Attention deficit disorder (ADD) has been historically defined as a genetic, biochemical disorder involving two neurotransmitters known to enhance attention processes within the brain. There is universal agreement that the “Real ADD” is a genetic disorder present in the immediate or extended family. The problem is that professionals do not agree upon what ADD is and what it is not. The difficulty lies in reaching a consensus among health care professionals in the most accurate way to diagnose it.
Defining the “Real ADD”
We are now in the process of analyzing test data collected by United Psychological Services for 20 years regarding this disorder. There are patterns seen in the test data that provide confirmation of the ability to accurately test for ADD. Previous analysis suggested that the primary symptoms associated with the “Real ADD” reflect problems of distractibility, inattention, daydreaming and failing to finish tasks. Children were found to have more problems with avoidance; procrastination and homework assignments either not completed or not turned in. Adults were found to have symptoms of anxiety, time management; problems with task completion, distractibility, fatigue and stress. Overactivity, hyperactivity, and impulsivity were not found to be characteristic of the “Real ADD”.
Unfortunately ADD is being over-diagnosed and confused with symptoms of other, undiagnosed disorders. The confusion has resulted in a population that is too diverse to accurately treat. If you believe that ADD is a disorder of the brain, the result of a neurotransmitter imbalance then it would make sense to test for this disorder using brain behavior and neuropsychological test measures. We have found that ADD can be accurately diagnosed as seen in individuals who return for re-evaluation. People have been re-tested after five, ten, and even fifteen years and the test results remain consistent providing confirmation that we are measuring the correct symptoms. Neuropsychological testing for ADD correlates with the results of self-report measures of attention symptoms. When there are discrepancies, typically the problem is the impact of another undiagnosed disorder such as sleep, cardiovascular disease or involving the brain. When the brain is involved ADD is known as an “acquired attention” problem resulting from injury to the brain.
Based upon 20 years of testing we have found that the primary problems from the “Real ADD” is that of language and emotions; difficulty with reading, dislike of reading and/or a reading comprehension problem. Reading problems leads to errors in reading directions and multiple choice questions, leading to more frustration and dislike of school. Avoidance of homework only leads to more avoidance and the commitment to completing unwanted tasks quicker and more efficiently. Lack of enjoyment of school does not foster interest in college and academics. Emotions of avoidance, procrastination and anxiety negate task completion and keeping promises. Eventually depression sets in as a result of significant people in one’s life being upset, angry and unhappy. Dislike of self follows as well as lowered confidence and belief in the ability to be successful. Fear of failure leads to fear of success as the cyclical pattern becomes more ensconced.
These issues cannot be resolved by medication through time. Medication is not being prescribed for emotions; the primary target is the attention symptoms. As a result the medication works only temporarily for a “honeymoon period” as a novel phenomenon. As the novelty of the medication intervention wears off, dosages get increased and the problem now becomes more complex, entangled by medication side effects. Without testing no one knows what to look for as a positive result of the medication other than increased focus and attention which are rather global concepts. The medication does not touch the problem of avoidance, procrastination or the reading difficulties. Several medications later, continued lack of success we see the beleaguered family, child, adolescent or adult.
It is far better and certainly more positive to diagnose early. If you see attention symptoms or dislike of school or reading difficulties don’t wait until your child becomes anxious, despondent, or avoids homework. A diagnosis of ADD does not always require medication. It may mean the intervention of our cognitive training program. We have been using this program for approximately ten years now and see differences on testing following completion of the program. Months, even years later, we see changes in the child or adult’s functioning on the same tests that we use to measure ADD with or without medication. Although we have no say in the matter people are typically not trying medication as the first alternative and instead completing our cognitive training. The inherent difficulties for the child requiring medicine every day are eliminated. We avoid the label and focus on treating the problem instead.
We are so excited about the possibilities that are now available and we see the “Real ADD” as a disorder than can be treated. Diagnosis is no longer something to put off because it does not automatically mean the need for medication. We also offer a tutorial program to develop study skills and then the child or adult is ready to set forth on a positive path of success whereby ADD symptoms are no longer a deterrent in their life.