ADHD 101

ADHD stands for Attention Deficit Hyperactivity Disorder. It is a condition that includes multiple behavioral aspects which present differently with every ADDer. Those aspects are summarized as Distractibility – the inability to keep attention on a specific task for a prolonged time – (Attention Deficit) Hyperactivity – Constant movement which can be either gross motor such as moving body parts back and forth or the urge to walk / run around, it can also be fine motor activity such as fidgeting and playing with small gadgets, and recent research added a third type of hyperactivity, brain hyperactivity, the constant nonstop bombardment of thoughts and ideas. Impulsivity – Acting before thinking such as blurting out in class, skipping ahead in lines, impulsive shopping or impulsively reacting to triggers by others. In recent research a complete new dimension was added to the ADHD diagnosis and treatment which is called Executive Functioning skills if the neurology of ADHD is well understood, EF fits right in.

Every person is born with a burning drive do perform and to achieve, is short, this drive is called stimulation, the brain also has a system to sense when an achievement has been obtained and so the drive is somewhat relaxed to allow the achievement action to take place and not to drive the person away from the thing he is in the middle of achieving, the Dopamine neurotransmitter does this function with what’s called the reward pathway, this means that whenever someone experiences a pleasurable experience, the dopamine levels in the brain, increase and as a result the brain understands that it is now satisfied, with ADDers, dopamine is not so readily available, and therefore the feeling of satisfied is not relayed as it is with other people, this causes the ADDer to always feel a desire for new stimulation and that causes him to be constantly drawn to new Interests, so even if he sets his attention on something he wants to do, the slightest distraction (which a non adder would switch off immediately) draws his attention away from what he was doing and thus he becomes interested in it until the next interesting distraction comes along and so on. The same thing explains hyperactivity, gross or fine motor movement is a form of stimulation, it stimulates the brain (think movement Vs boredom) so now we understand how ADHD and ADD are really the same but are expressed differently. The Impulsivity and EF portion of ADD have more to do with the prefrontal Cortex which is the brains stop sign to plan think before you take action, every person has a portion of the brain that has constant desires of all kinds such as food etc. but the prefrontal cortex is the stop sign that make the person think twice if it is worth to fill the desire against future consequences. With ADHD because this part of the brain doesn’t work as it should, inhibition and self regulation is a challenge.

There are some differences in the brain function and in brain maturity size in ADDers. ADDers brains lag about 2-3 years in development Vs. their non add peers. Also the neuro transmitters in ADDers lack certain capabilities that others have. The main known neuro transmitters that are affected are Dopamine which is responsible for movement, motivation and reward and in some ADDers Norepinephrine which is in charge of the Fight or Flight response. The known portion of the Brain that is affected by ADD is the prefrontal cortex which is the portion of the brain that is responsible for Long term planning, prioritization and inhibition.

As mentioned before ADHD stands for Attention Deficit Hyperactivity Disorder, ADD is Attention Deficit Disorder without Hyperactivity. In the old school these two conditions were viewed as two separate diagnoses the first reserved for those fidgety kids who couldn’t sit still and the latter for kids who were distracted and couldn’t keep there focus, in the 1980s? based on the then available science the 2 were joined and for a while it was referred to as ADHD with hyperactivity and ADHD without hyperactivity, recent research had proven that the neurological core cause of these conditions is the same but they are expressed differently in other words those kids who are inattentive and distracted, it is because their minds are hyperactive and thoughts flow through constantly non stop which causes them to be distracted… so now everything is called ADHD but there are two subtypes of ADHD one is called ADHD predominantly Inattentive and the other is called ADHD predominantly Hyperactive. It should be noted that many times, kids from one type will have a few symptoms of the other type but because the majority of symptoms are of one type, it is referred to as such.

Based on research of identical twins and other thorough research it is believed today that genetics and pre-birth effects are the main cause of ADHD. It should be noted that Attention Deficit or Hyperactivity in school or at work can be caused by many factors, including brain injury, lack of proper sleep, hearing loss, vision problems, and even unstable conditions at home but most professionals would rule out all of these external causes before stamping a diagnosis of ADHD because, for these external causes, the treatment plan must address these external causes instead of just addressing the inattention by medication, treatment of ADHD by medication is reserved for situations in which there is a neurological cause for the inattention or hyperactivity.

The scientifically backed answer is NO. The current science community doesn’t know of a method to cure ADHD, all that they can do is Medication and behavioral change programs such as CBT or Coaching. It is worth to mention, that there are some brain exercise programs and physical exercise that can help to reduce or eliminate many of the symptoms that come with ADHD, my experience is that it does help alleviate some of the symptoms and I explain it by Neuroplasticity, but I have not yet seen FULL healing of ADHD from any such program.

Most adhd meds work by increase the available levels of the Neurotransmitter Dopamine whereby increasing the feeling of stimulation and thus relaxing the brain as well as increasing the functionality of the prefrontal cortex.

The 2 obvious effects are either Distractibility and / or Hyperactivity. Distractibility is when the child tries to concentrate on what the teacher / tutor is teaching but is constantly distracted by other stimuli such as fire engine alarm, birds flying by, rain, noise of the Air condition, other children’s minor activity or movement, noise from outside the class room. This can sometimes cause him not to know the stuff he learned, but many times he does know his stuff due to compensating factors where he is able to comprehend the material even if he was distracted but the negative effects are caused by the teacher constantly having to remind him and discipline him, he is then labeled as the bad boy of the class which then has a spiral affect. Hyperactivity is when the child is constantly on the move, many teachers can not tolerate this and will not allow kids to fidget and definitely not stand up during class, for the ADDer who has this almost automatic urge to move this is a problem because the teacher is always on his back and he can not really help it but continue to fidget and to move around, this again causes an unnecessary strain on the child plus the labeling as the child who doesn’t obey the teacher, spiraling down from bad to worse to a low self esteem which can end up with anxiety and depression. Hyperactivity can also aggravate the children next to him which can be a cause for friction and or social un-acceptance. Executive Function challenges effect school kids from when they get up In the morning, where they cannot manage to get to school on time, when they finally got to school they may have forgotten their recess meal, the signed test or the note that they need to go to an appointment. They are also sometimes very disorganized and leave things all over the place and cannot find their paper/pen/book when needed, they also have time management issues so they may come back to class late after a break.

This question is usually asked by two groups of people, the first group are those who usually have difficulty with conceptualizing all kinds of mental illnesses and conditions, it is difficult for them to accept the idea that although the person looks totally alright on the outside and maybe be good looking and tall and handsome so how can it be that they have an issue that is keeping them from functioning well, the answer to this group is first of all, there is a physical part to ADHD [ and to mental illnesses as well], it is now documented by research that the brains size of children with ADHD is smaller than the same age children without ADHD, similarly, children who have ADHD, have different levels of Dopamine and Norepinephrine [neuro transmitters that the brain uses to make us function the way we do], and therefore it is a physical condition as well, but besides that, we work from the premise of “If the child could, he would”, many parents of ADDers who tried to change them were unsuccessful simply because, they DO have an underlying issue that was never addressed and as much as they would try to please, they just COULD NOT. This only proves that instead of sticking your head in the sand and insisting on the old way, you must open your eyes to see what’s in front of you and work with what you have and by addressing the underlying issue, you can with hashems help, see great results. The second group of people who ask this question are those who read or heard claims in the news that ADHD is a fabrication of the pharmaceutical companies who are promoting to drug up kids in order to rack in profits. In order to address these media claims we must first understand that the media’s survival depends on making drama and alarming claims to draw the attention of the public and to keep them in suspense, otherwise the public would not be interested in the media, so what happened was, that in the 1980s and 1990s, there was a large increase in prescriptions for Ritalin and similar ADHD meds, and the media picked up that there were some specialists who were concerned that some kids are prescribed Ritalin without going through the proper diagnostic procedures, but instead, a parent would complain to the family doctor that the child doesn’t behave at home or in school, and the doctor would prescribe Ritalin to calm them down, many of these kids were not ADHD but simply wild and misbehaving, and if put through the proper diagnostic procedure, they would not qualify as ADHD. When the media picked this up, they twisted it in a way so that the public was made to believe that ADHD is not a real thing but a fabrication by drug companies. The truth is, that anyone who suspects a child is ADHD should go to a properly trained psychologist and / or psychiatrist to get the proper diagnosis, and only then should they put their child on mediation is deemed the proper treatment, a family doctor should never be used to diagnose and treat ADHD, but the fact that some non-add kids got Ritalin doesn’t mean that it doesn’t exist. If you look further into the media reports, it is very obvious how they skewed the information in order to feed their agenda.

As explained earlier, ADDers have in internal drive that is not easy to satiate, this causes them to be constantly on the move and restless due to the internal drive for stimulation. Distractibility is caused in part by the constant wave of thoughts and ideas in the mind of the ADDer, but largely has to do with the inability to selectively focus his attention on things that are not as interesting to him, as well as by the inability to filter out external stimuli such as noise and visual stimuli, by not being able to filter out these stimuli while trying to focus on a certain task, his mind wanders to the external stimuli and gets stuck there.

Hyperactivity is very well treated with the proper dose of ADHD medication like Ritalin or Adderal, alternatively/ in addition to meds, or for those who choose not to medicate for ADHD, Coaching or CBT can be used to train the child to tame down his hyperactivity. Exercise is also very helpful to reduce hyperactivity, as it increases serotonin [a relaxing neurotransmitter] in the brain. For children in a class room it can be useful to let them play / fidget with small gadgets or with putty, this provides an outlet for the extra energy and for the needed stimulation. Letting them get up and walk every so often is very helpful.

ADHD medication is very functional in helping kids keep focus. In addition to or as an alternative to medication, attention can be improved in the class room by minimizing distractions such as placing the child away from a window and away from noise (even the noise of an air condition), ideally if he can be seated in a location where he can have a lot of eye contact with the teacher this would help him keep his focus. One major booster of attention is increasing the interest of the child in the subject, that is easier done in private tutoring than in the class room but whenever possible, bringing real life examples to the subject matter and making it relevant to the child in his life (family, social, enjoyment or imagination) bringing in slight drama or play helps very much in increasing interest and thus attention. There are also some exercises that train the brain to sustain focus for longer periods of time.

There are two scenarios where glasses can improve the symptom of ADHD. If the ADHD symptoms are caused solely because the child had vision problems to begin with, in this case the glasses will usually solve the issue completely, (there may be issues as a result of missed learning which can be addressed by private tutoring in reading and related missed skills), kids in this category will usually be hyperactive and / or inattentive but will not exhibit too many EF challenges e.g. they will score high in an EF screening. If the child has ADHD with EF functioning challenges (e.g. true ADHD), he may still benefit from glasses if he presents with reading / writing specific challenges. 50% of ADDers have what’s called “Co-Morbid Conditions” Co-Morbid means co-occurring, they have conditions separate from ADHD which qualify for a standalone diagnosis of a specific LD or mental condition. One of which is dyslexia which is a challenge in reading, these kids can greatly benefit from such glasses, in many cases, the glasses can solve much of the Hyperactivity / Distractibility, leaving them with just EF challenges.

The most common side effects are loss of appetite, sleep disturbance and zombie like feelings. For loss of appetite, it is recommended to take the meds in the morning right after breakfast so that he can eat a full nourishing breakfast to compensate for the missed lunch, by the evening, the med effect will usually be diminished. For sleep disturbance, there are several ways to deal with it. Some respond well to simply timing the meds to loss its effect before sleep time, for some, an additional smaller dose in the late afternoon helps them fall asleep better. For zombie feeling you should work with your doctor to adjust the medication (upwards or downwards, both are possible)

Executive functions are a group of abilities and necessary functionality that every person has [needs] this is the group of life skills that are inborn to every person that help him control his behavior, his thinking, and his actions. These functions are performed mainly by the prefrontal cortex region of the brain and they were named Executive function as it implies, these abilities are like the executive assistant to the person. e.g. the ability to think and plan for the future, the ability to manage priorities, the ability to inhibit internal drives to food and other bodily pleasures , the drive to spending or to anger. In summary these functions enable to person to think before he takes action and to weigh the benefits of a potential action against its possible consequences, the ability to delay gratification. Because as explained before, the root of ADHD is in part in the prefrontal cortex, ADDers lack in executive functioning and this is the reason why they may be impulsive, disorganized, unaware of time, unable to prioritize [ and as a result get overwhelmed at certain larger tasks which in turn causes procrastination] etc. all these require the ability to think ahead and make priorities, lacking these skills result in executive dysfunction.

Before we discuss how you can know if a child had ADHD, we should emphasize that you should never decide on a child that he has ADHD even if he exhibits many of the signs of ADHD. The reason is, that there are other mental and behavioral conditions that share many of the characteristics of ADHD and only a skilled and properly trained doctor who went through several YEARS of observations by other doctors is able to precisely diagnose the condition of this child. Nevertheless the following can be used as a criteria to suggest that the child might have ADHD and should be referred to the proper specialist who can diagnose and treat him. A child who over a longer period of time [at least 6-8 weeks] exhibits restlessness or distractibility that cannot be explained by Lack of sleep or nutrition, hardship at home or other hardships should be suspected that he might have ADHD, especially if he exhibits the above in conjunction with impulsivity [reacts out of expected proportion] or is very disorganized, has no sense of time, is unable to initiate a task, cannot prioritize or is very forgetful. There is a short form (ADHD-RS-IV) and long form (VADTRS) that is used to initially screen children for ADHD that can be used to determine if ADHD might be at play. If these screening tools result in a positive, to not conclude that the child has ADHD but conclude that he should be referred for further testing.

Possibly, but don’t panic. Many ordinary people, [in fact almost all people], have 1 or more ADHD traits, this doesn’t mean that they have ADHD though. In order to be officially diagnosed with ADHD, these traits must be so severe that they affect negatively your quality of life, just daydreaming once in a while is normal just as acting impulsive when you are under pressure and not well rested, but if this behavior is so severe that you SUFFER from it [socially of economically] then you should complete a screening rating scale for ADHD to determine if you should go for further testing.

This is what is called “Situational Variability” in ADHD. Because ADHD is a challenge of keeping focus on something that is not interesting [i.e. stimulating enough], if an ADDer finds himself doing something interesting, not only can he focus very well, but he can become hyper focused, that is, he becomes so intensely focused on that game that he would sometimes not notice his surroundings because he is so indulged in the game. This is because ADDers have a very narrow range of selective attention, which means, they can direct their attention on something they want anything below that range of interest, will be hypo focus e.g. he has weak focus and any minor distraction will pull away his attention, anything above that range, will be hyper focus that ho is so focused to the exclusion of anything else. Non ADDers have a much wider range of selective attention where they can choose to focus on something even if it is not as interesting, and on the other hand, when something is quite interesting, they would still not become hyper focused so fast.

Medication for ADHD is relatively very safe and very effective in treating many of the challenges of ADHD, it is safer than taking Tylenol for a headache and safer than taking antibiotics for an ear infection. Most of the arguments against ADHD medication is not based on solid knowledge, it is usually based on gossip because someone said that someone said this and that etc. The truth is that there are some real considerations before agreeing to ADD meds those include possible weight loss of the child (can be minimized by proper dosing and timing of the meds and by weekends off meds), stigmatizing the child (can be prevented by using proper communication and delivering a positive msg to the child) , and there are some concerns about possible long term effects from playing with the brain chemistry (these are not proven but yes, there is a possibility). One must still consider the possible outcomes of not treating ADHD which are severe based on my own experience, nine out of ten troubled-rebellious teens were non treated adhd. There are of course other possible treatment plans for ADHD if someone doesn’t want to start with meds, these can include Vitamins, physical Exercise, brain exercise, Coaching and or CBT but a the end of the day, if these don’t do the trick, you better grab whatever medication works for you because otherwise, the house may burn down and you will have no brain to protect, there just won’t be one at all.

The short answer is that 80% of ADDers do not outgrow their ADHD but it changes in its expression. It was once thought that ADHD is usually outgrown after teenage hood, this was in the days where the only definition for ADHD was hyperactivity. Now that we know that EF are an essential part of ADHD, and that inattentive and hyperactivity are both from the same cause with different expressions, it is understood that although one may outgrow the hyperactivity and impulsivity from childhood to adulthood, the ADHD is not outgrown but as the ADDer matures, he learns ways to better control his impulses and to tame his hyperactivity, but he remains affected by his ADHD in his EF abilities and in his remaining attention challenges.

ADHD can usually be noticed somewhere between nursery and 3rd grade if the hyper type and can go unnoticed for much longer if the inattentive type.

Adult ADHD as the word implies simply means the way adults are usually affected by ADHD. Unlike children who suffer most in school or with peers, Adults are affected by adhd in different ways such as job related issues, spouse related issues, issues with the law and managing their life in general [organizational issues] etc.

ADHD does have a strong genetic component, statistically, an ADDer has a 50% higher chance of having a sibling with ADD as well as a parent with ADHD

ADHD and depression / anxiety can be related in two possible ways. One is called “Co-Morbidity” which is a fancy name to other conditions (mental issues, behavioral issues or learning disorders) that can exist in a person who has ADHD but that are separate diagnosable conditions. These co-occurring conditions can include depression and anxiety, in fact more than 35% of ADDers have a diagnosable condition of anxiety or depression. It is not clear to date but it is hypothesized that the very same genetic or other factors that cause ADHD, cause those other conditions, these conditions are usually treated separately from ADHD [e.g. the person has to take 2 medications] but if one could address the underlying cause from its source, both conditions would improve. It is worth noting that when ADHD and another mental condition are treated simultaneously, the combination of the meds can complicate things and it is very important to be under the care of a highly competent doctor. There is also another way that these conditions can occur with ADHD and that is when ADHD has not been properly addressed for a prolonged period of time and the individual developed feelings of failure and of frustration, this can be the cause to situational anxiety and / or depression, if this is the case, then treating the ADHD should be the priority and usually after properly treating the ADHD [and sometimes with additional therapy] the anxiety or depression will disappear.

Coaching for ADHD works from several directions to improve the life of ADDers and to actually make them excel and achieve their high potential which in many cases is very very high. Education, knowledge is power. Many ADDers are not aware of the “why” of their challenges, they stumble a lot and try to overcome the challenges but so long as they don’t know the root cause of the challenge, it is difficult to find the right solutions. By educating them and matching their challenge to a known ADD challenge, they can then use the many possible known solutions to their challenge. Boosting self esteem, before ADDers learn all about their unique brain wiring, they face many obstacles and dead ends, this can sometimes give them a feeling of inadequacy, coaching works to shine the spotlight on their possibilities and strengths so that they can look at themselves from a positive perspective and as a results they can strive to higher goals and achieve higher results Finding ways that work for his unique brain. Many of the challenges faced by ADDers are only challenges because they think they need to do things like everyone else does, since ADDers are wired differently, they need to do things differently as well. Coaching aims at finding new ways to look at things and to do things the way their brain works, these new ways are “out of the box” and when adopted make for a smooth road ahead.

The reward pathway is a term used by neurologists when discussing the many wonderful systems that the brain employs to desire, experience, feel and appreciate pleasure. The way the brain communicates with the emotional systems and the way the brain handles thoughts and desires is by creating and converting certain brain-chemical called neuro transmitters these chemicals are sent from one portion of the brain to different portions of the brain in a very complicated system which as a result, the person experiences all of his thoughts and feelings. Brain scientists have identified certain areas of the brain and certain brain chemicals that are responsible for the different tasks involved in pleasure, from the moment the person has a feeling of pleasurable desire, to after the pleasure has been experienced. This complex chain of events is referred to as the “Reward Pathway”.

As indicated earlier, it is known that the ADD brain is affected in the area of the Pre Frontal Cortex and in the neurotransmitter called Dopamine, these two are an integral part of the Reward Pathway, as a result, ADDers can sometimes experience different levels of pleasure than ordinary people. For example the amount of pleasure that would usually satisfy an ordinary person, would either not be enough for the ADDer to experience the same amount of pleasure or it may be too much, [e.g. he would have the same amount of pleasurable experience from a much lesser amount]. This is important to know because sometimes you could

Firstly, it is true that the understanding of ADHD became much more prevalent in recent years, and although it is still far from well understood by the general public, there is a greater awareness of ADHD at large and this may be contributing to the increase in actual diagnosis of ADHD, whereby the same child who, 40 years ago, would have been labeled obnoxious and unmanageable, today that child is better understood and as a result is better treated and given a better chance to prosper. It is believed that even today, only 15% of ADDers are actually diagnosed and treated, this explains how many years ago there were even less people diagnosed with ADHD although they may have had the same qualifications of the diagnostic criteria. It is also true, that in recent years the diagnostic criteria for ADHD was broadened to include some people who would not been covered by the previous criteria and as a result there is an increase in ADHD diagnoses, but here again, based on the better understanding of ADHD that we have today, it is believed that those who didn’t previously qualify for the diagnosis, should have qualified so again, there is no actual increase in the prevalence of ADHD but there is an increase in the population who are correctly diagnosed with ADHD. There are some theories that claim an actual increase in ADHD and that goes together with the underlying cause of ADHD which is not clear to date but these theories who believe that ADD is caused by external environmental causes such as the food we eat etc., they claim that there is a greater amount of ADDers today because of the increase of children who are fed the wrong diets….

ADHD was recognized as a condition as early as 1902 under different names such as “minimal brain dysfunction” in the 1950s and ADD in the 1980s, then came ADHD in the 1990s. The medication for ADHD Ritalin dates back to the 1930s (under a different name) and Ritalin first appeared in the 1950s, since then Ritalin was improved by adding long acting versions and other classes of ADD meds appeared, one other very common medication is Adderal which first appeared in the 1990s.

The first thing you must do when the Meds seam to stop working is to evaluate your situation, has there been any major changes in the routine of the child One major one is a ny change in school routines. Changed teacher, changed subjects, or timings. Then evaluate such as different Sleep patterns, different eating patterns or even changes in his bathroom activity. These can have a major impact on the effectiveness of the Meds. Whether or not there were any changes, you should discuss the new developments with the doctor who prescribed the medications till now [and hopefully he was a well recommended psychiatrist, otherwise please get a recommendation to one.]. ADHD medication is not an exact science and in most cases the initial prescription will not be the final one, it must me “titrated” e.g. adjusted in order to find the exact dosage for this particular person. Once the proper dosage was achieved, it will usually last for a long time and should not encounter any problems, if you do encounter problems, the dose may need to be adjusted up or down or a new type of meds may be tried. Because ADHD medication titration is a skill, it is very important to use a doctor who is well versed and up to date on the ins and outs of ADD meds.

Medically, the criterion for an addiction is 1) Tolerance; the person needs to continue increasing the dose in order to achieve the same effect, 2) compulsive seeking and use; the person continues to use the substance, despite harmful consequences, and 3) Withdrawal; if stopped, the person experiences withdrawal symptoms such as Depression, sadness, and anxiety or mood disorders . With ADHD medication none of the above Is true.

There are many organizations that support ADHD in children and adults such as CHADD and ADDA their website offers tons of information on ADHD, CHADD has a monthly magazine called Attention Magazine with news and updates in the ADHD field. Books, to list a few, Dr. Ed Hallowell who is himself ADHD and is a respected authority, authored several books on child and adult ADD, “Driven To Distraction” , “SUPER PARENTING FOR ADD” and “Answers To Distraction”, Dr Russell Barkley is the top clinical researcher in the US on ADHD he has a book Taking Charge of ADHD that is very informative.

That if you support them and allow them to grow the way they are intended, they will grow up happy functional and successful adults, but if you try to deal with them just like all other children, without attending to their specific needs, the damage is irreversible and they have a 9 in 10 chance to grow up problematic.

Sure, all you need to do, is to let him grow up supporting his unique brain wiring.