Secrets of the ADHD Brain

Most people are neurologically equipped to determine what's important and get motivated to do it, even when it doesn't interest them. Then there are the rest of us, who have attention deficit.
by William Dodson, M.D.

ADHDers know that they are bright and clever, but they are never sure whether their abilities will show up when they need them.
ADHD is a confusing, contradictory, inconsistent, and frustrating condition. It is overwhelming to people who live with it every day. The diagnostic criteria that have been used for the last 40 years leave many people wondering whether they have the condition or not. Diagnosticians have long lists of symptoms to sort through and check off. The Diagnostic and Statistical Manual of Mental Disorders has 18 criteria, and other symptom lists cite as many as 100 traits.
Practitioners, including myself, have been trying to establish a simpler, clearer way to understand the impairments of ADHD. We have been looking for the "bright and shining line" that defines the condition, explains the source of impairments, and gives direction as to what to do about it.
My work for the last decade suggests that we have been missing something important about the fundamental nature of ADHD. I went back to the experts on the condition — the hundreds of people and their families I worked with who were diagnosed with it — to confirm my hypothesis. My goal was to look for the feature that everyone with ADHD has, and that neurotypical people don't have.
I found it. It is the ADHD nervous system, a unique and special creation that regulates attention and emotions in different ways than the nervous system in those without the condition.
The ADHD Zone

Almost every one of my patients and their families want to drop the term Attention Deficit Hyperactivity Disorder, because it describes the opposite of what they experience every moment of their lives. It is hard to call something a disorder when it imparts many positives. ADHD is not a damaged or defective nervous system. It is a nervous system that works well using its own set of rules. Despite ADHD's association with learning disabilities, most people with an ADHD nervous system have significantly higher-than-average IQs. They also use that higher IQ in different ways than neurotypical people. By the time most people with the condition reach high school, they are able to tackle problems that stump everyone else, and can jump to solutions that no one else saw.
The vast majority of adults with an ADHD nervous system are not overtly hyperactive. They are hyperactive internally.

Those with the condition don't have a shortage of attention. They pay too much attention to everything. Most people with unmedicated ADHD have four or five things going on in their minds at once. The hallmark of the ADHD nervous system is not attention deficit, but inconsistent attention.
Everyone with ADHD knows that they can "get in the zone" at least four or five times a day. When they are in the zone, they have no impairments, and the executive function deficits they may have had before entering the zone disappear. ADHDers know that they are bright and clever, but they are never sure whether their abilities will show up when they need them. The fact that symptoms and impairments come and go throughout the day is the defining trait of ADHD. It makes the condition mystifying and frustrating.

People with ADHD primarily get in the zone by being interested in, or intrigued by, what they are doing. I call it an interest-based nervous system. Judgmental friends and family see this as being unreliable or self-serving. When friends say, "You can do the things you like," they are describing the essence of the ADHD nervous system.

ADHD individuals also get in the zone when they are challenged or thrown into a competitive environment. Sometimes a new or novel task attracts their attention. Novelty is short-lived, though, and everything gets old after a while.
Most people with an ADHD nervous system can engage in tasks and access their abilities when the task is urgent — a do-or-die deadline, for instance. This is why procrastination is an almost universal impairment in people with ADHD. They want to get their work done, but they can't get started until the task becomes interesting, challenging, or urgent.

How the Rest of the World Functions

The 90 percent of non-ADHD people in the world are referred to as "neurotypical." It is not that they are "normal" or better. Their neurology is accepted and endorsed by the world. For people with a neurotypical nervous system, being interested in the task, or challenged, or finding the task novel or urgent is helpful, but it is not a prerequisite for doing it.

Neurotypical people use three different factors to decide what to do, how to get started on it, and to stick with it until it is completed:
1. the concept of importance (they think they should get it done).
2. the concept of secondary importance--they are motivated by the fact that their parents, teacher, boss, or someone they respect thinks the task is important to tackle and to complete.
3. the concept of rewards for doing a task and consequences/punishments for not doing it.
A person with an ADHD nervous system has never been able to use the idea of importance or rewards to start and do a task. They know what's important, they like rewards, and they don't like punishment. But for them, the things that motivate the rest of the world are merely nags.

The inability to use importance and rewards to get motivated has a lifelong impact on ADHDers' lives:
How can those diagnosed with the condition choose between multiple options if they can't use the concepts of importance and financial rewards to motivate them?
How can they make major decisions if the concepts of importance and rewards are neither helpful in making a decision nor a motivation to do what they choose? This understanding explains why none of the cognitive and behavioral therapies used to manage ADHD symptoms have a lasting benefit. Researchers view ADHD as stemming from a defective or deficit-based nervous system. I see ADHD stemming from a nervous system that works perfectly well by its own set of rules. Unfortunately, it does not work by any of the rules or techniques taught and encouraged in a neurotypical world.

That's why:
ADDers do not fit in the standard school system, which is built on repeating what someone else thinks is important and relevant.
ADDers do not flourish in the standard job that pays people to work on what someone else (namely, the boss) thinks is important.
ADDers are disorganized, because just about every organizational system out there is built on two things — prioritization and time management — that ADDers do not do well.
ADDers have a hard time choosing between alternatives, because everything has the same lack of importance. To them, all of the alternatives look the same.

People with an ADHD nervous system know that, if they get engaged with a task, they can do it. Far from being damaged goods, people with an ADHD nervous system are bright and clever. The main problem is that they were given a neurotypical owner's manual at birth. It works for everyone else, not for them.  

Don't Turn ADHDers into Neurotypicals
The implications of this new understanding are vast. The first thing to do is for coaches, doctors, and professionals to stop trying to turn ADHD people into neurotypical people. The goal should be to intervene as early as possible, before the ADHD individual has been frustrated and demoralized by struggling in a neurotypical world, where the deck is stacked against him. A therapeutic approach that has a chance of working, when nothing else has, should have two pieces:

Level the neurologic playing field with medication, so that the ADHD individual has the attention span, impulse control, and ability to be calm on the inside. For most people, this requires two different medications. Stimulants improve an ADHDer's day-to-day performance, helping him get things done. They are not effective at calming the internal hyperarousal that many with ADHD have. For those symptoms, the majority of people will benefit by adding one of the alpha agonist medications (clonidine/Kapvay or guanfacine/Intuniv) to the stimulant.

Medication, though, is not enough. A person can take the right medication at the right dose, but nothing will change if he still approaches tasks with neurotypical strategies.
The second piece of ADHD symptom management is to have an individual create his own ADHD owner's manual. The generic owner's manuals that have been written have been disappointing for people with the condition. Like everyone else, those with ADHD grow and mature over time. What interests and challenges someone at seven years old will not interest and challenge him at 27.

Write Your Own Rules
The ADHD owner's manual has to be based on current successes. How do you get in the zone now? Under what circumstances do you succeed and thrive in your current life? Rather than focus on where you fall short, you need to identify how you get into the zone and function at remarkable levels.

I usually suggest that my patients carry around a notepad or a tape recorder for a month to write down or explain how they get in the zone.

Is it because they are intrigued? If so, what, specifically, in the task or situation intrigues them? Is it because they feel competitive? If so, what in the "opponent" or situation brings up the competitive juices?

At the end of the month, most people have compiled 50 or 60 different techniques that they know work for them. When called on to perform and become engaged, they now understand how their nervous system works and which techniques are helpful.

I have seen these strategies work for many ADDers, because they stepped back and figured out the triggers they need to pull. This approach does not try to change people with an ADHD nervous system into neurotypical people (as if that were possible), but gives lifelong help because it builds on their strengths.

Article retrieved from: http://www.additudemag.com/adhd/article/10117-2.html

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Toddlers becoming so addicted to iPads they require therapy

Children as young as four are becoming so addicted to smartphones and iPads that they require psychological treatment. 

By Victoria Ward         

4:29PM BST 21 Apr 2013

Experts have warned that parents who allow babies and toddlers to access tablet computers for several hours a day are in danger of causing “dangerous” long term effects. 

The youngest known patient being treated in the UK is a four-year-old girl from the South East. 

Her parents enrolled her for compulsive behaviour therapy after she became increasingly “distressed and inconsolable” when the iPad was taken away from her. 

Her use of the device had escalated over the course of a year and she had become addicted to using it up for to four hours a day.

Dr Richard Graham, who launched the UK’s first technology addiction programme three years ago, said he believed there were many more addicts of her age. 

“The child's mother called me and described her symptoms,” he said.

"She told me she had developed an obsession with the device and would ask for it constantly. She was using it three to four hours every day and showed increased agitation if it was removed." 

Dr Graham said that young technology addicts experienced the same withdrawal symptoms as alcoholics or heroin addicts, when the devices were taken away. 

He warned that the condition prevented young people from forming normal social relationships, leaving them drained by the constant interaction.

"Children have access to the internet almost from birth now,” he told the Sunday Mirror. 

“They see their parents playing on their mobile devices and they want to play too. It's difficult, because having a device can also be very useful in terms of having a reward, having a pacifier. But if you don't get the balance right it can be very dangerous. 

"They can't cope and become addicted, reacting with tantrums and uncontrollable behaviour when they are taken away. Then as they grow older, the problem only gets worse. Even the most shy kids, when they hit their teens, suddenly want to become sociable and popular." 

It is feared that products such as baby-proof iPad covers and iPotties, which feature built-in iPad stands, only fuel the problem. 

Parents who have found themselves unable to wean their children off computer games and mobile phones are paying up to £16,000 for a 28-day “digital detox” programme designed by Dr Graham at the Capio Nightingale Hospital in London. 

Psychiatrists estimate that the number of people who have become digitally dependent has risen by 30 per cent over the past three years.

A survey last week revealed that more than half of parents allowed their babies to play with their phone or tablet device. 

One in seven of more than 1,000 parents questioned by babies.co.uk website admitted that they let them use the gadgets for four or more hours a day. 

James Macfarlane, managing director of the website, said: “Given that babies between 3-12 months are awake for only around 10 hours per day this is a huge proportion of their waking day. 

“Although 81 per cent of our users felt that children today spend too much time on smart devices, it hasn’t put most of them off using them to entertain their baby.” 

Article retrieved from: http://www.telegraph.co.uk/technology/10008707/Toddlers-becoming-so-addicted-to-iPads-they-require-therapy.html

Image retrieved from:  http://blog.bt-store.com/wp-content/uploads/2011/03/baby-ipad.jpg

and 

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and 

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Behavioral Techniques for Children With ADHD

Learning behavior management techniques is considered to be an essential part of any successful ADHD treatment program for children. Most experts agree that combining medication treatments with extended behavior management is the most effective way to manage ADHD in children and adolescents.





There are three basic categories or levels of ADHD behavioral training for children:
1) Parent training in effective child behavior management methods.
2) Classroom behavior modification techniques and academic interventions.
3) Special educational placement.
Behavior management is most often used with younger children with ADHD, but it can be used in adolescents up to 18 years old and even adults. In children and adolescents, the two basic principles are:

• Modeling behavior by encouraging good behavior with healthy praise or rewards. This works best if the reward or praise immediately follows the positive behavior.
• Negatively reinforcing bad behavior by allowing appropriate consequences to occur naturally.

Behavior Management Strategies for Preschoolers (Age 5 and Younger)
To help younger kids with ADHD, try these behavior management techniques:

•  Provide a consistent routine to the days and structure to the environment. Let them know when the routine is changing or something unusual is going to happen, such as a visit from a relative, a trip to the store, or a vacation.
• Give your child clear boundaries and expectations. These instructions and guidelines are best given right before the activity or situation.
• Devise an appropriate reward system for good behavior or for completing a certain number of positive behaviors, such as a merit point or gold star program with a specific reward, such as a favorite activity. Avoid using food and especially candy for rewards.
• Engage your child in constructive and mind-building activities, such as reading, games, and puzzles by participating in the activities yourself.
• Some parents find that using a timer for activities is a good way to build and reinforce structure. For example, setting a reasonable time limit for a bath or playtime helps train the child to expect limitations, even on pleasurable activities. Giving a child a time limit for chore completion is also useful, especially if a reward is given for finishing on time.

Behavior Management Strategies for Children Ages 6-12
Behavior management strategies for older children with ADHD may include:

• As much as possible, give clear instructions and explanations for tasks throughout the day. If a task is complex or lengthy, break it down into steps that are more manageable, keeping in mind that as the child learns to manage their behavior, the steps and tasks can become more complex.
• Reward the child appropriately for good behavior and tasks completed. Set up a clear system of rewards (point system, gold stars) so that the child knows what to expect when they complete a task or refine their behavior.
• Bear in mind that as your child gets older they will be more sensitive to how they appear to others and may overreact or be unduly ashamed when they are disciplined in front of others. It is important to have a plan for appropriate discipline for misbehaving that does not require carrying out in front of others. Setting up a specific consequence for a certain behavior is probably the best method of providing consistency and fairness for your child.
• Communicate regularly with your child's teachers so that behavior patterns can be dealt with before they become a major problem and before the teachers get overly frustrated with the situation.
• Always set a good example for your child. Children with ADHD need role models for behavior more than other children, and the adults in their lives are very important.

Behavior Management Strategies for Teenagers
Most parents know that teenagers (regardless of whether or not they have ADHD) are completely different animals. Here are some behavior management techniques just for teens:

• As your child matures, it is important to involve them in setting expectations, rewards, and consequences. Empowering them in this manner will improve their self-esteem and reinforce the concept that they are ultimately the masters of their own behavior and can create positive results with good behavior.
• Teenagers are often very sensitive of how they appear to others and may overreact or be unduly ashamed when they are disciplined in front of others. As adolescents they are experiencing hormonal changes and sexual development, and this brings up a whole host of new issues. Teenage years can be tough enough without ADHD, so be gentle and understanding. Communicate openly with them about the issues surrounding physical and sexual maturation.
• Continue to communicate regularly with your child's teachers so that behavior patterns can be dealt with before they become a major problem and before the teachers get overly frustrated with the situation.
• Continue to be consistent and fair in your own behavior. Having a predictable, reasonable parent is always an asset for children with ADHD.
• Continue to set a good example for your child. Teens with ADHD need role models for behavior more than other kids, and the adults in their lives are very important.
• If you find yourself becoming overwhelmed by the situation, speak to a professional. It is only natural that you have needs and questions in this process, so seek help when needed.

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Article retrieved from: 

http://www.webmd.com/add-adhd/guide/adhd-behavioral-techniques

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Developmental Coordination Disorder Often Misdiagnosed As ADHD

13 Feb 2012

Children showing difficulty carrying out routine actions, such as getting dressed, playing with particular types of games, drawing, copying from the board in school and even typing at the computer, could be suffering from developmental coordination disorder (DCD), and not necessarily from ADHD or other more familiar disorders, points out Prof. Sara Rosenblum of the Department of Occupational Therapy at the University of Haifa, whose new study set out to shed new light on DCD. "In quite a few cases, children are not diagnosed early enough or are given an incorrect diagnosis, which can lead to frustration and a sense of disability. It can even result in a decline that requires psychological therapy," she explains. 

A person with DCD suffers from childhood and throughout adult life. Unlike various illnesses or trauma, says Prof. Rosenblum, this disorder is expressed in the inability to control the process of carrying out a particular motor task, consolidate it in memory and repeat the same task automatically. "Simple tasks, such as closing buttons, tying laces, writing or riding a bicycle, which for healthy people become automatic, are difficult to carry out for people with DCD. When those children grow up, they are more likely to have trouble with temporal and spatial organization and have difficulty estimating distance and speed, which could prevent them from learning to drive successfully and even to ride a bicycle," she adds. 

Since the deficit is neural-based, meaning that it is founded in atypical brain activity, it is particularly difficult to diagnose in children. Going undiagnosed often exacerbates the individual's sense of frustration and shame, and they are therefore more likely to grow up to be introverted adults. The current study, conducted by Prof. Rosenblum andDr. Miri Livneh-Zirinski of Kupat Holim Meuhedet (one of Israel's public health plans), set out to identify DCD in children by means of a simple and noninvasive test of writing tasks. 

Two sample groups participated in the study: 20 children diagnosed with DCD and 20 children with no known symptoms of the disorder. Each participant was asked to write down their name, write out the alphabet and copy a full paragraph. The tasks were conducted using a special electronic pen and pad and a program developed by the researcher that shows objective measures that relate to the temporal and spatial characteristics of the writing, and pressure implemented on the pad. These measures can be analyzed with regard to motor, sensory and cognitive performance by taking note of elements such as in-air time per stroke, force of writing, and the time taken to write each letter. 

The study found that the two groups showed very different characteristics in various parameters. Those with DCD took up to three times longer than the other children writing each letter; they also held the pen in the air for longer; and they placed more pressure on the pad with the pen. According to Prof. Rosenblum, these results give further emphasis to the suffering that children with DCD undergo in the classroom and any time they are required to complete a writing task. 

"Children with DCD are 'transparent': they have no physiological or intellectual deformities, and in many cases, they are above average in their intelligence. But they are not able to complete tasks that require coordination between motor, sensory and cognitive functions. Our study comes to show how a simple everyday task can be used to diagnose individuals with DCD, and subsequently enable them to get the necessary treatment and guidance with occupational therapy," concludes Prof. Rosenblum. 

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Article retrieved from: http://www.medicalnewstoday.com/releases/241476.php

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Improved Behavior For Children With ADHD Taking Part In Physical Activity Program

19 Jan 2012
While children who suffer from attention-deficit hyperactivity disorder (ADHD) struggle with hyperactive-impulses and have trouble maintaining attention, a recent study found that a structured physical activity program may help to improve their muscular capacities, motor skills, behavior assessments, and the ability to process information. This new exploratory study was released in the recent issue of the Journal of Attention Disorders (published by SAGE).

Authors Claudia Verret, Marie-Claude Guay, Claude Berthiaume, Phillip Gardiner, and Louise Béliveau enrolled ten children in a physical activity program that included a warm-up, aerobic activity, muscular and motor-skill exercises, and a cool-down. The objective of each session was to maintain moderate to high-intensity activity throughout each session as observed by a heart-rate monitor. 

"A main finding of this study is that both parents and teachers observed better behavioral scores in the physical activity group," wrote the authors. "This could mean that positive effects of physical activity may occur in different settings of the children's life." 

The authors monitored ten children with ADHD who were participating in the physical activity program three times a week and eleven different children with ADHD as part of a control group.

The authors wrote, "Considering the beneficial effect of physical activity participation on some important ADHD-related variables, schools and parents of children with ADHD should look to maximize opportunities for structured group physical activity in their children's life." 


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School Support for ADHD Children May Be Missing the Mark: Inattention, Not Hyperactivity, Is Associated With Educational Failure

ScienceDaily (Sep. 12, 2011) — New research from the University of Montreal shows that inattention, rather than hyperactivity, is the most important indicator when it comes to finishing a high school education.

"Children with attention problems need preventative intervention early in their development," explained lead author Dr. Jean-Baptiste Pingault, who is also affiliated with Sainte-Justine Mother and Child University Hospital. The researchers came to their conclusion after looking at data collected from the parents and teachers of 2000 children over a period of almost twenty years.
In this study, attention problems were evaluated by teachers who looked for behaviour such as an inability to concentrate, absentmindedness, or a tendency to give up or be easily distracted. Hyperactivity was identified by behaviour such as restlessness, running around, squirming and being fidgety. The researchers found that only 29% of children with attention problems finished high school compared to 89% of children who did not manifest these inattention problems. When it came to hyperactivity, the difference was smaller: 40% versus 77%. After correcting the data for other influencing factors, such as socioeconomic status and health issues that are correlated with ADHD, inattention still made a highly significant contribution which was not the case for hyperactivity.
"In the school system, children who have attention difficulties are often forgotten because, unlike hyperactive kids, they don't disturb the class," said Dr. Sylvana Côte, who led the study. "However, we know that we can train children to pay attention through appropriate activities, and that can help encourage success at school."
The results of the study have been published as mental health experts have begun to debate whether or not it would be appropriate to separate hyperactivity and inattention problems in the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). "These two health issues have now been more precisely dissected, and we may now need to define a differentiated type of inattention that is independent from hyperactivity, to improve our understanding of the phenomenon and better tailor interventions," Pingault said.
The study will be published in the American Journal of Psychiatry on November 1, 2011. The research was funded in part by the Fonds Québécois de la recherche sur la société et la culture, the Social Sciences and Humanities Research Council of Canada, the Canadian Institutes of Health Research, the US National Science Foundation, the National Institute of Mental Health and the US National Consortium on Violence Research. The University of Montreal and Sainte-Justine Mother and Child University Hospital are known officially as Université de Montréal and Centre hospitalier universitaire Sainte-Justine, respectively.

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The Mysteries of ADD and High IQ

The five truths about attention deficit disorder.
Published on August 16, 2011 by Thomas E. Brown, Ph.D. in The Mysteries of ADD

We recently published a study of 117 high IQ children and adolescents with ADD. (Note: In this article, the term ADD is used to refer to both ADD and ADHD). All of these very bright students were struggling in school and often also in social relationships because of their ADD-related problems. Results from that study uncovered a pattern of vulnerabilities in executive functions, the management system of the brain, that caused these bright students to have chronic difficulty in focusing on their work, in getting their work done adequately, in keeping in mind what they had just heard or read, and in organizing and completing assignments. Some have been mystified as to how very bright students could suffer from ADD. They assume that being smart protects a person from the difficulties associated with ADD. This study shows that it doesn'

Here are 5 questions that our research team repeatedly encountered from high IQ kids and their parents and teachers:

1. Doesn't a person have to be hyper or have behavior problems to have ADD?

No! Most of the children and teenagers in this study of ADD were not hyperactive and had few, if any, significant behavior problems. For decades, this syndrome now known as ADD or ADHD was seen as a behavior disorder, a set of problems seen just in little kids who couldn't sit still, wouldn't shut up and who frustrated parents and teachers with chronic misbehavior. Research over the past 20 years has dramatically changed understanding of ADD by showing that many who fully meet diagnostic criteria for ADD have never had significant behavior problems. The core of ADD as it is now understood is a developmental delay in executive functions, a cluster of cognitive abilities that regulate other functions of the mind.

2. How can someone be really smart and yet have ADD?

All of the 117 kids in this study fully met diagnostic criteria for ADD and all had IQ scores of 120 or more, placing them in the top 9 percent of their age group on basic intelligence. Some were strongest in verbal comprehension, some were strongest in visual-spatial reasoning, and some were equally strong in both.

ADD has nothing to do with how smart a person is. Some individuals with ADD are super-smart on IQ tests, many score in the average range, and some are much lower.

Students in this study, compared to others of the same age, were impaired not by lack of smarts, but by chronic inability to deploy their smarts in effective work and in getting along with other people. One of the measures used in our study was a rating scale that inquires about impairments in various clusters that describe executive functions (EF). Everyone has problems with these various functions sometimes; people with ADD have much more difficulty with these functions than do most others of the same age.

 


Data from this study show that individuals can have very high IQ and still suffer significant impairments in each of these executive functions that are essential for working effectively and for getting along with other people.

3. How can someone be an honor student in elementary school and then struggle and fail repeatedly in high school or college?

Most of the students in this study got high grades in elementary school. Many were in special programs for talented and gifted students. Their school difficulties tended to begin when they made the move from elementary school, where they were with one teacher and the same group of classmates most of the day. Entry into middle school or junior high often brought increasing difficulties in keeping track of assignments and in completing homework. We explain that these students struggled when required to operate more independently without that one teacher who can help to keep tasks and expectations organized for all subjects throughout the day. As homework requirements escalated and parents were less able to monitor what was going on in all the various classes, many of these very bright students began to flounder.

Some of the older students in the study had managed to function well even with the demands of middle school and high school. Many of them had parents who were successful in maintaining supportive scaffolding around their sons and daughters, helping them to prioritize, plan, monitor and complete multiple assignments. Often the ADD impairments of these strongly supported high IQ students did not show up until they went away to college or university. There, lost without the strong daily support of their parents, many of these very bright students were unable to cope with their schoolwork, had plummeting grades and were required to take a semester off or transfer to another, less challenging college. Just being very smart is not enough to be successful in college, university or employment; one also needs to be able to manage oneself, to work productively and to get along reasonably well with peers, professors, supervisors, and employers.

4. How can someone focus very well on playing a sport, video games, drawing, or making music and not be able to focus enough on almost anything else?

The most mystifying aspect of ADD is that everyone who has this disorder is able to focus very well on a few specific types of tasks, even though they have great difficulty in focusing effectively on almost everything else. All of the students in this study reported that they had no difficulty in exercising executive functions very well for a few specific activities. For some it was participating in a sport or making art or music. For others, focus came easily for repairing car engines, cooking, using the computer, or designing websites. When asked to explain why they could focus on those few specific activities, but not on other tasks they recognized as important, the students typically responded by saying: "If it's something that really interests me, I can focus. If it's not really interesting to me, I just can't focus, even when I know it's important and I really need to do it."

One of our patients explained this: "ADD is like having erectile dysfunction of the mind. If the task is something that really interests you, you're up for it and can perform. If it's not something that turns you on, you can't get it up and you're not able to perform." The capacity to focus and mobilize executive functions for a task depends primarily on release of dopamine in specific areas of the brain and that release of dopamine is not under voluntary control.

5. Does anyone ever get over having ADD as they get older?

Back when ADD was seen as simple hyperactivity, it was believed that anyone with ADD would outgrow those problems by the time they were about 14 years old, if not before. That view made sense because for several decades ADD was seen as just hyperactive behavior, not as a problem with attention and EF. Often, though not always, hyperactive symptoms of ADD do go away as one gets older. But longer term studies have shown that for about 70-80 percent of those with ADD, their attentional symptoms tend to persist into adulthood, even if hyperactive problems have remitted. We published an earlier study of 157 high IQ adults with ADD. The design of that research was almost identical to this recent study of kids with ADD and the results were very similar. For many, the EF impairments of ADD persist into adulthood.

Despite the persistence of ADD, many of those affected experience less impairment from ADD symptoms as they get older. Three reasons may contribute to such improvement: for many with ADD, junior high, high school and the first few years of university are the most difficult. This is because these are the years when one is required to cope with the widest range of academic tasks with the least opportunity to escape from the ones you're not that good in. When one gets further along in education or employment it is often possible to specialize in work that is more interesting and which one can do reasonably well, without carrying so much of a burden of more challenging tasks. Second, imaging studies have shown that the course of brain development in adolescents with ADD is very similar to that of their age mates, except in a few specific regions of brain that are essential for executive functions. Individuals with ADD tend to catch up in development of these delayed regions of brain crucial for EF about 3 to 5 years behind their peers. This may account for some students who do poorly in high school and early college, then return to more advanced education a few years later and are very successful.

A third factor that helps many with ADD to improve their impaired executive functioning is treatment with appropriate medication. For about 80 percent of those with ADD, executive function can be improved significantly with a carefully managed regimen of medication approved for treatment of ADD. Medications cannot cure ADD, but, just as eyeglasses can improve vision when worn, for most individuals, regardless of IQ level, medication treatment for ADD can significantly improve executive functioning when it is appropriately used.

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