Tell me about the research on ADD ADHD AD/HD.

Hyperactive, misbehaving children have been with us for as long as children. Until the end of the 19th century they were considered morally defective and punished unless they were Apaches.

In 1902, Dr. George Still described the symptoms and suggested for the first time that there might be a biological basis to their uncontrollable behavior, a genetic bias toward moral corruption. The problem has continued to attract a great deal of research. In 1998 a study done for the American Medical Association concluded "ADHD is one of the best-researched disorders in medicine, and the overall data on its validity are far more compelling than for most mental disorders and even for many medical conditions"1

Since 1902, the theories have changed from moral defect to minimum brain damage to a difference in brain wiring. Physical hyperactivity often diminishes in adolescence so it was assumed to be a childhood problem. Through early studies on hyperactive/impulsive children, researchers discovered that many of them also had significant problems sustaining attention. Then they began to see children who had problems of attention but were not hyperactive. It was assumed that inattention also diminished with the hyperactivity.

In 1977 the first article was published recognizing attention problems in adults. The late 1980's brought slow recognition of the chronic frustration faced by adults with problems of attention.

In 1990, Alan Zametkin of the National Institute of Health published a landmark paper. He demonstrated with PET (Positron Emission Tomagraphy) scans that adults with ADD had decreased activity in the prefrontal cortex when doing a task requiring concentration while normal subjects had increased activity. This means activating the brakes when you step on the accelerator. For the first time researchers had visual evidence of a biological effect. Brains are different.

In 1994 the DSM IV ( Diagnostic and Statistical Manual of the American Psychiatric Association.) defined two sets of symptoms under the term AD/HD (Attention Deficit and Hyperactivity Disorder).The symptoms for hyperactivity and impulsiveness are called AD/HD predominantly hyperactive-impulsive type and symptoms for inattention are called AD/HD predominantly inattentive type. A third diagnosis is the ADHD combined type when both sets of symptoms are present.

The current understanding of the inattentive type is of a problem with the executive functions. The executive functions are the tasks of the orchestra conductor or the Chief Executive Officer (CEO) of a company: activating, organizing, integrating, deploying. In addition, the problem is not permanent but is highly situational. When an individual has a high level of interest, he can function very effectively, but he can not organize, recall or activate when needed. "Will power" alone does not work. In many situations, the harder he tries the less he can do.

Further research has shown that the neurotransmitter dopamine plays a key role in the attention system "Laboratory studies have shown that in many species dopamine plays a critical role in mobilizing attention, facilitating learning and motivating behavior that is critical for adaptation."

The report cited above also concluded that "Medications have been unequivocally shown (i.e. by double blind, placebo-controlled studies) to reduce core symptoms of hyperactivity, impulsivity, and inattentiveness." 1 The problems of ADHD are primarily biological but there are often psychological problems as well. Medication aids the biological problem as glasses help the person who is nearsighted, but glasses don't teach you to read. People with AD/HD may have a distorted view of themselves and the world. Coaching can help them achieve a better awareness of who they are and how they relate to the world. They may require therapy as well to resolve psychological problems resulting from an unsupportive environment.

Research has also shown that ADHD is often associated with other problems such as drug addiction, alcohol abuse, and crime. The findings suggest that people with ADHD are seeking self medication to relieve the underlying malaise. When the ADHD is treated, the other problems diminish and are more treatable.

ADHD is not like being pregnant: you are or you aren't. ADHD is dimensional; you may be a little bit ADHD or extremely ADHD. You may be ADHD sometimes but not at other times. Your symptoms may not look the same as your sister's or your father's. You may feel just fine and leave the problems to other people.

The important questions are

• how does ADHD affect your life?
• do you want to change?

If the answer is yes, you now have options available which were unknown a few years ago. Research continues into the way brains works. New medications are being developed and new understandings lead to better strategies for living.

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