By Dr. Lindsay Martin
ADD is not only a childhood condition
It’s been a fairly controversial issue over the last complete decade or so, in terms of whether or not this goes onto adulthood. It is a neurodevelopment disorder and it’s certainly most diagnosed in childhood, but about a 3rd of children will go on and develop the disorder or continue that disorder into adulthood and many will only be diagnosed as an adult.
ADD can be treated by more then just Ritalin
Many people actually will not require medication if they have the capacity to develop the organisational skills, the time management skills to get beyond the disorder – they do very well. And in terms of Ritalin, we now have several psycho stimulants similar to Ritalin, that’s something that we could use but they are also non-stimulant medications as well.
In addition to that we actually do use cognitive strategies now to make a really big difference. So in terms of treatment, I would have to say it’s really very broad nowadays.
You can still thrive in life with ADD
In terms of a diagnosis, these children and these adults are eccentric, they are interesting, their characters. I would very strongly say getting the right support, perhaps just an ADD coach is all you need – that would be sufficient for some to actually move beyond the illness itself or disorder itself. If in some and probably the majority of instances we actually do use medication, that plus the cognitive strategies, many go on to become doctors, lawyers, police, nurses; you name it, across the board.
They are very productive people. It isn’t a diagnosis that I would say is something that you are condemned with that you are not going to manage in life; you are not going to do well.
How does it affect the working memory
In terms of ADD, the working memory dysfunction is one of the core features of the disorder, it tends to go on and off, on and off, on and off.
Now, the working memory is where we store or hold our day-to-day information. It’s not something that’s actually been encoded. So you encode into short-term memory and then you encode into long-term memory and it gets stored away. Working memory isn’t encoded, so if it goes off that information is gone.
And so in order to trying and get past this, the sorts of things that people may develop these days. They have more of a photographic short-term memory. They have posted notes everywhere; they appear quite chaotic in their presentation. They also appear not to be listening or to not hear what you say because the information that they have just received has gone.
Can it be treated with cognitive learning
This has certainly being coming to the fore off late, is that we now have quite a cognitive behavioural package that we use to help with ADD. We consider that the medication will improve focus, will improve the capacity to concentrate and concentrate for longer, improves the capacity to delay your response and therefore have a greater opportunity for be a better behavioural response – that’s great, but there are a lot of things that the medicine doesn’t help and this is where the cognitive behavioural strategies really coming to their own.
The sort of things inherent in an attention disorder
- Capacity to organise oneself
- Ability to feel time
- Poor time management is inherent in an attention disorder.
If we consider the cognitive strategies, they help manage these additional factors that often can be what leads us to come undone, particularly if you know your diagnosis as an adult and you are trying to juggle responsibilities of parenting, work and your relationship. You know the more you put on yourself, the more difficult it is to actually manage. So to add in cognitive strategies, where we would assist in terms of the additional dysfunctional that comes with the disorder – it makes all the difference and it means that your medication is not the be all and end all.
Intelligence is not linked to ADD, in fact intelligence allows someone with the disorder to get around it
It’s something that comes up quite a lot actually when I suggest to someone – perhaps you may have attention disorder. Oh no, no! I did really well at school, and that’s usually the response I get and it really has nothing to do with your intelligence. If you are particularly intelligent, it probably isn’t going to be picked up at school.
The intelligence is going to enable you to actually circumvent a lot of the difficulties that come along and therefore what we tend to see in the adult is once an intelligent person is stressed with multiple responsibilities, that’s when they start to fray around the edges and that’s when they start to present. The sorts of things that they are presenting with is, I feel overwhelmed, I am really anxious, I am not able to manage anything, I just feel totally overwhelmed with everything that’s going on. Often underlying that anxiety or depressive presentation is somebody who has an attention deficit, which hasn’t been picked up because the intelligence is quite high. So I think that’s really important to stress that it really has nothing to do with intelligence, however, untreated ADD can impair the performance and so someone who perhaps has a high intelligence but has quite a significant disorder is going to perform a lot lower than your expectations and that often is something to sort of suggest, “what’s going on? Why is this person not performing how you would expect them to be performing giving their intelligence?”. That’s often one of the indicators that something maybe wrong.
ADD doesn’t always mean high energy
I would strongly suggest that the current typical model or perception that we have of ADD is that young boy, running amok, climbing the walls… really very naughty and very destructive within the classroom . That would be a very small percentage of children and it’s not saying he doesn’t have ADD but in a lot of instances that child probably has a lot of other issues going on.
The majority of persons with an Attention Disorder are going to present in a far more subtle manner – the chatterbox, the person squirming in their seat. The people that read, but can’t take on board the information to hold it long enough to answer the questions. The child that doesn’t seem to be listening that isn’t being naughty but just doesn’t seem to be listening, the child that seems to forget a lot of things. These are the sorts of behaviors that would come out on a school report for instance – such and such would be so much better if they stop talking in class, such and such would be so much better if they are actually focused – these are the sort of things that on a school report literally gives us the information that there is something wrong with the attention.
The difference between ADD and ADHD
The two are actually one in the same and they are used interchangeably. ADHD is actually the current diagnostic label and it means that an Attention Deficit Hyperactivity Disorder. However, there are sort of multiple different forms of the disorder. Some will present more with attention focus issues whereas others will be more hyperactive. The hyperactivity tends to change over time, so as the brain develops the behavior changes. So a hyperactive child might be a child with a heap of energy, really boisterous, really talkative. Hyperactive adult perhaps is someone who is always on the go, always driven, got to do… got to do… got to do, but feels an internal tension, a restlessness inside them. They don’t like to sit still.
So in terms of ADHD and ADD, we use the diagnosis interchangeably but it really doesn’t matter whether we use one or the other because there is such variability in the ADD spectrum.
People with ADD don’t have trouble paying attention, they have trouble choosing what to pay attention to
If you look at the disorder as one where there isn’t a filter for instance, that everything is coming in and they are unable to specifically focus on one thing, so that their mind is full of ideas racing around, they are thinking about 3-4 steps in front of themselves. Everything around them is a stimulus but also as well as they sort of external stimuli, there is also the internal stimuli as well.
Many people with an attention disorder have trouble focusing on their internal world, and so they perhaps aren’t aware that they are hungry and they miss meals. They also may not be aware that they are full and therefore over eat. There are issues in sensitivities often around diet. There may also be issues and sensitivities around a number of other physical functions and therefore when we look at the attention disorders, it really is a disorder that is highly variable but it is also about not being able to focus on multiple stimulus that’s coming towards the person.
Medication cant fix ADD
In terms of the current treatment, there is absolutely no cure for ADD in terms of the concept that I am going to take this medicine and it’s going to fix it. So, the medicine that we have at the moment is not like an Anti-biotic, where we are going to get rid of the problem.
What does happen though is medication enables us to actually rewire the brain. It enables us to learn the behavioural strategies to do it differently. Many people that start medication don’t take it for life, they may take it only for a couple of years and in that time they have been able to learn how to do it differently. They have actually become aware so that they can focus now in their internal world and external world, and they are aware of their behavior and then they can actually change it.
So if we consider the disorder to be one where I am not aware of how I impact others – these are the sorts of changes that medicine helps us be aware of and therefore I can change.
There are some people that do continue medicine for a prolonged period of time but they seem to be less than the number that actually stop taking the medicine. And what we often say is, this isn’t something you have to take, and this is isn’t something you have to take for the rest of your life. This is something that we would recommend helps you get to the next stage where perhaps you are not going to need as much.
What are the long term effects of ADD medication
What we do know thus far. Is that there is a very small chance of developing a dilated cardiac muscle. Now what does that mean? That basically means that over a long period of time, those people that are potentially vulnerable to heart disease can perhaps develop a stretched heart muscle. This is of an incidence that is extremely low, and therefore what I would suggest is that very slim the risk factor needs to be weighed up against not treating.
And what happens when we don’t treat? What we tend to see is someone with a lifelong history of depression, anxiety, low level of achievement, poor self-esteem, poor self-worth. These issues and these results of untreated ADD are often linked to an increase risk of suicide. So, I would always say weigh up the very small risks against a considerable risk of things going wrong.
In terms of that risk of heart disease, what is very important and what I would always suggest that anybody on psycho stimulant medicine, have your blood pressure checked regularly. Make sure that you are seen by your general practitioner, and make sure your heart is being looked at. So regular health checks are a must.
If you or a loved one is suffering any of the above mentioned symptoms, please consult your GP and start the process to better understand and manage ADD. It might be the best thing you do in your life.