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the facts about
Attention Deficit Disorder

ADD is a disorder of the frontal lobe supervisory system, parietal lobe and its connections. Symptoms of ADD resemble what has traditionally been termed a "frontal lobe disorder" characterized by problems with planning and organization, sequencing, utilization of feedback and modification of behavior as a consequence of feedback, maintaining and switching of sets and information processing skills. There is decreased arousal and vigilance resulting in inconsistent and variable behavior. Behavioral symptoms include a range of symptoms including a loss of internal excitement, a craving for stimulation, forgetfulness, carelessness, lack of tolerance, avoidance and procrastination, hypo- and hyperactivity, inappropriate behavior, distractibility, lack of insight and awareness and both slow and quick movement.

ADD is also represented as an attention and concentration disorder theoretically involving subcortical connections to the frontal lobe that serve as a gating mechanism in the brain. Irrelevant information needs to be gated out thus allowing the individual to focus on some information and not be overwhelmed by all of the incoming stimuli from the external environment.

ADD is a biochemical disorder involving neurotransmitters or brain messengers. The disorder is basically genetic and a consequence of a biochemical imbalance in the brain. Those with the disorder usually present symptoms quite early in life and continue to present symptoms throughout their adult life. This is not a disorder that can be outgrown as formerly believed. By the time of adulthood the entire fabric of the individual's life has been affected.

Deficiencies that are present in early childhood are chronic in nature. They do improve with maturation but deficits persist and can be observed when compared to same-age peers. Deficiencies can lead to social problems and increased controlling responses by those in the external environment. Lack of success to control this disorder leaves those significant in the individual's life frustrated and the ADD individual rejected.

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Common Conditions Associated with ADD

1. Conduct Problems (60+%):
Oppositional, defiant behavior
Temper tantrums
Anger outbursts
Destructiveness
Verbal and physical aggression
2. Academic Performance Problems (90+%):
Underachievement
Variability of performance
Learning disabilities
3. Emotional Immaturity (50+%):
Over-reaction to situations
Low frustration tolerance
Low self-esteem
4. Social Skills Problems (50+%):
Selfish, self-centered
Rejected by peers due to intrusive, aggressive behavior
Little regard for social consequences
Immature play and social interests
Poor self-awareness
5. Immature Motor Coordination (30-60%):
Enuresis (20%)
Encopresis (10%)
Allergies, colds, otitis
Increased minor physical anomalies
Increased sleep disturbance (30%)

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Attention Deficit Disorder: A Definition

ADD is a developmental disorder characterized by:
Poor sustained attention
Difficulty maintaining vigilance
Impulsivity
Difficulty with delay of gratification
Increased variability of task performance
The syndrome develops in early childhood and is not accounted for by other gross disturbances or impairments.
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ADD Without Hyperactivity:

These children appear to have the most predominant general trait of inattentiveness. The following behaviors can be observed:
Excessive daydreaming, "spacey" appearance
Cognitive sluggishness (processing disorder is possible)
Hypoactive, lethargic
Excessive confusion or mental "fogginess"
Inconsistent memory retrieval
Increased anxiety
Socially reticent or diminished social involvement
Rarely aggressive or oppositional
Rarely impulsive
These children will be classified in the DSM-IV as Attention Deficit Hyperactivity Disorder, Predominantly Inattentive Type. Children must have at least 6 items from the following list and there is a disturbance of 6 months duration. The items must be to the degree of being developmentally inappropriate and there is no evidence of impulsivity or hyperactivity for the past 6 months.
  1. Often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities
  2. Often has difficulty sustaining attention in tasks or play activities
  3. Often seems not to listen when spoken to directly
  4. Often does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
  5. Often has difficulty organizing tasks and activities
  6. Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or housework)
  7. Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books or tools)
  8. Often in easily distracted by extraneous stimuli
  9. Often is forgetful in daily activities

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ADD With Hyperactivity

The disorder is to be classified predominantly as a disturbance of hyperactive-impulsive behavior that can be associated with inattention. According to the DSM-IV, the age of onset is around 7 years; there is a disturbance of 6 months duration; it is classified as Attention Deficit Disorder, Predominantly Hyperactive-Impulsive Type. There is no evidence of inattention for the past 6 months.

    Hyperactivity:
  1. Often leaves seat in classroom or in other situations in which remaining seated is expected
  2. Often fidgets with hands or feet or squirms in seat
  3. Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
  4. Often has difficulty playing or engaging in leisure activities quietly
  5. Often is "on the go" or often acts as if "driven by a motor"
  6. Often talks excessively
    Impulsivity:
  1. Often interrupts or intrudes on others (i.e., butts into other children's games)
  2. Often blurts out answers to questions before they have been completed
  3. Often has difficulty waiting for his or her turn in games or group situations
The basic characteristics are:
Inattention
Impulsivity
Hyperactivity
Diminished rule-governed behavior
Variability of task performance
There is a combined type disorder if both criteria of Inattention and Hyperactive-Impulsivity have been met for a duration of 6 months. There must be clear evidence of significant impairment in social, academic or occupational functioning. The above is in accordance with the DSM-IV. However, clinically, this does not appear to be the case. What would qualify as the combined type of disorder may well be the Overfocused Subtype of Attention Deficit Disorder without Hyperactivity.

This Overfocused Subtype is characterized by the tendency to become overfocused, almost to the point of perseveration, on thoughts, ideas, things, events and so on. These individuals tend to be very sensitive to clothing and touch. This can be observed in infancy (sometimes in the form of being described as "colicky"). They are highly anxious, susceptible to allergies and asthma.

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Other Diagnoses:

Oppositional Defiant Disorder is viewed as a disorder of hostile and defiant behavior towards others, arising in childhood and frequently culminating in Conduct Disorder.

To be defined as ODD, children must have 4 items of the following list:

  1. Often loses temper
  2. Argues with adults
  3. Actively defies or refuses adults' requests or rules
  4. Deliberately does things that annoy other people
  5. Blames others for his or her own mistakes or misbehavior
  6. Often touchy or easily annoyed by others
  7. Angry and resentful
  8. Often spiteful or vindictive
To be defined as CD, the individual must have at least 3 of the following 15 items in the past 12 months with at least one criterion present in the past 6 months.

    Aggression to people and animals:
  1. Bullies, threatens or intimidates others
  2. Often initiates physical fights with others
  3. Has used a weapon that can cause serious physical harm to others (such as a bat, brick, broken bottle, knife, gun)
  4. Has been physically cruel to people
  5. Has been physically cruel to animals
  6. Has stolen while confronting a victim (such as mugging, purse-snatching, extortion or armed robbery)
  7. Has forced someone into sexual activity

    Destruction of property:

  8. Has deliberately engaged in fire-setting with the intention of causing serious damage
  9. Has deliberately destroyed others' property (other than by fire-setting)

    Deceitfulness or theft:

  10. Has broken into someone else's home, building or car
  11. Often lies to obtain goods or favors or obligations (i.e., "cons" others)
  12. Has stolen items of nontrivial value without confronting a victim (such as shoplifting, but without breaking and entering; forgery)

    Serious violations of rules:

  13. Often stays out at night despite parental prohibitions, beginning before the age of 13 years
  14. Has run away from home overnight at least twice while living in parental or parental-surrogate home (or once without returning for a lengthy period of time)
  15. Often is truant from school beginning before 13 years of age

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ADD in Adults

70% of those diagnosed as having ADD continue to be affected into adulthood. The following characteristics are observed in adults:
Inability to complete tasks
Impulsivity and non-reflectiveness (which leads to poor judgment in both personal and work decisions)
Problematic interpersonal relationships
Lack of insight
Hot or explosive temper
Lack of organization
Lack of reward or feedback system (which leads to a chronic unhappiness and dissatisfaction with frequent job and relationship changes)
Low stress tolerance
Vulnerable to stress
"Flies off the handle quickly"
Planning disorder
Low frustration tolerance
Carelessness
Lack of foresight
Absentmindedness
Difficulty keeping promises
Problems with day-to-day organization of family life
Mental and physical restlessness
Notetaking and paperwork problems
Financial problems
Missed appointments: missing times, dates, events
Mild to severe communication problems
It has been shown through research that adults suffering from residual ADD exhibit the following:
More auto accidents
More geographically mobile (location change more often)
More antisocial behavior in general
Poor performance in later schooling
Less job success
Self-esteem problems (low self-esteem)
Relationship problems
Problems increase with complexity of life, job, marriage and family as well as the aging process.

According to the DSM-IV, Adult ADD can be characterized by symptoms of both Inattention and Hyperactive-Impulsive behavior.

    Inattention.
  1. Trouble directing and sustaining attention
  2. Difficulty completing projects
  3. Easily overwhelmed by tasks of daily living
  4. Trouble maintaining an organized living or work place
  5. Inconsistent work performance
  6. Lacks attention to detail
    Hyperactivity-Impulsivity.
  1. Makes decisions impulsively, fails to anticipate consequences
  2. Difficulty delaying gratification, involved in stimulation-seeking
  3. Restless and fidgety
  4. Makes statements and comments without considering their impact
  5. Impatient and easily frustrated
  6. Frequent traffic violations

Positive Attributes:
Life is exciting and interesting
Movers and shakers
Builders of businesses
Great in sales
Passionate individuals
Risk-takers
Self-employed individuals
Any situation where a great deal of emotionality is helpful

There is grief and loss after discovery of an attention disorder as an adult for all that was missed.

There is a phenomenon called "alexithymia" meaning "feelings without words" that clearly characterizes the presence of this disorder.

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Adult ADD Cognitive Mistakes Checklist

  1. Do you find that you read something and need to read it again?
  2. Do you forget what you went to another part of the house for?
  3. Do you fail to hear people speaking to you when you are doing something else?
  4. Do you have important letters that have gone unanswered for days?
  5. Do you fail to see what you want in the supermarket even though it is there?
  6. Do you forget what you wanted when you walk into the store to buy it?
  7. Do you forget what you wanted to say even though it is on the tip of your tongue?
  8. Do you find there are times you can't think of anything to say?
  9. Do you find yourself throwing things away that you did not mean to throw away?
  10. Does your mind wander while watching TV?
  11. Do you have difficulty sustaining conversation when there are other voices in the house?
  12. Do you find yourself not listening to someone you are talking to?
  13. Do you find yourself suddenly losing track of what you wanted to say in the middle of speaking?
  14. Do you find yourself starting to do something and then getting distracted into doing something else?
  15. Do you find it difficult to do more than one thing at a time?

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This page based on a handout prepared by United Psychological Services, P.C., Attention Deficit Disorder Clinic, 14210 Timberwyck, Shelby Twp, MI 48315. Barbara C. Fisher, Ph.D., fully licensed psychologist. Ross A. Beckley, Ed.S., L.L.P., limited licensed psychologist.