharge them effectively. And the other thing we know is that for eight out of 10 people who have ADHD, if they are given the right amount of the right medication, the system can function better.

For some, it is enormous how much it helps. For others, it's substantial, but not huge. It helps others a little, but not that much. And two out of 10 it doesn't work at all. But the fact is, even though it is a chemical problem, the medications we have for ADHD don't cure anything. It's not like you have strep throat, you take an antibiotic and that clears up the infection. It looks more like my glasses. I have a problem with my eyes. I can not see well. If I'm looking at typewriter-sized type, it looks blurry to me. If I put them on, I can read it as well as anyone.

Take them off, I'm back where I started. Glasses don't fix my eyes. They just help me see when I have them on. And the same goes for the medications we use to treat ADHD. But it's also important to recognize that medication is only one aspect of important treatment for someone with ADHD. And there are many ways that we help people with ADHD by helping them learn skills, helping them use some technologies and strategies to be able to cope with whatever they have to face at school, at work or in their family. and social relationships. And it's more effective to be able to, first of all, have a really good assessment, understand exactly what issues with ADHD this particular person is having, and then have the team (if it's a child) of the child, the parents, and the doctor. , in consultation with the educators and teachers who work with them, to try to assess what this child's strengths are.

That is our starting point. What are the difficulties? And what plan can we develop that will allow us to build on those strengths and help the child or adult learn ways to more effectively cope with their difficulties so they can be successful and reach their full potential?