Causes of ADHD

There may be several different "causes of ADHD" just as there are different types of ADHD. The most recent research models describing "Attention Deficit Hyperactivity Disorder" suggest that several areas of the brain may be affected by ADHD. These include the

• frontal lobes
• inhibitory mechanisms of the cortex
• limbic system
• reticular activating system

Each of these areas of the brain is associated with various functions, or qualities, or abilities.

What Causes ADHD

The most recent models describing what is happening neurologically in the brains of people with Attention Deficit Disorder suggest that several areas of the brain may be affected by the disorder, including the Frontal Lobes, the Inhibitory Mechanisms of the Cortex, the Limbic System, and the Reticular Activating System. Each of these areas or systems of the brain is associated with various functions of the brain.

Neurotransmitters such as Dopamine work to activate brain cells, and regions of the brain. Too much activation, or too little, can cause ADHD symptoms. One-third of the neurotransmitters in the brain are glutamate, and brain research is now looking at the intricate relationships between glutamate, dopamine, and norepinephrine in the functioning of the pre-frontal cortex. Glutamine is the pre-curser of glutamate. Research is revealing that the glutamate network neurotransmissions from the pre-frontal cortex to other areas of the brain are enhanced by dopamine and norepinephrine. Too little dopamine or norepinephrine is a problem, and too much is a problem. And the importance of glutamate in PFC functioning is beginning to come to the forefront in research.

Brain imaging gives new insight into underlying cause of ADHD

Brain imaging gives new insight into underlying cause of ADHD

Neurological Causes of ADHD

The frontal lobes help us to pay attention to tasks, focus concentration, make good decisions, plan ahead, learn and remember what we have learned, and behave appropriately for the situation.

The inhibitory mechanisms of the cortex keep us from being hyperactive, from saying things out of turn, and from getting mad at inappropriate times, for examples. They help us to "inhibit" our behaviors.

It has been said that 70% of the brain is there to inhibit the other 30%.

When the inhibitory mechanisms of the brain aren't working as hard as they ought to, then we can see results of what are sometimes called "dis-inhibition disorders" such as impulsive behaviors, quick temper, poor decision making, hyperactivity, and so on.

The limbic system is the base of our emotions and our highly vigilant look-out tower. If over-activated, a person might have wide mood swings, or quick temper outbursts. He might also be "over-aroused," quick to startle, touching everything around him, hyper-vigilant.

A normally functioning limbic system would provide for normal emotional changes, normal levels of energy, normal sleep routines, and normal levels of coping with stress. A dysfunctional limbic system results in problems with those areas.

The frontal lobes help us to pay attention to tasks, focus concentration, make good decisions, plan ahead, learn and remember what we have learned. The frontal lobes also help us to behave appropriately for a given situation. Emotional issues such as anger, frustration, and irritability that come on impulsively in some types of ADHD probably come from the pre-frontal cortex.

The inhibitory mechanisms of the cortex keep us from being hyperactive, from saying things out of turn, and from getting mad at inappropriate times, for examples. These inhibitory mechanisms of the cortex help us to "inhibit" our behaviors. When the inhibitory mechanisms of the brain aren't working as efficiently as they ought , then we can see results of what are sometimes called "dis-inhibition disorders" such as impulsive behaviors, quick temper, poor decision making, hyperactivity, and so on.

Attention Deficit Disorder might affect one, two, or all three of these areas, resulting in several different "styles" or "profiles" of children (and adults) with Attention Deficit Hyperactivity Disorder.

Back to "What is ADHD"? index

This book section: What is ADHD?

Douglas Cowan, Psy.D., M.S. is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

PDF of this page: What causes ADHD?

ADHD : How Many People Have Attention Deficit Disorder ?

"Attention Deficit Hyperactivity Disorder" impacts somewhere between 5% and 9% of children and teenagers, and about 4% of adults, according to recent studies in the U.S. World-wide studies estimate the prevalence of ADHD at about 5%, as do older U.S. studies. The higher estimated prevalence rates may be due to a better understanding of what ADHD is, and to better diagnostic tools. But it is also possible that the higher rates are due to some with similar disorders, such as Aspergers or Fetal Alcohol Syndrome being mis-diagnosed with ADHD.

Less than half of the children with Attention Deficit Hyperactivity Disorder ever "out-grow" it in adolescence or adulthood. If untreated, the disorder can have long-term adverse effects into adolescence and adulthood, and it can certainly impact an adult's employment and relationships.

ADHD has different "looks" or "types." This is discussed in great detail under the section the different types of ADHD which we encourage you to read through. For some it severely impacts behavior, and for others it mostly impacts learning, concentration, or information processing speed. For the group in the middle, it just impacts their attention, focus, concentration, and getting the job done.

But there is help! In fact, there are several good treatment interventions to help overcome ADHD, and we want you to learn about all of them. We have over 300 pages of information on Attention Deficit Hyperactivity Disorder here at the ADD ADHD Information Library. Look around and learn about the new ideas in treatment, see the new sections for parents and grandparents, and read our weekly articles and blogs. Subscribe to our weekly newsletter to have the weekly articles send right to you via email for your convenience as you learn more about ADHD.

About 35% of all children referred to mental health clinics are referred for "Attention Deficit Hyperactivity Disorder" or ADHD. It is one of the most prevalent, and most studied, of all childhood psychiatric disorders.

Back to "What is ADHD"? index

You may see published estimates stating that Attention Deficit Hyperactivity Disorder may effect as much as 20% of children in America, but these numbers are not really supported by research data, and are probably inflated for the purpose of trying to sell something.

The 8% number is a solid number supported by research. In years past we have conservatively stated 5% as the solid number. But now the National Institute of Mental Health is estimating 7% of children with ADHD. The 2002 National Health and Nutrition Examination Survey estimated 8.2% and the 2003 National Survey of Children's Health estimated 7.8%.

In 2006 the CDC's report on "Diagnosed Attention Deficit Hyperactivity Disorder and Learning Disability": 2004-2006 reported 8.4% of children with ADHD : 4.7% of children with ADHD without any Learning Disabilities; and 3.7% of children with ADHD and a LD of some type. The same study also estimated 4.9% of children had a LD, but no ADHD. This study reported that boys are twice more likely than girls to have ADHD without a LD, and about twice as likely as girls to have both ADHD and a LD.

At 8% each classroom in America will have two, maybe three ADHD kids in the class. So it is a very real, and very significant problem across America.

ADHD Prevalence : Why Does It Seem That There Are More Children With Attention Deficit Hyperactivity Disorder Than Before?

The percentage of people with Attention Deficit Hyperactivity Disorder is increasing slightly each year, but here are some likely reasons why it seems that "there is more ADHD" than ever before:

• You are more aware of problems like this as a parent than you were as a child. You have grown up now;
• The news and entertainment media have talked about Attention Deficit Hyperactivity Disorder a lot more than in the past, raising your awareness level;
• Children who were Drug Exposed in utero, or Fetal Alcohol Syndrome children have many of the same problems as children with Attention Deficit Hyperactivity Disorder, and are often misdiagnosed by physicians as being ADD ADHD.
• When used, there are some great diagnostic tools today that were not available in the past.

Prevalence of ADHD

Back to "What is ADHD"? index

This book section: What is ADHD?

Douglas Cowan, Psy.D., M.S. is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

PDF of this page: How Common is ADHD?

Key Points About ADHD in Children and Teens

• ADHD is a Neuro-Biological Disorder
• Inattention to boring tasks
• Focus it is hard to stay focused to the right thing
• Self-Control it can be hard to maintain self-control, causing impulsive behaviors
• Hyperactivity is excessive, non-goal directed motor activity
• Easily bored unless doing something really exciting or stimulating
• ADHD is a problem with "working memory," "inhibition," and "executive functions."

Just what exactly is ADHD ?

ADHD is the short abbreviation for "Attention Deficit Hyperactivity Disorder", which is a diagnostic label for children with a particular neuro-biological disorder. About nine-percent of children and teens have this condition in the United States, making it one of the most common childhood behavior disorders. Of all children referred to counselors or other mental health professionals, more are referred for ADHD than for any other condition.

ADHD is a chronic and unrelenting problem. And those children, teens, and even adults with ADHD will have problems in many of the areas of their life, including home, school, work, and in relationships. Our new eBook on Marriage and ADHD may be helpful for those adults who are married to someone with ADHD and find that they are struggling a little bit in their marriage. See more below.

Though ADHD may change a bit through the years as the person matures, it will usually last into adulthood in one way or another.

"ADHD" is a neuro-biological disorder.

That means that it is not the result of bad parenting, or watching too much T.V., or a lack of either discipline or love by parents. ADHD has neuro-biological roots. And there are very strong genetic factors that influence both brain function and development.

ADHD impacts individuals in four main areas of their life:

• Inattention - causing people to have problems paying attention to routine or boring tasks, or staying focused on a task long enough to finish the task, especially if the task is not very interesting. The person might be able to focus on interesting projects or entertainment such as video games for long periods of time, but it is the mundain tasks of life that are very difficult.
• Impulsivity - which is a lack of self-control. Impulsive behaviors, or choices, can cause havoc in relationships, work, school, or life. Saying things, or doing things without thinking first, or considering the consequences, is a pretty classic symptom of ADHD in both children and adults.
• Hyperactivity - which is being "bouncy" like Tigger. They are always "on the go," and restless. This is mostly seen in younger children, and this is the symptom most likely to be "outgrown" as one matures.
• And some with ADHD are very easily bored and distracted, unless the task at hand is very stimulating, like a video game those with ADHD are often easily bored by mundane tasks like homework, or chores around the house.

If you think that you, or someone you know, may have ADHD, here are some things that you can do right now:

First, go and have a look around the ADHD Information Library at Newideas.net. We have over 200 articles filled with tips, insights, and ideas to help you understand ADHD just a bit better. For more information on how to reach Doug Cowan, visit http://douglascowan.me.

Second, you can start trying some of the alternative treatments that don't involved any medications. If they don't work, then you can always try medications later. And then know when it is time to talk with your doctor or other health care provider, and see what they think. Attend and Extress are two excellent over the counter products to get. You can get them at nutrition2you.com. Also start a focused eating program for ADHD. Learn what to eat and what not to eat to optimize your brain. You can get that at ADHDdiet.info or just look below. Try these things for a few weeks and see how they help.

Our ADHD Diet and Eating Program has been available on the internet since 1997, and has been used by hundreds, or thousands of families each year since. It has always been available for free. We have revised it, and updated it for 2013 and now have all of the elements available in a PDF eBook format for just $20.00. If you cannot afford the $20, the older version of the ADHD diet is still available for free at the ADHD Information Library at Newideas.net. And when you get the eBook, you can also try the ADHD Newsletter for six month – FREE.

The newly revised ADHD eating program has enough improvements and enhancements that we think its worth the small investment of $20. After all, an hour with our nutritional consultant is $200, and an hour consultation with therapist and author Dr. Douglas Cowan via Skype is $150. So we believe this is good information that may just help to solve one or two problems for you, and help you to think differently about how you eat, and what you eat every day.

Get our updated ADHD Eating Program. It's in PDF format for easy download and printing. You can begin using the concepts and information just minutes from now! When you buy it through PayPal you will automatically be directed to our download page. Simply download, and print, and get started today!

ADHD Children Estimated at 9% by New Study

How prevalent is ADHD ? A new ADHD study reports some attention getting numbers. The first is that about 9% of children and teenagers in the United States have "attention deficit hyperactivity disorder" – ADHD. The second number is that only about 1/3 of those children and teenagers with ADHD are getting medical treatment. There have been a number of similar studies done through the years, but this study is considered important because it used the most modern diagnostic criteria

for ADHD today, the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition.

The ADHD Information Library has written and maintained for years that about 5% of children in the US had ADHD, and that it has been both “over-diagnosed” and “under-diagnosed.” Over-diagnosed in the sense that often the medical evaluations leading to a diagnosis don’t consider the differential diagnoses that need to be ruled out before diagnosing ADHD, such as fetal alcohol syndrome, head injuries, tourette’s syndrome, bipolar disorder, and more (see http://newideas.net/adhd/differential-diagnosis ). But recently we have had to adjust with the times, and accept the estimates of three major studies published in 2002, 2003, and 2006, that 7.5% to 8.5% of children and teens have ADHD.

Our concern is that this study may have fallen into the same trap. Simply reporting that 9% of children meet the DSM-IV criteria for ADHD is not the same as 9% of the kids having ADHD. Rather, many children who meet the criteria for ADHD actually have some other disorder. And we have reported that ADHD is under-diagnosed in the sense that only about 1/3 of the kids who actually have ADHD ever get treatment. This study confirms that estimate.

Obviously a lot of this has to do with definitions. In our label of ADHD do we include "acquired" forms of ADHD along with "inherited" ADHD ? "Acquired" forms of ADHD would include those who were born with head injuries from FAS and drug exposure in utero, and those who suffered from illnesses that have left them with ADHD symptoms.



Go to the ADHD Diet Information site to get the full ADHD diet in eBook PDF format, including our UPDATES for 2013. We also have the full 21 minute information video on our ADHD eating program.

One researcher says that those with "acquired ADHD" make up about 33% of all who are diagnosed with ADHD. So that would satisfy us. The 9% with ADHD number now becomes 6% with a genetically based neuro-biological ADHD, plus 3% with "acquired ADHD" from some type of brain injury from any number of causes.

"There is a perception that ADHD is overdiagnosed and overtreated," said lead researcher Dr. Tanya E. Froehlich, from Cincinnati Children's Medical Center. "But our study shows that for those who meet the criteria for ADHD, the opposite problem -- underdiagnosis and undertreatment -- seems to be occurring."

The researchers found that some 2.4 million children between the ages of 8 and 15 meet the medical definition of ADHD, but an estimated 1.2 million children haven't been diagnosed or treated, Froehlich said, adding that "girls were more likely to be undiagnosed."

The researchers studies the data on 3,082 children who participated in the National Health and Nutrition Examination Survey. Using interviews, the researchers were able to establish whether a child met the criteria for ADHD. They also used data from doctors and the numbers of ADHD medications being used to establish diagnosis and treatment patterns, according to the report.

The researchers found that of the 8.7 percent of children who met the criteria for ADHD, only 47.9 percent had been diagnosed with the condition and only 32 percent were treated consistently with medications.

Froehlich said more needs to be done to identify and treat children with ADHD. "It's not a trivial disorder," she said. "It can have an impact on the child and the family if it is not diagnosed and addressed. We need to redouble our efforts to help doctors spot the symptoms of ADHD and make an accurate diagnosis."

September 2007 issue of Archives of Pediatrics & Adolescent Medicine.

Back to "What is ADHD"? index

This book section: What is ADHD?

Douglas Cowan, Psy.D., M.S. is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

Is ADHD Real? Evidence for ADHD as a Real Neurological Disorder

Yes, ADHD is a REAL mental health problem - it really is an attention deficit disorder.

There are lots of objections to ADHD made below, and they are in BOLD. And my answers follow.

At best it was a dialogue, at worst a debate of sorts. In 2000 I was homebound with pneumonia when someone brought me a copy of the Journal of Biblical Counseling with an article by Ed Welch on ADD ADHD. Since I am both a Pastor, and a Family Therapist, they wanted my opinion on the article. My opinions are clear below. Please use this response to the article as a teaching tool - a tool that I hope will both sharpen critical thinking skills, and lay out sufficient evidence for Attention Deficit Disorder to stand as a valid medical problem in the minds of those who wish it were not so. For professional and Christian counseling in Tehachapi or Bakersfield, CA., visit http://douglascowan.me.


To: David Powlison, Editor. Journal of Biblical Counseling
RE: What You Should Know About Attention Deficit Disorder by Edward T. Welch

Dear Sir,

It was with some interest that I read the article What You Should Know About Attention Deficit Disorder by Edward Welch after having it handed to me by a member of our church.

There were elements of the article that were insightful, helpful, and needed to be said in a public forum, especially the discussion of the moral and spiritual dimensions of behavior. For this part of the article I applaud Mr. Welch.

However, Mr. Welch's discussion on the physiological and biological aspects of ADD ADHD was lacking to the point of being misleading to the readers. I am sure that Mr. Welch had no intention of misleading any readers, as that would hardly reflect the "biblical guidelines with which to understand ADD" that he seeks to communicate.

Therefore, for the sake of clarifying some details, may I present the following evidence. Perhaps in the near future you would run an article that would present some of this information to your readers, so that they have an accurate understanding of the disorder.

"As with everything we read and hear, Christians should assimilate this information with biblical discernment. The material on ADD is often interesting and helpful, but it is not Scriptural. Therefore, it can be prone to unbiblical assumptions and errors." - p 58

This is true. Yet it would be better placed in the context that all Truth is from God, and that there is extensive research data, objective research data, which seeks to discover Truth. Though this data can be incorrectly interpreted and wrongly used, valid research data describes the objective functioning of a system, person, brain, or whatever is being studied.

"Other books use a biological approach, claiming that brain functioning explains every behavior." - p 58

I might say that I have read several books on the biological realities of ADD ADHD, and brain functioning in general, and none of them have claimed "that brain functioning explains every behavior."

They do, however, point out the differences in both structure and function of a brain with ADD ADHD, or other disorders, vs. brains without these disorders. It is misleading to suggest that "books (using) a biological approach" make such a claim. Perhaps one or two do, but I am not familiar with any at all.

"In other words, their attention is inconsistent rather than universally poor." - 59

This is a fair description, although a better description would be that their attention is "inflexible."

People with neurological difficulties, whether ADHD, head injuries, autism, fetal alcohol syndrome, forms of depression, or dementias, have varying degrees of neurological inflexibility .

Neurological flexibility is a sign of a healthy brain.

It is the ability to move attention from "global" forms of attention to "specific" forms of attention at will, in a fraction of a second. These various types of attention are objective and observable (with PETS, SPECTs, EEGs, QEEGs, and other technologies). People with ADD have difficulty moving from specific to global, or global to specific, styles of attention.

It should be noted that inflexibility of attention is a marker of a neurological problem, though by itself is not diagnostic of any specific problem.

"First, ADHD is not a precisely circumscribed set of symptoms. The ever-present "often" in the diagnostic criteria betrays the loose boundaries of ADD, and it explains why Americans use the diagnosis so frequently. Almost anyone can squeeze into the parameters - at least on certain days." - p 59

This statement is also potentially misleading to the readers .

"The ever-present 'often' in the diagnostic criteria." is very similar to the "ever present" "nearly every day" in the diagnostic criteria for Depression.

The "often" is simply a realistic description of life for individuals with ADHD. It is not "always" as with a structural head injury. It is "often" because it is the result of neurological mechanisms being "often" under-aroused and "often" under-performing.

". . . and it explains why Americans use the diagnosis so frequently."

Studies show that about 5% of the population has ADHD. Over-diagnosis, if there is any, is not due to the diagnostic criteria, but rather to a lack of a comprehensive diagnostic work-ups by most physicians. Many physicians are simply lazy or too rushed to make a careful diagnosis.

"Almost anyone can squeeze into the parameters - at least on certain days."

This is misleading to the readers, and simply not true.

Remember, the DSM-IV also includes these important, and highly discriminating, criteria:

• Six or more symptoms of Inattention, having lasted at least six months , to a degree that is maladaptive ;
• Six or more symptoms of Impulsivity-Hyperactivity, having lasted at least six months , to a degree that is maladaptive ;
• Symptoms of the disorder were present before the age of seven ;
• Impairment is present in a variety of settings ; and
• There is clear evidence of clinically significant impairment in social, academic, or occupational functioning.

The reality is that barely anyone can "squeeze into these parameters." But about 5% of the population does.

It is careless to suggest that "anyone. at least on certain days" can meet the diagnostic criteria. It also conveys a negative picture of those who do actually suffer with the condition.

Would you publish a statement that read, "Almost anyone can squeeze into the parameters of Alzheimer's - at least on certain days?" I would certainly hope not, and yet it is published in connection with ADHD. This is disappointing.

"Second, ADHD is a description of behavior, not an explanation . It tries to describe symptoms rather than explain the causes of those symptoms." - 59

Again misleading, and out of context.

The authors of the DSM-IV themselves point out that they make no attempts to describe the etiology of any of the 300 or more diagnostic categories ranging from Alzheimer's to Trichotillomania. It is not the purpose of the diagnostic criteria to explain the cause of a disorder, only to categorize the disorder in a realistic manner so that it can (1) be treated successfully, and (2) be researched effectively. It is from the research that we find the explanation of the causes of ADHD, not from the diagnostic criteria. It is also disappointing that no research in the field was noted, as it would have been helpful to your readers. This leads to the next quote from Mr. Welch:

"The reason it is important to distinguish between description and explanation is that the ADHD literature typically does not distinguish between them. Most discussions about ADHD assume that the list of descriptions is equivalent to establishing a medical diagnosis."

The point is that the purpose of the diagnostic criteria is to establish a medical diagnosis. And the purpose of the diagnosis is for successful treatment and efficient research.

"The popular assumption is that there is an underlying biological cause for the behaviors, but the assumption is unfounded. Although there are dozens of biological theories to explain ADHD, there are presently no physical markers for it; there are no medical tests that detect its presence. Food additives, birth and delivery problems, inner ear problems, and brain differences are only a few of the theories that are unsupported by evidence."

There are, in fact, biological causes for the behaviors. We cite just a few examples of the research below.

But what are these "behaviors" that we are talking about? The "behaviors" of the diagnostic criteria. We are not talking about behaviors with a moral basis such as hitting your sister. We are talking about the specific behaviors of the DSM-IV diagnostic criteria for ADHD.

"Although there are dozens of biological theories to explain ADHD, there are presently no physical markers for it;."

Just because there are dozens of theories, most of which will prove to be wrong and go away, does not mean that one (or more) of the theories are not accurate descriptions of reality. In fact, research shows that there are several "physical markers" of ADHD.

Dr. Daniel Amen - What You Need to Know About ADD

Best selling author, Dr. Daniel Amen on ADD - as seen on The Wellness Hour with Randy Alvarez

Here are a few articles, both from peer reviewed journals and from the media discussing peer reviewed journal articles, that might be of interest to your readers. They are just 15 studies or articles about the various biological underpinnings of ADHD.

It is certainly not a comprehensive list, as there have probably been more than 200 similar studies published in the past ten years alone. These are just the studies that I looked up last weekend for another project and already had in my word processor:

Brain Scan Found Effective in Diagnosing Attention Deficit Disorder

New York Times Syndicate - December 16, 1999
RICHARD SALTUS

Brain scans have identified a clear-cut chemical abnormality in people with attention deficit-hyperactivity disorder, a problem that makes life difficult for an estimated 3 to 5 percent of US schoolchildren, scientists say..
It could be a first step toward a long-sought objective test for ADHD, say researchers at Harvard Medical School and Massachusetts General Hospital.

http://neuroscience.about.com/science/neuroscience/library/pr/blpr991216...

Do executive function deficits differentiate between adolescents with ADHD and oppositional defiant/conduct disorder? A neuropsychological study using the Six Elements Test and Hayling Sentence Completion Test

J Abnorm Child Psychol 2000 Oct;28(5):403-14
Clark C, Prior M, Kinsella GJ
School of Psychological Science, La Trobe University, Victoria, Australia.
[Record supplied by publisher]

Two neuropsychological measures of executive functions--Six Elements Tests (SET) and Hayling Sentence Completion Test (HSCT)-were administered to 110 adolescents, aged 12-15 years. Participants comprised four groups: Attention Deficit Hyperactivity Disorder (ADHD) only (n = 35). ADHD and Oppositional Defiant Disorder/Conduct Disorder (ODD/CD) (n = 38), ODD/CD only (n = 11), and a normal community control group (n = 26).

Results indicated that adolescents with ADHD performed significantly worse on both the SET and HSCT than those without ADHD, whether or not they also had ODD/CD. The adolescents with ADHD and with comorbid ADHD and ODD/CD were significantly more impaired in their ability to generate strategies and to monitor their ongoing behavior compared with age-matched controls and adolescents with ODD/CD only. It is argued that among adolescents with clinically significant levels of externalizing behavior problems, executive function deficits are specific to those with ADHD. The findings support the sensitivity of these two relatively new tests of executive functions and their ecological validity in tapping into everyday situations, which are potentially problematic for individuals with ADHD.

Executive functions and developmental psychopathology.

J Child Psychol Psychiatry 1996 Jan;37(1):51-87
Pennington BF, Ozonoff S
Department of Psychology, University of Denver, CO 80208, USA.

In this paper, we consider the domain of executive functions (EFs) and their possible role in developmental psychopathologies. We first consider general theoretical and measurement issues involved in studying EFs and then review studies of EFs in four developmental psychopathologies: attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), autism, and Tourette syndrome (TS).

Our review reveals that EF deficits are consistently found in both ADHD and autism but not in CD (without ADHD) or in TS. Moreover, both the severity and profile of EF deficits appears to differ across ADHD and autism. Molar EF deficits are more severe in the latter than the former. In the few studies of more specific EF tasks, there are impairments in motor inhibition in ADHD but not in autism, whereas there are impairments in verbal working memory in autism but not ADHD. We close with a discussion of implications for future research.

Brain Differences in Attention Deficit Disorder

Scientists have strong new evidence that attention deficit disorder (ADD)--a condition in which children are hyperactive and have difficulty concentrating--stems from an abnormality in the brain. According to a report in today's Proceedings of the National Academy of Sciences, children with ADD have elevated nerve firing in a brain region involved in motor activity.

In addition, the researchers found, Ritalin--the drug most commonly prescribed for the disorder--triggers a surprisingly different biochemical response in the brains of children with ADD than in those without the condition.
http://neuroscience.about.com/science/neuroscience/gi/dynamic/offsite.ht...

Reduction of (3H)-imipramine binding sites on platelets of conduct-disordered children .

Neuropsychopharmacology 1987 Dec;1(1):55-62
Stoff DM, Pollock L, Vitiello B, Behar D, Bridger WH
Medical College of Pennsylvania, Eastern Pennsylvania Psychiatric Institute, Department of Psychiatry.

Binding characteristics of tritiated imipramine on blood platelets were determined in daytime hospitalized prepubertal children who had mixed diagnoses of conduct disorder (CD) plus attention deficit disorder hyperactivity (ADDH) and in inpatient adolescents who had a history of aggressive behavior.

The number of (3H)-imipramine maximal binding sites (Bmax) was significantly lower in the prepubertal patient group of CD plus ADDH; the dissociation constant (Kd) was not significantly different. There were significant negative correlations between Bmax and the Externalizing or Aggressive factors of the Child Behavior Checklist when the CD plus ADDH prepubertal patients were combined with their matched controls and within the adolescent inpatient group.

We propose that a decreased platelet imipramine binding Bmax value, as an index of disturbed presynaptic serotonergic activity, is not specific to depression and may be used as a biologic marker for the lack of behavioral constraint in heterogeneous. populations of psychiatric patients.

Neuropsychiatric and neuropsychological findings in conduct disorder and attention-deficit hyperactivity disorder.

J Neuropsychiatry Clin Neurosci 1994 Summer;6(3):245-9
Aronowitz B, Liebowitz M, Hollander E, Fazzini E, Durlach-Misteli C, Frenkel M, Mosovich S, Garfinkel R, Saoud J, DelBene D, et al
Department of Psychiatry, New York State Psychiatric Institute, New York.

Neuropsychiatric and neuropsychological evaluations were performed in a pilot study of adolescents with DSM-III-R disruptive behavior disorders, including conduct disorder (CD) and attention-deficit hyperactivity disorder (ADHD).

The following comparisons were made: 1) CD comorbid with ADHD vs. CD only; 2) all subjects with ADHD vs. all non-ADHD; and 3) all subjects with CD vs. all non-CD. The CD + ADHD group had increased left-sided soft signs compared with the CD group. CD + ADHD subjects significantly underperformed CD subjects on several executive functioning measures, with no differences on Verbal IQ subtests. Results are discrepant with previous findings of deficient verbal functioning in delinquent populations.

NIMH: Genetics Fact Sheets:Attention-Deficit Hyperactivity Disorder

Phenotype:Attention-deficit hyperactivity disorder (ADHD) has its onset in childhood and is characterized by developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity.

Epidemiology: In a large sample from the U.S. population, the prevalence of ADHD (male: female ratio) in school-age children was 6.7 percent (5.1:1)[2].

Depending on the use of adaptive functioning ratings to define definite maladjustment, prevalence estimates of 6.6 percent and 9.5 percent

Family Studies: Several studies demonstrate that ADHD aggregates in families [13-15]. The rates in probands' sibs in three older studies [16-18] ranged from 17 percent to 41 percent, with respective rates in controls' sibs ranging from zero to 8 percent [16, 17]. Rates of childhood ADHD in parents of hyperactive probands in several older studies ranged from 15 percent to 44 percent for fathers and 4 percent to 38 percent for mothers [19-22], although one study found no evidence of an increased rate of childhood ADHD in parents of ADHD probands

Twin Studies: Two small twin studies found that 4 of 4 [34] and 3 of 3 [35] MZ twins were concordant for ADHD. A larger twin study [33] reported respective MZ and dizygotic (DZ) probandwise concordance rates of 51 percent and 33 percent, with a heritability estimate of 64 percent.

Adoption Studies: Increased rates of hyperactivity or a history of hyperactivity have been found among both adopted-away sibs of children with ADHD [43] and the biological parents of hyperactive boys compared with controls [21, 44, 45].

Mode of Inheritance: Deutsch and colleagues found limited evidence in a small sample [46] for an incompletely penetrant autosomal dominant single major locus transmission. A segregation analysis of a different data set [25] also resulted in statistical evidence -- including estimates of transmission parameters that were not significantly different from Mendelian expectations -- for an incompletely penetrant dominant or additive autosomal single major locus [47]. Low penetrance estimates predicted that only 46 percent of boys and 31 percent of girls with the ADHD gene would develop the disorder.

Molecular Genetic Studies: A population-based association study reported evidence of an association between ADHD and an allele at the dopamine D2 receptor gene on 11q (p = 0.0003) [48], but this finding has not been replicated and was most likely an artifact of population stratification. The Tranmission Disequilibrium Test (TDT) [49] was used in a family-based association study to identify an association between ADHD and a specific allele at the dopamine transporter locus on 5p (p = 0.006) [50]. Another population-based association study found an association between ADHD and an allele at the dopamine D4 receptor on 11p (p = 0.01) [51].

http://www.nimh.nih.gov/research/genetics.htm#gen12a

Quantitative EEG and Auditory Event-Related Potentials in the Evaluation of Attention-Deficit/Hyperactivity Disorder: Effects of Methylphenidate and Implications for Neurofeedback Training

J. F. Lubar, M. O. Swartwood, J. N. Swartwood, D. L. Timmermann
University of Tennessee

Neurophysiological correlates of Attention Deficit Disorder with and without Hyperactivity (ADD/HD) and effects of methylphenidate are explored using electroencephalographic (EEG) and auditory eventrelated potentials (ERPs).

In the first of four studies, a database of ADD/HD individuals of varying ages and matched adolescent/adult controls is presented. Study 2 compares controls and age-matched children with ADD, and children with ADHD on and off methylphenidate. Study 3 examines habituation of the auditory ERPs of controls and children with ADHD both on and off methylphenidate. The relationship between successful neurofeedback training and EEG changes is presented in Study 4.

Overall, these studies support a neurologic basis for AD/HD and raise questions regarding the role of methylphenidate in modulating cortical processing.

Establishing an EEG Norm-Base for ADD v. non-ADD

Review of a journal article by Troy Janzen, Ken Graap, Stephan Stephanson, Wilma Marshall, and George Fitzsimmons, "Differences in Baseline EEG Measures for ADD and Normally Achieving Preadolescent Males" Biofeedback and Self-Regulation, Vol. 20, No. 1, 1995, pp. 65-82.

Three well known tests (WISC-R, WRMT-R, WRAT-R) were administered to all subjects prior to the main part of the study, a series of cognitive tests performed while connected to a 19 lead EEG cap.

Findings:

The most consistent finding was that ADD subjects have significantly higher theta amplitudes (p

There were also differences in the ratios of theta to beta and theta to SMR for baseline and all tasks at all sites, but the differences were significant only for some tasks at the parietal sites.

The raw beta and SMR amplitudes themselves were not significantly different between the two groups.

The authors conclude that although the number of subjects was small, there were significant differences that could be observed. These findings form a starter set of data for additional efforts.

ADHD PET Scan

Brain scan images produced by positron emision tomography (PET) show differences between an adult with Attention deficit Hyperactivity Disorder (ADHD) (right) and an adult free of the disease (left).

Source: Alan Zametkin, M.D.
Section on Clinical Brain Imaging, Laboratory of Cerebral Metabolism
Division of Intramural Research Programs, NIMH, 1990
http://www.nimh.nih.gov/publicat/adhdbrain.cfm

Attentional difficulties in hyperactive and conduct-disordered children: a processing deficit.

J Child Psychol Psychiatry 1994 Oct;35(7):1229-45
Leung PW, Connolly KJ
Department of Psychology, Chinese University of Hong Kong, Shatin, New Territories.

A random population sample of 1479 Chinese boys from Hong Kong was screened and diagnosed in a two-stage epidemiological study. Four groups, age 7-8, were distinguished: (1) a pure hyperactive group (HA), (2) a mixed hyperactive/conduct-disordered group (HA+CD), (3) a pure conduct-disordered group (CD), and (4) a normal control group (N).

On a visual search task, only the HA children showed a specific processing deficit in performance. This confirms the diagnostic value of such a deficit for hyperactivity, differentiating it from conduct disorder. The failure to find a similar deficit in the HA+CD group raises questions concerning the clinical identity of these children. Each group showed a performance decrement over time in the visual search task but the decrement did not differ between the four groups. This observation is not congruent with the reports of a short attention span in hyperactive children; explanations of this apparent contradiction are considered.

Researchers Identify Key Area of Brain Implicated in Children with Attention Deficit Hyperactivity Disorder

March 28, 2000 McLean Hospital AScribe Newswire

BELMONT, Mass., March 28 (AScribe News) -- Researchers at McLean Hospital, using a new brain imaging technique they developed, have identified a key area of the brain that is underactive in children with attention deficit hyperactivity disorder (ADHD). The technique, a new form of functional magnetic resonance imaging (fMRI), also enabled the researchers to show how Ritalin restored function in ADHD children who were demonstrably hyperactive

http://neuroscience.about.com/science/neuroscience/library/pr/blpr000328...

The role of genetic factors in conduct disorder based on studies of Tourette syndrome and attention-deficit hyperactivity disorder probands and their relatives.

J Dev Behav Pediatr 1995 Jun;16(3):142-57
Comings DE
Department of Medical Genetics, City of Hope Medical Center, Duarte, California 91010, USA.

To examine the role of genetic factors in oppositional defiant disorder (ODD) and conduct disorder (CD), 38 variables relating to the relevant DSM-III-R criteria, as well as other angry and aggressive behaviors, were examined in 1177 Tourette syndrome (TS) and attention-deficit hyperactivity disorder (ADHD) probands, their first-degree relatives, and controls.

Two techniques were used: (1) a genetic loading technique comparing the frequency of symptoms in groups with progressively less genetic loading for Gts and ADHD genes, and (2) comparison of the frequency of symptoms in relatives with, versus relatives without, TS or ADHD. When significant, the latter rules out ascertainment bias and inappropriate controls.

For TS, the results were significant with most p values less than 10(-8). The same trends were seen in the smaller number of ADHD families. A polygenic model is proposed in which TS and ADHD alone represent lesser degrees of genetic loading and expression, and TS + CD not equal to ADHD represents a higher degree of genetic loading and expression of genes common to all three disorders. These studies emphasize the important role of genetic factors in ODD and CD. The therapeutic implications are discussed.

New genetic link to ADHD

NEW YORK, Sep 15 (Reuters Health) - Researchers have found a gene alteration that may contribute to attention deficit hyperactivity disorder (ADHD) in some children.

The risk levels associated with the new alteration, in the dopamine receptor gene DRD4, are similar to those linked to a previously identified variant of DRD4, the researchers note.
http://onhealth.webmd.com/family/briefs/wire/item,100745.asp

Neuropsychological deficits in adolescent-onset schizophrenia compared with attention deficit hyperactivity disorder.

Am J Psychiatry 1999 Aug;156(8):1216-22
Oie M, Rund BR
National Centre for Child and Adolescent Psychiatry, University of Oslo, Norway.

OBJECTIVE: Impaired neuropsychological performance involving abstraction-flexibility, memory, motor function, and attention has frequently been reported in schizophrenia as well as in attention deficit hyperactivity disorder (ADHD).

This study represents an attempt to compare groups of adolescents with schizophrenia and ADHD on a comprehensive neuropsychological test battery. Such a comparison affords the opportunity to ascertain differences in the degree, profile, and specificity of impairments.

Neuropsychological functioning of adults with attention deficit hyperactivity disorder.

J Clin Exp Neuropsychol 2000 Feb;22(1):115-24
Walker AJ, Shores EA, Trollor JN, Lee T, Sachdev PS
Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia.

The neuropsychological functioning of adults with Attention Deficit Hyperactivity Disorder (ADHD) was compared to that of healthy controls and individuals with mild psychiatric disorders including attentional complaints. Thirty adults in each group were examined on the Conners' Continuous Performance Test (CPT) and measures of attention, executive function, psychomotor speed, and arithmetic skills.

The ADHD group performed lower than healthy controls on most measures. However when compared to the psychiatric group, the performances of the ADHD group were not significantly lower on any of the measures.
http://mentalhelp.net/adhd/research/

As you can see, these studies focus on different issues, though most examine either executive functions, or the locations of the brain involved in executive functions, attention, or memory.

It would be hard to conclude that because there are several neurological differences in the brains of ADHD individuals vs. non-ADHD individuals, that somehow that equated to there being no neurological differences.

Once again.

"The popular assumption is that there is an underlying biological cause for the behaviors, but the assumption is unfounded. Although there are dozens of biological theories to explain ADD, there are presently no physical markers for it; there are no medical tests that detect its presence. Food additives, birth and delivery problems, inner ear problems, and brain differences are only a few of the theories that are. unsupported by evidence."

". . . there are presently no physical markers for it;"

As shown above, this statement is not supported by research.

There are many physical markers for it. One just needs a fMRI, SPECT scan, QEEG, or PET scan, to see them.

I have personally performed hundreds of EEGs and some QEEGs, and can attest first hand to the differences in brainwave patterns of ADD ADHD individuals vs. non-ADD ADHD subjects.

". . . there are no medical tests that detect its presence."

This is also misleading to the readers.

Many, if not most, biologically based medical conditions are diagnosed by the observation and experience of a trained clinician or physician. Many medical conditions have no "medical tests" that detect its presence.

For example, I am presently house-bound recovering from pneumonia which has nearly killed me.

Until July, 2000, there were no "medical tests" that detect the presence of pneumonia. Just last summer a urine test was approved by the FDA which is between 75% and 80% accurate in diagnosing pneumonia. There are no blood tests, or other forms of "medical tests" to diagnose it.

My pneumonia was diagnosed solely on the observation and experience of the physician, after another physician the day before examined me and told me I had the flu.

The doctor who made the life-saving diagnosis listened to my breathing and coughing. He observed and interpreted a chest x-ray. Then he made a judgment, a diagnosis, based on observation and experience (not on empirical, objective results from any medical tests), and began treatment.

The x-ray, my coughing, etc., gave him evidence of a condition only. He had no "medical tests" (he did not try the new urine test) to tell him if I had viral pneumonia, bacterial pneumonia, or mycoplasmic pneumonia. Yet based on observation and experience he started a course of treatment. The treatment involved the use of powerful medications, and the treatment has so far been beneficial.

The fact that there are no blood tests - "medical tests" - to diagnose pneumonia is hardly evidence that I am not suffering from a medical condition.

ADHD is also diagnosed by clinicians through observation and experience.

The clinician would rely on developmental, family, academic, and genetic histories, behavioral rating scales, and objective testing. There are tests, psychological and neurocognitive tests, that are extremely helpful in making a diagnosis, such as continuous performance tests and other tests of executive functions.

There aren't any blood or urine tests - "medical tests" - as Mr. Welch would say. But that does not invalidate the biological basis for the condition.

"There are some medical problems that can provoke ADD symptoms. For example, thyroid problems can affect energy level, and hearing or visual impairments can make paying attention difficult."

Yes, these are true. But they describe thyroid problems, and hearing or visual problems, completely separate medical conditions which happen to share some symptoms with ADHD. They do not cause Attention Deficit Hyperactivity Disorder. Depression and anxiety can cause symptoms that look like ADD, but they are not ADD. A head injury can cause symptoms that look like ADD, but a head injury is not ADD.

The neurological problems that cause ADHD are the cause of ADHD. Mr. Welch is simply unwilling to admit that there is a neurological, biological, physiological basis for a very real condition called ADHD. His position, however, is not supported by the reality presented in the research.

"That a stimulant drug would help some children focus seems paradoxical. You would expect that children would be even more physically and mentally excitable when taking it."

First, the effects of Ritalin, or any stimulant including caffeine, are not "paradoxical" in ADHD individuals. They are predictable. And they are effective.

Two significant contributors to ADHD are a lack of dopamine, or an effective lack of dopamine, in the frontal lobes, and a restriction of blood flow in the frontal lobes. Research supports this.

Stimulants, from caffeine to Ritalin, are known to do two things well: increase blood flow, and increase dopamine levels in the brain. Therefore it is not paradoxical at all. One would expect that stimulants would increase performance for individuals with this condition, and they do in about 75% to 80% of the cases.

"One thing, however, is clear. Ritalin does not treat any known chemical deficiency in a child's brain."

What research supports this position? Why is this "clear?"

Ritalin does in fact "treat known chemical (deficiencies) in a child's brain."

It does in fact increase the utilization of dopamine. This is similar to other medications, such as antidepressants, used treat other known brain chemical deficiencies such as a lack of seratonin.

While it is true that stimulants to not "fix" the condition, this does not take away from its usefulness. Insulin does not "fix" diabetes either. But in the short-term stimulants, like Insulin, works to "normalize" or at least "improve" the situation. To say that stimulants "are not a cure" is true. Insulin is not a "cure" either. But both are helpful.

Thank you for your time in considering this perspective.

Sincerely,

Douglas L. Cowan, Psy.D., M.S.

This book section: What is ADHD?

Douglas Cowan, Psy.D., M.S. is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

The ADA and ADHD

Recently the staff at the ADHD Information Library at newideas.net was asked if children with ADHD were protected under the American with Disabilities Act of 1990. This parent wrote that if in fact ADHD was included in the Disabilities Act, then perhaps her child was “being discriminated against." For professional and Christian counseling in Tehachapi or Bakersfield, CA., visit http://douglascowan.me.

The answer to the question is somewhat long and complicated. So we will begin with writing that while someone with ADHD may qualify for protection under the Americans with Disabilities Act, not everyone with the diagnosis of ADHD will qualify. And that may include you or your child.

Certainly parents want the very best for their children. And people tend to want everything that they feel that they are “entitled” to from the government. But sometimes we can expect too much from our public agencies, and sometimes we look to the wrong places for help. So let's examine the issue in detail.

The Americans with Disabilities Act was established by Congress in 1990. The purpose of the Act is to end discrimination against persons with disabilities when it comes to housing, education, public transportation, recreation, health services, voting, and access to public services. It also aims to provide equal employment opportunities for people with disabilities.

The ADA was written to offer protections to individuals with disabilities, not individuals with any particular diagnosis. The Americans with Disabilities Act seeks to protect individuals with significant impairments in function.

Since Congress enacted the ADA courts have had several challenges in defining the scope of the Act.

• What exactly is a disability?
• Who would be defined as having a disability?
• Is having a diagnosis the same as having a disability?

These are some of the questions that the courts have had to wrestle with, not to mention the questions related to how schools, work places, public transportation agencies, and more, are to implement the Act in daily operations with both employees and customers.

By the way, it is estimated that the population of the United States is over 300 million persons. And it is estimate that about 19% of persons have some type of long-lasting condition or disability. That would be somewhere near 60 million persons. This includes about 3.5% with a sensory disability involving sight or hearing, about 8% with a condition that limits basic physical activities such as walking or lifting. It also includes millions of people with mental, emotional, or cognitive impairments. See the details in the Census 2000 Brief titled, "Disability Status 2000" at http://www.census.gov/prod/2003pubs/c2kbr-17.pdf

So, to the Question: Is Attention Deficit Hyperactivity – ADHD – included in the ADA?

The answer is “Yes, No, or Maybe.”

The ADA defines “disability” as a physical or mental impairment that substantially limits
one or more “major life activities,” such as walking, seeing, hearing, or learning. Having a
diagnosed impairment, such as ADHD, does not necessarily mean that an individual is disabled within the meaning of the ADA.

The ADA does provide for "mental" conditions or mental illnesses, and potentially ADHD fits in this category. But as with physical impairments, the diagnosis of a mental illness or mental impairment such as ADHD is not sufficient by itself to qualify for protection under ADA. Again, having a “diagnosis” is not the same as having a “disability.”

Back to "What is ADHD"? index

This book section: What is ADHD?

Douglas Cowan, Psy.D., M.S. is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

Is there a difference between "ADHD" and "ADD" ?

It can be a bit confusing, but the "difference between ADD and ADHD" is really just a matter of terms.

Once the American Psychiatric Association's diagnostic manual (DSM 3) referred to the disorder as either "Attention Deficit Disorder - with hyperactivity" or "Attention Deficit Disorder - without hyperactivity." This is how the two terms "ADD" (without hyperactivity) or "ADHD" (with hyperactivity) were formed.

Way back in 1994 the APA came out with the new manual (DSM 4) that changed the category to "Attention Deficit/Hyperactivity Disorder" and then described three sub-categories:

• Attention Deficit/Hyperactivity Disorder, Predominantly Inattentive Type
• Attention Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type
• Attention Deficit/Hyperactivity Disorder, Combined Type

At this point the term "ADD" was really obsolete, but it was part of the cultural vocabulary.

On the internet it is very difficult to use the term "ADD" as it looks like a word used in mathematics, or on forms to insert an item. "ADD Child" might mean a child with attention disorder, or that you should have another baby, or that there is a list that you should add another name to.



Go to the ADHD Diet Information site to get the full ADHD diet in eBook PDF format, including our UPDATES for 2013. We also have the full 21 minute information video on our ADHD eating program.

So on the internet today the most common term is "ADHD" and for the sake of the good ol' days we refer often to "ADD ADHD".

Back to "What is ADHD"? index

This book section: What is ADHD?

Douglas Cowan, Psy.D., M.S. is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

Defining "INATTENTION" in ADHD

ADHD doctors often talk about "inattention" as a symptom of ADHD. When we talk about "attention" or "inattention" we need to find ways to conceptualize just what the words mean. One way to look at it is as two different kinds of cognitive abilities:

• The ability to focus on a specific and targeted task put in front of us to do, such as school work, and
• the ability to pay attention in a more global sense to the world around us, for example the buzz of the lights overhead, and the touch of the clothes on your skin, and the children playing outside of the classroom.

In this model there are two different kinds of paying attention. And the better and faster you are at being able to shift from one kind of attention back to the other, the better you are at paying attention. But when one cannot shift easily from global attention to focused, or visa versa, then this neurological inflexibility is a problem. It is a form of "inattention" and is a problem with ADHD.

Paying Attention to the Right Thing

One good definition of "Paying Attention" is - “Sustaining attention to the right thing at the right time.” One part of that definition is that the person with ADHD has to pick the right thing to pay attention to. That's the “selecting” part of the definition. A better word might be "Filtering." The brain is supposed to filter out distractions, or stimuli which compete for our attention, but might not be important at that moment. Many children with attention problems pay attention to everything in the world around them equally, such as giving equal time to the touch of the clothes on their skin, the buzz of the lights overhead, the kids outside the classroom, and the math worksheet in front of them. This, of course, is a problem if he needs to be paying attention to only the math worksheet or the teacher.

So this kind of "inattention" is being unable to resist distractions and focus to the right thing. The person with ADHD responds to the distraction, which of course keeps them from ever completing the task at hand. There are lots of "shiny things" in every ADHD person's life, or room, or office, or garage. Of course, the better someone is at filtering out or resisting being distracted by shiny things, the better they are at completing their tasks or reaching their goals. We call this "focus" and focus helps.

An interesting neurological note is that this type of distractability is not located in the area of the brain that processes "sensory" information. The person with ADHD does not have a "sensory processing" problem or a "perception" problem. They perceive the world like everyone else does. They see the same, hear the same, though they may be a bit more sensitive to some sounds and lights. But ADHD is not a perception problem. The big problem with ADHD is that they have great difficulty resisting the distractions and staying focused to the job at hand. This distractability is on the motor side of the brain, it is behavioral. It is a motor abnormality that they simply cannot resist moving to check out the shiny thing. They get up, look at it, touch it, talk about it. But it is just a shiny thing - a distraction
from the job at hand. For more information on how to reach Doug Cowan, visit http://douglascowan.me.

ADHD and Executive Function

Dr. Russell Barkley, a professor of psychiatry at the University of South Carolina, is a leading expert on ADHD. Here he discusses the five cognitive abilities that appear to be impaired in children with ADHD. For more from the Child Mind Institute v...

Perseverance as Part of Attention Too

Another part of inattention in ADHD is a lack of persistence and perseverance in working to complete a job, or reach a goal. In this type of inattention the problem is the lack of ability to sustain focus and attention over time in order to complete the job, task, or goal. This is "sustained attention" or "time on task" in the classroom or office. The problem is that ADHD is characterized by a lack of persistence This too is from the motor areas of the brain, not the perception or sensory areas. There is not enough self-motivation to stay focused, rather there is the impulse to get up and check out the shiny things. This keeps people with ADHD on task long enough to complete the job.

This is the "moving from one task to another" without finishing anything. Unless the task is very rewarding, like a video game or TV, the person with ADHD will move from one thing to another to another.

The motor aspect of this inattention, the moving from one thing to another, is the difference between this kind of inattention and the inattention caused by depression, or anxiety, or learning disabilities, or hearing voices in your head. These are more perceptual processing problems, though there can be a lot of restlessness with any of them. But ADHD is a motor problem causing a lack of focus and perseverance to a task.

Boring School Work Causes Inattention

Many Children with Attention Disorders have trouble concentrating on the specific task in front of them, especially if they are working on something like school work or chores that are only moderately interesting, or not interesting at all. These tasks are simply not rewarding or motivating. One of the characteristics of inattention in ADHD is a lack of self-motivation. There just is not that internal drive and desire to finish a boring task. External motivations like the rewards from video games will capture the attention, but tasks without these external rewards will not get done.

ADHD kids have to be very motivated, very excited, very interested in what they're doing in order to pay attention. Now, you might be thinking, "This is not my kid. I have a kid who could play Nintendo, and be so focused that the house could burn down around him, and he'd never notice." Well, that could be. A lot of these kids could do just exactly that. Nintendo is interesting, its challenging, and its fun. Kids get immediate feedback, they could play Nintendo for hours.

But just put a math worksheet in front of them and see how different it is. They have a terrible time paying attention to something that's not interesting or that's not motivating, which accounts for about 85% of school work, and about 100% of chores.

Lack of Flexibility with Attention

Part of the problem with Attention Deficit Hyperactivity Disorder – ADHD - is a lack of FLEXIBILITY with attention. A person without ADHD has the ability to shift from attention that is focused on a specific task at hand to the kind of attention that is global many times in just a few seconds. Whenever he wants, someone without ADHD can shift from reading a book, to scanning the room to know where our kids are and what they are doing, and then very quickly returning to focus on reading.

Those without ADHD have Flexibility in their ability to Focus, shifting from specific focus to global focus at will and very quickly. Individuals with ADHD do not have this same Flexibility of focus. Those with Attention Deficit Hyperactivity Disorder have a very difficult time shifting from a global focus, such as they might have at recess or lunch break, to a specific focus that would be required when they return to the classroom to study math and work on the math worksheet in front of them.

This is why it seems that kids with ADHD could play Nintendo, be really focused on that task, and not notice the house burning down around them.

Back to "What is ADHD"? index

Working Memory and ADHD

Another ADHD characteristic is the difficulty in getting back to work, returning to the task, once having been distracted by the shiny thing in the room, or outside of the room. People with ADHD don't return to the task that they just left, they just move on to the next thing. Even when having been distracted people without ADHD can keep in mind what they have been working on and why. This is referred to as "working memory" which is different from either long-term memory functions or short-term memory functions. Working memory is remembering what you need to do, and how to do it, so that you can get it done before it's too late and while it still matters.

People with ADHD have impaired working memory. They have trouble keeping the information in mind that they need for the task so that they can complete the job or reach the goal. So they just wander from thing to thing, task to task, without ever completing anything really. This is a "working memory" deficit in ADHD. This is a time problem, a focus problem, a remembering what it takes to get the job done problem. And yes, it is what you see in older people as their working memory and executive functions begin to wane.

In this sense ADHD is not a deficit of skills, or knowledge. It is a deficit of results. It is a problem with performance.

Working memory deficits also impact one's ability to tell time. Not as in looking at a clock and knowing what time it is, but rather being aware of how long something will take to do, or how long it has been since leaving for school, or whatever. ADHD causes an awareness of time deficit. ADHD causes people to live in the moment (which has now passed), without really thinking much about the future. Things in the future simply have little value when compared to what is happening right now. As a result it is common to see people with working memory deficits from ADHD to be unprepared when the future does arrive. Homework is not finished, the report not done. Preparations for winter not made. Its not procrastination as much as living in the "now". Both past and future have little value compared to the present.

This book section: What is ADHD?

Douglas Cowan, Psy.D., M.S. is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

IMPULSIVITY

Being "impulsive" means to act without thinking first, just acting upon your impluses. Impulsivity is acting without thinking about the consequences or the future. Acting without thinking... this is one of the characteristics of ADHD. ADHD is an "impulse control" disorder.

People with ADHD have "impaired motor inhibition" which means that part of ADHD is having great difficulty in keeping yourself from reacting to the things going on around you, difficulty controlling yourself from getting up and seeing what is happening outside, or down the hall. This is one of the distinguishing features of ADHD even into adulthood. This is why people with ADHD are described as "making impulsive decisions" or "failing to think before they act" or "acting without thinking about the consequences."

Impulsivity is found in two areas:

• Behavioral Impulsivity - the things that you do
• Cognitive Impulsivity - the way that you think and make choices

Behavioral Impulsivity

ADHD individuals with behavioral impulsivity don't stop and think first before they act. No matter how many times you tell this kid, "stop and think first," the next time the situation comes up, he may well do the same impulsive thing again. They have an inability to control and inhibit having a physical reaction to things around them. They have to get up, they have to blurt out, they have to throw the rock. Or they have to be very motivated to stop themselves.

Children with ADHD are seen fidgeting and squirming in their chairs, running and climbing when they shouldn't, and often are touching everything around them. By adulthood this has calmed down, but they are still always looking for something stimulating to do, keeping busy with tasks that they will never finish.

Children with ADHD often aren't learning from their past mistakes. Their learning threshold is very high, and if you don't excite them, or motivate them enough to get them above that learning threshold, they don't learn, and they make the same the same mistake again and again.

ADHD children with behavioral impulsivity often:

• act without thinking first,
• cut in line,
• can't wait their turn in line or in a game,
• blurt out answers in class,
• speak when they're supposed to be quiet,
• may show aggressive behaviors,
• are often a little too loud,
• sometimes fight,
• often have poor social skills, which of course is the death socially for teenagers with ADHD,
• impulsively say the wrong thing at the wrong time.

In high school the ADHD teen can get one date, but they can't get the second date because they might impulsively blurt out something and then say, "Why did I say that?" The other teens are asking, "Who is this guy?" and often begin to avoid him.

Also, sometimes these impulsive kids fail to learn those subtle social cues that everybody else has learned, and so they're socially awkward and often don't know why. Often they are without friends by the third grade.

ADHD and Executive Function

Dr. Russell Barkley, a professor of psychiatry at the University of South Carolina, is a leading expert on ADHD. Here he discusses the five cognitive abilities that appear to be impaired in children with ADHD. For more from the Child Mind Institute v...

Cognitive Impulsivity in ADHD

Cognitive impulsivity means that they guess a lot. Guessing is their problem solving method of choice. Cognitively impulsive ADHD kids will make a multiple number of guesses in a short period of time.

On a matching task, or if you give them multiple choices orally, you'll see them guess for the right answer very quickly, "it's this one, no, its this one, no, wait, its this one," until finally you step in and, when he guesses right, you'll say, "That's it!"

Of course this just reinforces his guessing.

These cognitively impulsive ADHD kids have very limited problem solving strategies. They don't stop and look and the problem and then say, "Well, I could do it this way first, then do that, then I'll be done." They don't approach problem solving that way. They usually just guess and let trial and error take its course.

Now remember, being fast is not a problem. Some have pointed out that “being fast and accurate is good." It's fast and inaccurate that is a problem.

Back to "What is ADHD"? index

Executive Functions and ADHD

ADHD is a disorder of self-control. It is a "dis-inhibition disorder." There are deficits in self-regulation which is a neurological function. Self-control, self-regulation, and inhibition are functions of the brain's "executive system" which is driven in the frontal lobes. The "executive functions" of the brain organize one's behaviors across time to prepare for what is coming in the future. It keeps a person organized.

ADHD causes problems in every area of the executive system. As a result those with ADHD are impulsive, distracted, unaware of time used or time needed, focused on "now" and unmotivated to prepare for the future (talks about it but won't work to get ready for it), and have trouble solving problems. Because of this, ADHD becomes "Results Deficit Disorder" in children, teens, and adults. The job doesn't get done in time, if it is done at all. Planning, problem solving, and performance are all lacking while impulsivity rules.

This book section: What is ADHD?

Douglas Cowan, Psy.D., M.S. is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

What is “Hyperactivity” in ADHD?

If you have a child who is hyperactive, you need no explanation. He's the one running across the ceiling. But for the rest of you, this is what we mean.

These are kids that act as if they are driven by a motor.

They "go." You wind them up in the morning and they "go" until they're finally exhausted, and then they go to sleep, maybe. Some of these sleep pretty well during the night, and some of them hardly need sleep at all. Three hours of sleep and they're up and ready to go.

Each child is different, each child is unique.

Remember that there are several different types of Attention Deficit Hyperactivity Disorder – ADHD.

Hyperactivity Defined

One definition of hyperactivity is "high levels of non-goal directed motor activity."

A child with high levels of motor activity that is always directed at a goal may not be clinically hyperactive. He may be a future professional athlete or rocket scientist.

It's the kid who bounces from one activity to another, in a manner inappropriate for their age, which is our concern.

Hyperactivity is often thought of as the child being “over aroused.”

There is a part of your brain that is constantly scanning the environment to see if there are any changes in that environment.

If anything has changed, then that part of the brain asks the question, “Is this new thing in the environment good or bad? Is it something good to eat, or is it going to eat me? How should I feel about this new thing? Should I like it, or be afraid or it?”

In many ADHD kids who are hyperactive this part of the brain is overly sensitive, and the kids are seen as being easily startled or scared, overreacting to things, touching everything around them, and being very edgy.

They never seem to be able to just relax.

Some of these kids also have a very quick temper, a short fuse. They are sometimes explosive. They often lose friends because of their intensity and temper, and they often seem to run over people like a tornado.

Back to "What is ADHD"? index

But as we have said, a lot of ADHD kids are not hyperactive. And the kids who are not hyperactive tend to be girls, and they tend to sit in the back of the classroom and just quietly get C's and D's when everyone knows they should be getting A's and B's. These kids with ADHD without hyperactivity are the one's being labeled as "lazy" and at the parent conferences the parents are told, "He or she could do better if they'd just try harder."

The good news about hyperactivity in ADHD is the with time the running, climbing, yelling, fidgeting, squirming, and fighting of hyperactivity tend to mellow out as the brain matures. Teens and adults will become more "restless" then the childhood "hyperactive".

ADHD Hyperactive Kids : About ADHD Impulsive Hyperactive Type in Children, Teens, and Adults

From newideas.net the ADD ADHD Information Library. Learn about ADHD "Impulsive Hyperactive" Type with Doug Cowan, Psy.D. This classic type of ADHD, which we call Tigger Type ADHD is more common with males, and is characterized by inattention, impuls...

This book section: What is ADHD?

Douglas Cowan, Psy.D., M.S. is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

ADHD is Not Related to IQ or Intelligence

Attention Deficit Hyperactivity Disorder is not related to I.Q.

Some parents are convinced that if their child has ADD ADHD it means that they are retarded. They see their child's poor performance in school or at home and just assume that the child is not very smart.

On the other hand, other parents say, "I've heard that AD/HD kids are really very, very bright. I think my child must have ADHD," as if they wanted to wear a button that said, "My child is smarter than your child because he has ADHD."

Well, that's ridiculous.

Some Attention Deficit Hyperactivity Disorder kids are below average I.Q., and some are even retarded. Some ADHD kids are above average I.Q., and some are even quite brilliant.

Most Kids are Average

But the awful truth for a parent to hear is that MOST kids are AVERAGE I.Q.

That's why they call it "average."

And most Attention Deficit Hyperactivity Disorder kids have average I.Q. as well. They just have a real tough time in the classroom setting.

In fact, if you think about it, the classroom setting is probably the worst possible setting for these kids. There are a lot of distractions, they are told to sit still, don't move, don't talk, to pay attention to boring worksheets, and keep on task until the work is finished. None of these things come easily to Attention Deficit Hyperactivity Disorder kids.

It is true that most ADHD kids will score poorly on certain of the IQ test's sub-tests, especially those that have to do with short-term memory or focused attention. And these specific deficits will pull down the over all IQ scores. But take those predictably poor areas of performance away and the great majority of ADHD kids will be "average."

This book section: What is ADHD?

Douglas Cowan, Psy.D., M.S. is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

ADHD in School

Can you imagine the most difficult environment for a child who had difficulty sitting still, difficulty paying attention, and who loved to talk to other children?

Imagine that this child had to go into this environment every day, and was expected to perform in this environment at the same level as children who didn't have attention problems.

Problems in the Classroom

When you think about it, it is the classroom setting that is this difficult setting for these kids. There are a lot of distractions, yet they are told to sit still, don't move, don't talk, and to pay attention to boring worksheets, and keep on task until the work is finished. None of these things come easily to Attention Deficit Hyperactivity Disorder kids. But day by day, off to school they go.

Often the Attention Deficit Hyperactivity Disorder child has special educational needs, though not always. Most Attention Deficit Hyperactivity Disorder kids can be successful in the regular classroom with some help.

As many as 30% of those with ADHD also have a specific learning disability that can make reading, writing, or learning math, very difficult.

We tend to see Lower academic achievement for I.Q. If they ought to be A students, they're getting C's instead. If they ought to be B students, they're getting D's instead.

Many Attention Deficit Hyperactivity Disorder kids "hit a wall" in school as the school year progresses. Every week they just get a little farther and farther behind, until they're so far behind that it's impossible to catch up.

They lose their homework assignments, even after they have spent hours working on them. And they study hard for tests only to perform poorly the next day. They just slip farther and farther behind with each passing week.

Third Grade

ADHD is most often recognized and referred for treatment in third grade.

This is when kids most often hit the "academic wall." In third grade they are expected to do more and more work on their own, and they are given more homework to do as well.

Seventh Grade

We also see many referrals in seventh grade, or when the child leaves Elementary School for Junior High School, with several classes and several teachers. Many Attention Deficit Hyperactivity Disorder kids who found ways to compensate in Elementary School are totally lost in Junior High School.

An excellent site with over 500 classroom interventions for ADHD is at ADDinSchool.com to help you work with children and teens impacted by ADHD in school.

This book section: What is ADHD?

Douglas Cowan, Psy.D., M.S. is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

"Attention Deficit Hyperactivity Disorder" or ADHD

Attention Deficit Hyperactivity Disorder is a medical condition, a neuro-biological disorder, caused by genetic factors that result in certain neurological differences including the size, function, activation, and development of the human brain. ADHD is one of the most common childhood behavior disorders. It is seen in about 5% to 9% of all children and teenagers, depending on the study and the definition. Children with ADHD have impaired functioning in a variety of settings, including at home, in school, and in relationships with peers. ADHD is persistant and chronic. If untreated, ADHD children can have long-term adverse effects into adolescence and adulthood. About 4% of the population still has their symptoms from the childhood ADHD bad enough that they are diagnosed as "Adult ADHD."



Attention Deficit Hyperactivity Disorder comes in a variety of types.

We have our own way of describing the different types of ADHD that is easy for both parents and children to understand, using the characters from the Winnie the Pooh stories. Pooh Bear has his head in the clouds, Piglet is anxious and worried, Eeyore is slow and depressed, Tigger is hyper and impulsive, Rabbit is over-focused and rigid. These are pretty descriptive of most of the different types of ADHD that present for treatment.

In the American Psychiatric Association's DSM IV manual, the different types of ADHD all fall under the main category of Attention Deficit Hyperactivity Disorder (ADHD). The main category is then subdivided into

• ADHD Inattentive Type
• ADHD Impulsive-Hyperactive Type
• ADHD Combined Type

In the old DSM-III the terms attention deficit disorder "with hyperactivity" or "without hyperactivity" were also used. Attention Deficit Hyperactivity Disorder comes in various forms, and truly, no two ADD ADHD kids are exactly alike. But there are two sub-groups to focus on in terms of both behaviors and neurology: ADHD Inattentive Type vs. ADHD Combined Type. And these two may actually be two different disorders, not just two types of ADHD. What about the Impulsive-Hyperactive Types? Well as time passes and they mature a bit, the hyperactivity calms down and "impulsive-hyperactive type" person gets re-diagnosed as a "combined type" person. This occurs about 90% of the time, so they are probably really the same thing, but just in different stages at different ages.

Description of Attention Deficit Hyperactivity Disorder or ADHD

Attention Deficit Hyperactivity Disorder might affect one, two, or several areas of the brain, resulting in the different "styles" or "profiles" of children (and adults) with ADD ADHD. These different profiles impact performance in these four areas that we will just list briefly here, but expore in more detail in other articles:

• Inattention, which is a problem with losing focus and not being good at paying attention to the right thing at the right time
• Impulsivity, which is a problem with a lack of impulse control, or a lack of self-control
• Hyperactivity, which is a problem with over-activity or motor restlessness - always "on the go"
• Finally, a problem which is not yet an "official" problem found in the diagnostic manuals, but ought to be: being easily bored, especially if the task is not interesting, or is only somewhat interesting

A few other important characteristics of this disorder are:

1) That it is SEEN IN MOST SITUATIONS, not just at school, or just in the home. When the problem is seen only at home, we then would wonder if perhaps the child is depressed, or if the child is just being non-compliant with the parents;

2) That the problems are apparent BEFORE the AGE OF SEVEN (7).

Since Attention Deficit Hyperactivity Disorder is thought to be a neurologically based disorder, we would expect that outside of acquiring its symptoms from a head injury, the individual with Attention Deficit Hyperactivity Disorder would have been born with the disorder. Even though the disorder might not become much of a problem until the second or third grade when the school work becomes more demanding, one would expect that at least some of the symptoms were noted before the age of seven.

Characterized by inattention, impulsivity, and perhaps hyperactivity, we have found that there are several different types of ADHD. Each type has a different symptom profile, and each type requires a different treatment strategy for the most effective treatment. Learn about the different types of ADHD and specific treatment strategies for each type of ADHD.

There are a number of effective ADHD medications available today, including those made from methylphenidate, better known as Ritalin. ADHD medications are discussed in this section.

Great alternative treatments to ADHD medication are also available, including Attend and Extress, which are manufactured and sold by VAXA International, EEG Biofeedback training, and our ADHD diet recommendations. These ADHD alternative treatments can be used along with medications, or in many cases can be used instead of ADHD medications.

ADHD is a neurological condition with a genetic basis and we discuss the neurology of ADHD. There are also many conditions that look like ADHD, but are not. A good assessment for ADHD will take “differential diagnoses” into account.

Treatment options and treatment planning for ADHD are considered and discussed.

This book section: What is ADHD?

Douglas Cowan, Psy.D., MFT is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.



Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

We have hundreds of articles here at the ADD ADHD Information Library to help you learn just what is ADHD.

Inattention, Impulsivity, Hyperactivity = ADHD?

When we talk about attention, we are talking about two different kinds of abilities:

The ability to focus on a specific task put in front of us to do, such as school work, and the ability to pay attention in a more global sense to the world around us, to be able to pay attention to the buzz of the lights overhead, and the touch of the clothes on your skin, and the children playing outside of the classroom. These are two different kinds of attention.

One Definition of "Paying Attention" is - “Sustaining and selecting to the right cue.”

One part of that definition is that the child has to pick the right thing to pay attention to. That's the “selecting” part of the definition.

A better word might be "Filtering." The brain is supposed to filter out distractions, or stimuli which compete for our attention, but might not be important at that moment.

Many children with attention problems pay attention to everything in the world around them equally, such as giving equal time to the touch of the clothes on their skin, the buzz of the lights overhead, the kids outside the classroom, and the math worksheet in front of them. This, of course, is a problem if he needs to be paying attention to only the math worksheet.
Many Children with Attention Disorders have trouble concentrating on the specific task in front of them, especially if they are working on something like school work or chores that are only moderately interesting, or not interesting at all. These kids have to be very motivated, very excited, very interested in what they're doing in order to pay attention.

What are Inattention, Impulsivity, Hyperactivity, and Boredom in ADHD?
adhd in school addThis Is NOT My Child…

Now, you might be thinking,

"This is not my kid. I have a kid who could play Nintendo, and be so focused that the house could burn down around him, and he'd never notice."

Well, that could be. A lot of these kids could do just exactly that. Nintendo is interesting, its challenging, and its fun. Kids get immediate feedback, they could play Nintendo for hours.

But just put a math worksheet in front of them and see how different it is. They have a terrible time paying attention to something that's not interesting or that's not motivating, which accounts for about 85% of school work, and about 100% of chores.
add adhd school
Lack of Flexibility with Attention

Part of the problem with Attention Deficit Hyperactivity Disorder – ADHD - is a lack of FLEXIBILITY with attention.

A person without ADHD has the ability to shift from attention that is focused on a specific task at hand to the kind of attention that is global many times in just a few seconds. At will those without ADHD can shift from reading a book, to scanning the room to know where our kids are and what they are doing, and then very quickly returning to focus on our reading.

Without ADHD we have Flexibility in our ability to Focus. We can shift from specific focus to global focus at will and very quickly.

Individuals with ADHD do not have this same Flexibility of focus. Those with Attention Deficit Hyperactivity Disorder – ADHD – have a very difficult time shifting from a global focus, such as they might have at recess or lunch break, to a specific focus that would be required when they return to the classroom to study math and work on the math worksheet in front of them.

This is why kids with Attention Deficit Hyperactivity Disorder – ADHD – could play Nintendo, be really focused on that task, and not notice the house burning down around them. Or you telling them to talk out the trash.
Paying Attention to the Right Thing

A second type of problem with Attention Deficit Hyperactivity Disorder – ADHD – is sustaining attention to the task long enough to finish the task. We may call this “attention span.”

Many children with Attention Deficit Hyperactivity Disorder – ADHD – may be able to focus attention to the correct task for a while, but then can't sustain it for very long. Their “attention span” is very short for their age. Unless kept highly motivated, these children have a very hard time staying focused long enough to finish the work that they start.

They are often seen as fidgety, easily distracted, and “day-dreamers.” These are the people who may start five different projects, but fail to finish any of them. They may begin to clean their rooms, but after a short time become distracted by their toys or baseball cards and forget all about the job that they are supposed to be working on.

A note about children with this type of Attention Deficit Hyperactivity Disorder – ADHD > Inattentive Type: Often children as described above are not impulsive or hyperactive. They just appear to be “space-cadets,” unfocused, or lazy.

Children with only the Inattentive Type of Attention Deficit Hyperactivity Disorder – ADHD – tend to be females (60% females to 40% males). They are the least likely Attention Deficit Disorder subgroup to receive any help for their condition, especially the boys with Inattentive ADHD.

Kids who are just ADHD Inattentive Type are like space-cadets. They are in a brain fog. They are like Winnie the Pooh.

They are often seen failing to pay close attention to details, or having trouble keeping their minds focused on a task, especially with school work or chores. They often don't seem to be listening. They are often disorganized.

They often will try to get out of doing their homework because it is just such a boring task. They are the kids that will spend two hours to complete a 20 minute homework assignment, and then fail to turn it in to the teacher the next day because they have lost it in their back pack or sent it to the Bermuda triangle of homework assignments.
IMPULSIVITY

Impulsivity is found in two areas:

Behaviorally and Cognitively.

Behavioral impulsivity would include what you do.

ADHD er's with behavioral impulsivity don't stop and think first before they act. No matter how many times you tell this kid, "stop and think first," the next time the situation comes up, he may well do the same impulsive thing again.

Kids with ADHD often aren't learning from their past mistakes. Their learning threshold is very high, and if you don't excite them, or motivate them enough to get them above that learning threshold, they don't learn, and they make the same the same mistake again and again.

ADHD er's with behavioral impulsivity act without thinking first, cut in line, can't wait their turn in line or in a game, blurt out answers in class, speak when they're supposed to be quiet, maybe show aggressive behaviors, are often a little too loud, and sometimes fights.

They often have poor social skills, which of course is the death socially for teenagers with ADHD. They impulsively say the wrong thing at the wrong time. They can get one date, but they can't get the second date because they might impulsively blurt out something and then say, "Why did I say that?" The other teens are asking, "Who is this guy?" and often begin to avoid him.

Also, sometimes these kids fail to learn those subtle social cues that everybody else has learned, and so they're socially awkward and often don't know why.

Cognitive impulsivity means that they guess a lot. Guessing is their problem solving method of choice.

Cognitively impulsive ADHD kids will make a multiple number of guesses in a short period of time. On a matching task, or if you give them multiple choices orally, you'll see them guess for the right answer very quickly, "it's this one, no, its this one, no, wait, its this one," until finally you step in and, when he guesses right, you'll say, "That's it!" Of course this just reinforces his guessing.

These cognitively impulsive ADHD kids have very limited problem solving strategies. They don't stop and look and the problem and then say, "Well, I could do it this way first, then do that, then I'll be done." They don't approach problem solving that way. They usually just guess and let trial and error take its course.
Being Fast is NOT a Problem

Now remember, being fast is not a problem. Some have pointed out that “being fast and accurate is good." It's fast and inaccurate that is a problem.

Impulsive kids are often seen interrupting others in conversations, or blurting out answers in class. They often have trouble waiting their turn in games, or have trouble lining up at school. They just don't wait... or think...before they act.
HYPERACTIVITY

First of all, not all of the kids with Attention Deficit Hyperactivity Disorder are hyperactive. Perhaps as many as two out of three are, but perhaps as few as only 50%.

So, that means that as many as 35% to 50% of kids with ADHD are not hyperactive.

Most of the ADHD kids that we see in our private practice setting are hyperactive kids, because they get in the most trouble. Their parents are usually pulling their hair out and saying, "We've got to get this child some help." The sad truth is that if a parent is going to spring for money to get treatment for his kid, that kid's usually got to get in trouble. So that's why we see the hyperactive kids the most in treatment.
What is “Hyperactivity”?

If you have a child who is hyperactive, you need no explanation. He's the one running across the ceiling. But for the rest of you, this is what I mean.

These are kids that act as if they are driven by a motor. They "go." You wind them up in the morning and they "go" until they're finally exhausted, and then they go to sleep, maybe. Some of these sleep pretty well during the night, and some of them hardly need sleep at all. Three hours of sleep and they're up and ready to go.

Each child is different, each child is unique. Remember that there are several different types of Attention Deficit Hyperactivity Disorder – ADHD.

One definition of hyperactivity is "high levels of non-goal directed motor activity."

A child with high levels of motor activity that is always directed at a goal may not be clinically hyperactive. He may be a future professional athlete or rocket scientist. It's the kid who bounces from one activity to another, in a manner inappropriate for their age, which is our concern.

Hyperactivity is often thought of as the child being “over aroused.”

There is a part of your brain that is constantly scanning the environment to see if there are any changes in that environment. If anything has changed, then that part of the brain asks the question, “Is this new thing in the environment good or bad? Is it something good to eat, or is it going to eat me? How should I feel about this new thing? Should I like it, or be afraid or it?”

In many ADHD kids who are hyperactive this part of the brain is overly sensitive, and the kids are seen as being easily startled or scared, overreacting to things, touching everything around them, and being very edgy.

They never seem to be able to just relax.

Some of these kids also have a very quick temper, a short fuse. They are sometimes explosive. They often lose friends because of their intensity and temper, and they often seem to run over people like a tornado.

But as we have said, a lot of ADHD kids are not hyperactive. And the kids who are not hyperactive tend to be girls, and they tend to sit in the back of the classroom and just quietly get C's and D's when everyone knows they should be getting A's and B's.

These kids with ADHD without hyperactivity are the one's being labeled as "lazy" and at the parent conferences the parents are told, "He or she could do better if they'd just try harder."
EASILY BORED

Also as we've said, these kids with ADHD are easily bored, especially at school and with chores.

If the subject is interesting, then he's OK. If the subject or task is only moderately interesting, or not interesting at all, then he can't sustain his motivation levels, or his attention to task long enough to get the job done.

Although it's not in the literature, nor in the diagnostic criteria, this aspect of being easily bored is the most common element that I've seen with these children.

Since most of the work from school is boring, and since everything to do with chores at home is boring, these kids can have a very difficult time growing up.

ADHD Information

This book section: What is ADHD?

Douglas Cowan, Psy.D., MFT is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

ADHD in Americans with Disabilities Act ADA Court Cases

We are not lawyers, and our readers probably are not either, but it is interesting to look at some of the recent court cases regarding the ADA that directly related to children or adults with Attention Deficit Hyperactivity Disorder.

These two cases seem to expand the definition of “major life activities” to include concentration and cognitive functions:

• Brown v. Cox Medical Centers (8th Cir. 2002), where reportedly the court stated that the "ability to perform cognitive functions" is a major life activity;
• Gagliardo v. Connaught Laboratories, Inc. (3d Cir. 2002), where reportedly the court held that "concentrating and remembering (more generally, cognitive function)" are major life activities.
But the courts have placed limitations on the scope of the Act as well, and have not just tried to accommodate everyone with ADHD. The court has its limits, and they have ruled that the ADA has its limits.

For example Knapp v. City of Columbus (2006 U.S. App. LEXIS 17081) is the story of three firefighters with ADHD who wanted the City to make accommodations for them in their jobs. The U.S. Court of Appeals for the Sixth Circuit declined to extend ADA coverage to three firefighters who had Attention Deficit Hyperactivity Disorder.

Three firefighters had claimed that ADHD substantially limited their ability to learn, so the City should make accommodations for them. But the court held that the firefighters failed to establish that their ADHD met the standards to qualify as a disability under the ADA.

A very important limitation of Act involved a ruling from an earlier Supreme Court case with Toyota in 2002 which the Sixth Circuit Court used in this case with the firefighters. The Sixth Circuit applied the U.S. Supreme Court’s test in Toyota Motor Mfg., Kentucky, Inc. v. Williams, 534 U.S. 184 (2002).

Under the Toyota Motor ruling the courts must consider whether the person making the claim is unable to perform the variety of tasks central to most people’s daily lives, not whether the claimant is unable to perform the tasks associated with his or her specific job.

When applying this test, the Sixth Circuit wrote that when a person who is seeking protection or accommodations under the ADA can fully compensate for an impairment through medication, personal practice, or an alteration of behavior, a “disability,” as defined by the Disabilities Act, does not exist.

In other words, if a child, teen, or adult with ADHD can “get the task done” or “get the job done” by using medications, applying behavioral management techniques, receiving counseling, using biofeedback, using Attend, or other treatment interventions, then they do not have a disability that is protected under the ADA.

In this court case, all three firefighters testified that taking Ritalin controlled their symptoms, and that they were able to fulfill their family and work obligations. Thus, an ADA disability was not found.

So, it would follow that if you, or your child, could function pretty well at work or in school when taking medication or Attend, or using some other treatment, no disability as defined under the ADA would exist – at least according to the 6th Circuit Court.

Also, it seems that as a result of this ruling, employers under the Sixth Circuit do not need to make accommodations for employees with ADHD under these conditions:

1. When the disorder has not been shown to substantially impair their ability to perform tasks central to daily life;
2. When the ADHD symptoms can be improved by medication or other treatments.

Here is a pretty good list from a major university of the conditions that must be met for ADHD to qualify for coverage and protection under the American with Disabilities Act of 1990:

• The ADHD must cause significant impact or limitation in a major life activity or function;
• The individual must be regarded as having a disability;
• The individual must have a record of having been viewed as being disabled;
• The applicant must also be able to perform the essential job functions with or without accommodations to qualify as an individual with a disability under the meaning of the Act.

To establish that an individual is covered under the ADA, documentation must indicate that a specific disability exists and that the identified disability substantially limits one or more major life activities. Documentation must also support the accommodations requested.

1. The evaluation must be conducted by a qualified professional, such as psychologist, neuropsychologist, psychiatrist, or other medical doctor who has had comprehensive training in the differential diagnosis of ADHD and direct experience with an adult ADHD population. The name, title, and professional credentials of the evaluator should be clearly stated. All reports should be on letterhead, typed, dated, signed and otherwise legible.
2. Documentation must be current. The diagnostic evaluation must adequately address the individual’s current level of functioning and need for accommodations. In most cases, the evaluation must have been completed in the last three years. A school plan, such as an Individualized Education Plan (IEP) or 504 Plan, is insufficient documentation for a university, but can be included for consideration as part of a more comprehensive evaluative report.

Documentation necessary to substantiate the diagnosis must be comprehensive and include:

• Evidence of early impairment. Historical information must be presented to demonstrate symptoms in childhood which manifested in more than one setting.
• Evidence of current impairment, which may include presenting attentional symptoms and/or ongoing impulsive/hyperactive behaviors that significantly impair functioning in two or more settings. In addition, the diagnostic interview should include information from, but not limited to, the following sources: developmental history, family history, academic history, medical history, and prior psycho-educational test reports.
• Alternative diagnoses or explanations should be ruled out. The evaluator must investigate and discuss the possibility of dual diagnoses and alternative or coexisting mood, behavioral, neurological, and/or personality disorders that may confound the diagnosis of ADHD.
• Relevant testing information must be provided and all data must reflect a diagnosis of ADHD and a resultant substantial limitation to learning.
• Documentation must include a specific diagnosis. The diagnosis must include specific criteria based on the DSM-IV, including evidence of impairment during childhood, presentation of symptoms for at least the past six months, and clear evidence of significant impairment in two or more settings. The diagnostician should use direct language in the diagnosis of ADHD, avoiding the use of such terms as “suggests,” “is indicative of,” or “attentional problems.”
• An interpretive summary must be provided that demonstrates that alternative explanations have been ruled out and that explains how the presence of ADHD was determined, the effects of any mitigating measures (such as medication), the substantial limitation to learning caused by the ADHD, and the rationale for specific accommodations.

Obviously, dealing with government regulations with their specific definitions can be very frustrating and difficult. It would be important to have realistic expectations in regards to the American with Disabilities Act and ADHD.

We would recommend getting legal advice from an attorney who specializes in educational law, or has expertise in the Americans with Disabilities Act, to learn more about how the ADA may apply in a specific case to a particular individual with ADHD.

Youtube Videos for other sources for other points of view:

Your Rights under the Individuals with disability education act (IDEA)

Your Child's Rights under the Individuals with Disability Education Act

Americans with Disabilities Act and ADHD

This book section: What is ADHD?

Douglas Cowan, Psy.D., MFT is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

It is important to remember that many, or most, children with ADHD will never really “out-grow” the problems that ADHD brings. We have discussed this in detail in our reporting on ADHD and Depression in females, and in other articles through the years.

This week another reminder of this was published in a national survey of 1,007 adults with ADHD. The survey looked at how adults with ADHD cope at home, at work, and in relationships with others. The survey was published just in time for the 2008 Chadd Conference, and the 2008 ADHD National Awareness Day.

What the survey found was that, of those adults with ADHD:

• 75% reported that ADHD strongly impacted their ability to stay focused to a task long enough to complete it;
• 70% reported that ADHD strongly impacted their ability to focus on what others were saying;
• 65% reported that ADHD strongly impacted their responsibilities at home;
• 60% reported that ADHD strongly impacted their ability to stay seated through a business meeting, or to organized projects, or follow through with projects until they are completed;
• 57% reported that ADHD strongly impacted their relationships with their families and friends;
• 56% reported that ADHD strongly impacted their ability to advance in their work place or career;
• 47% reported that ADHD caused them to have to work harder than others just to accomplish the same amount of work as those without ADHD;

The survey group was asked about what they would like to accomplish, or treatment goals:

• 50% reported that they would like to get their house organized, and 28% reported that they needed to get their personal finances more organized;
• 38% reported that they needed to get their moodiness under control, and 26% wanted to improve their relationships with others;
• 36% felt that their ADHD symptoms were still not under control, and many report feeling depressed thinking about how hard it is to be an adult with ADHD.

The study was headed up by two big names in the ADHD community: Ed (Ned) Hallowell, M.D., who has written important books such as “Driven to Distraction,” and Natalie Knochenhauer, who as a mother of ADHD children has become an important advocate in the Philadelphia area.

The study was funded by McNeill Pediatrics, which, by the way, markets CONCERTA (methylphenidate HCI) for the treatment of ADHD in adults, as well as in children. Hallowell and Knochenhauer are both paid consultants for McNeill Pediatrics. So there is an element of this study that is designed to market CONCERTA to those adults who are not receiving any treatment, feel that their ADHD is not under control, and etc.

But this study should be more than that.

• IF conservatively 5% of the children in the USA have ADHD, and
• IF conservatively 50% of the children in the USA will “out-grow” their ADHD symptoms by the age of 20 or so, and
• IF there are approximately 300 million people in the USA,
• THEN there are conservatively 7,500,000 adults in the USA alone dealing with “adult ADHD.” And if 38% of them feel that their ADHD is not under control, or are depressed by their ADHD, and so on, well that’s a lot of people suffering from ADHD even into adulthood (38% of 7.5 million adults with ADHD is 2,850,000 adults who feel it is out of control or feel depressed because of their ADHD).

If you are an adult with ADHD, and you are feeling that you can’t get ahead at work because of it, or you can’t get organized, or motivated, or get your moods under control, there is help for you.

Yes, medications like Concerta can help. Stimulant medications can help to increase time on task, focus to boring tasks, and so on. Consider medications as a treatment option and talk to your doctor about it.

We also like people to try the combination of an ADHD diet (including high protein, low carbohydrate breakfasts and some caffeine), with ATTEND, Extress or Deprex (for mood stabilization) and Memorin for memory improvement. See the Different Types of ADHD for specific treatment strategies.

With either of the approaches above, counseling or coaching for ADHD as well as for skills and strategies to improve relationships and work performance are essential.

This book section: What is ADHD?

Douglas Cowan, Psy.D., MFT is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

Atypical Frontal Brain Activation in ADHD: Preschool and Elementary School Boys and Girls.

Attention-deficit/hyperactivity disorder (ADHD) is a common psychiatric disorder that significantly hampers psychosocial adaptation (e.g., Biederman et al., 1996; Tannock, 1998). Several findings point to the involvement of a right-sided frontostriatal dysfunction in ADHD symptoms.

An alerting network for maintaining a vigilant state is assumed to be localized in the right frontal lobe (Posner and Petersen, 1990). This hypothesis is supported by the fact that the development of attention in normal children correlated with magnetic resonance imaging (MRI)-derived morphometric measures of the anterior cingulate, particularly the right (Casey et al., 1992).

Adults and children with focal, especially frontal, right-hemispheric lesions display behavior problems comparable with those in children with ADHD, such as inattention, defective response inhibition, and impersistence (Heilman et al., 1991).

Findings of structural neuroimaging studies underscore the assumption of a right frontal deficit in ADHD. Using MRI, abnormal - though markedly diverging - findings in several brain regions (e.g., basal ganglia, corpus callosum) were reported in children with ADHD (Filipek, 1999; Tannock, 1998), but all studies examining the frontal region found the right anterior frontal cortex to be smaller than in nonADHD children (Casey et al., 1997; Castellanos et al., 1996; Filipek et al., 1997; Hynd et al., 1990).

Casey et al. (1997) correlated performance of ADHD children and control children in 3 response inhibition tasks with MRI-based anatomical measures of the prefrontal cortex and the basal ganglia. Significant negative correlations between task performance and volume of the prefrontal cortex and caudate nuclei emerged, predominantly in the right hemisphere, suggesting that the right frontostriatal circuitry is intimately involved in response inhibition.

(Statistical Data Included)

Author/s: Lioba Baving
Issue: Nov, 1999

This book section: What is ADHD?

Douglas Cowan, Psy.D., MFT is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

Genetic Causes of ADHD : DNA Research

Researchers at Cardiff University have recently published a study in The Lancet claiming that they have found the first direct evidence of a genetic link, or genetic cause for attention-deficit hyperactivity disorder in children, teens, and adults. The research team also reports that this is evidence for ADHD being a neurological disorder, such as autism, and not due to environmental factors such as bad parenting.

However, their research study was immediately countered in Britain by those who insist that ADHD is due primarily to environmental factors, primarily stress and the release of cortisol in young children.

The Cardiff University study examined the DNA from 366 children who had been diagnoses with ADHD, and compared their DNA to over 1,000 children without the disorder. They found significant differences in the DNA of 15% of the ADHD group, specifically in regions of the chromosomes previously identified with autism and schizophrenia, which are other neurological disorders. This compared to finding these same variations in only 7% of the control group.

In her interview with the BBC, professor Anita Thapar said, “Here we have very clear evidence for ADHD being a genetic disorder.” However, she also went on to say that there are several factors that contribute to ADHD, and the severity of the disorder in any individual. “It’s a complicated mix.”

The study also went on to stress that as of yet there has not been one single gene identified as the cause of ADHD, but they hope that in the future some of the biological mysteries of ADHD will be solved, leading to new and better treatments.

The flip-side to this study is that they only found the DNA variations in 15% of the children diagnosed with ADHD – which means that in 85% of the children diagnosed with ADHD in this study there was no genetic variation identified. So what are the implications for those children? Does that mean that there are no genetic factors causing their ADHD?

First evidence of genetic changes linked to ADHD | A film by the Wellcome Trust

This research provides the first direct evidence that attention-deficit/hyperactivity disorder (ADHD) is a genetic condition. Scientists at Cardiff University found that children with ADHD were more likely to have small segments of their DNA duplicat...

While we believe from our clinical experiences that genetics play a large part in all of the ADHD in the world, we don’t believe that it necessarily is the cause for your individual child’s ADHD. Through the years we estimated that in about 80% of the cases that we treated (well over 1,000 children, teens, and adults) there was at least one close relative who had either ADHD, Tourettes Syndrome, Obsessive-Compulsive Disorder, or Alcoholism. So we “believe” (just on our experience) that there is a genetic component in most cases.

However, we also know that many children who have been diagnosed with ADHD actually have some other condition that looks like ADHD but is not, such as a head injury, fetal alcohol syndrome, in utero drug exposure, Tourettes Syndrome, depression, environmental allergies, or have been exposed to environmental toxins as children.

We have no doubt that part of this conflict involves the accuracy of a diagnosis of ADHD, or lack thereof. For example, if a child who is inattentive, impulsive, and hyperactive because of fetal alcohol syndrome is incorrectly diagnosed with ADHD, there would be no “genetic” cause, or “genetic link” to be discovered for their “ADHD” disorder.

Also interviewed by the BBC was Child Psychologist Oliver James, who disputed the conclusions of the study’s authors. Dr. James comes from a primarily environmental side of the debate on the causes of ADHD, and he stated on the BBC interview that in his opinion the findings of the study “have been hyped in the most outrageous fashion.” He especially focused on the 85% of the children diagnosed with ADHD for whom no genetic differences could be found. “What is really significant is the role of the environment.” He believes that the primary cause of ADHD in children is “children being very stressed out” which results in high levels of cortisol being released into they bodies. He believes that parents can help their children to learn to deal with the stress, and decrease the cortisol levels and therefore their ADHD symptoms.

Professor Tim Kendall of the National Collaborating Centre for Mental Health is another skeptic of the study’s results. He is of the opinion that there may be a number of factors that cause ADHD, and that putting the cause purely on genetics might lead to children being given incorrect or unnecessary treatments. "…(The cause of ADHD is) a mixture of genetic and environmental factors, and the important thing is that we don't end up thinking this is a biological problem which is only subject to biological treatments like Ritalin."

We would expect that as technology advances the study of the brain, and human genetics, that we would find out a lot more about the biology of ADHD. But with so many being given the diagnosis, rightly or wrongly, we would also expect that until some very great advancements are made in the diagnosis of ADHD at the level of the doctor’s office, or therapist’s office, that this conflict between nature or nurture in ADHD will continue in full force.

This book section: What is ADHD?

Douglas Cowan, Psy.D., MFT is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

Premature Or Low Birthweight Babies At Significantly Increased Risk Of Hyperactivity Disorder

Premature or low birthweight babies are up to three times as likely to become hyperactive, with low attention spans, suggests research published ahead of print in the Archives of Disease in Childhood.

The Danish research team compared the birth records of 834 children with confirmed HKD with those of 20,100 children with no mental disorders. All the children were born between 1980 and 1994.

Children born at between 34 and 36 weeks were around 70% more likely to develop the disorder than children born at term. Babies at born below 34 completed weeks were almost three times as likely to develop the disorder.

Low birthweight babies born at term were also at risk, the study showed.

Note: This story has been adapted from a news release issued by BMJ Specialty Journals. See Doug Cowan's website at DouglasCowan.me.

ADHD Boys Brain Functioning

Stanford neuro-scientists have found a clear difference in brain functioning between boys who have attention deficit disorder [ADHD] and those who do not, a step that could lead to better diagnosis of the most common developmental disorder of childhood.

Follow-up studies will be required before the results of this study on a small number of boys can lead to brain-based methods of diagnosis, caution the lead researchers, Research Associate Chandan Vaidya and Associate Professor John Gabrieli of Stanford's Department of Psychology.

Ritalin Effects on ADHD

Theirs is the first study, however, to show that Ritalin, the drug most commonly used to treat ADD, has different effects on the brains of people with and without ADD, and where those differences occur in the brain. The findings are reported in the Nov. 24 issue of the Proceedings of the National Academy of Sciences.

The study is also the first to use functional magnetic resonance imaging [FMRI] in the study of ADD. This imaging method can show brain differences in individual people, instead of in averages of differences of two groups. This is critical for diagnosis, which has to be established on an individual basis. Unlike methods used in other studies of ADD, FMRI does not require injection or inhalation of radioactive substances. It relies instead on naturally occurring changes in brain function, which makes it appropriate for research and clinical purposes for children.

Co-authors of the study are medical doctors Glenn Austin and Hugh Ridlehuber and school psychologist Gary Kirkorian of the Community/Academia Coalition in Los Altos, Calif. and Gary Glover and John Desmond of the Stanford Medical Center's Radiology Department.

The findings have drawn considerable attention from neuroscientists because "ADD is so widespread, so controversial and confusing, and these are among the few clear findings in that field," said Gabrieli, who heads the brain imaging laboratory where the research was done.

Attention deficit disorder, which often includes hyperactivity, is currently diagnosed on the basis of subjective observations of youngsters' behavior. If the new findings can be replicated, he said, it might be possible to make a biological diagnosis of the disorder by using FMRI. Since the common treatment for ADD is a prescription drug whose long-term effects on brain function are not known, parents and pediatricians most likely would welcome a more definitive way to diagnose the disorder.

Comparing the brain images later, researchers found a clear difference in the activation of neuronal tissue in two structures in the striatal region, which is known to be involved in motor control. The brain activation differences between the boys with ADD and those without were even more dramatic when the subjects were asked to perform the same task after taking the drug Ritalin. Ritalin is a stimulant medication used to temporarily relieve symptoms of ADD, such as inattention, impulsivity and hyperactivity.

"Both the normal kids and the ADD kids got better in their impulse control when they had taken the drug," Vaidya said. "Ritalin improved everyone's performance, but how it actually did it differed in the brains."

The boys with ADD showed more activity in the affected striatal structures (specifically known as the caudate and putamen) when taking the drug than when not. The healthy boys, in contrast, showed the reverse - less activity in those areas when taking the drug than when not.

"From past work with adults and children, some of which required injecting radioactive material, a consensus developed that it is the frontal striatal circuitry of the brain that is what's not right with this disorder," Vaidya said. "That is why we imaged this part of the brain, and our study confirmed that these structures are, indeed, important for ADD."

Ritalin primarily, but not exclusively, influences dopamine neurotransmission. The opposite effects of Ritalin on boys with ADD and boys without the disorder suggest that ADD involves atypical dopamine modulation in the striatum, she said.

The researchers caution that the study was conducted with a small group and needs to be replicated with girls as well as with more boys before they can be certain they have found a universal neurobiological marker for the disorder. They also reported that they tried the experiment on three other boys who had not been diagnosed with ADD but who had siblings with the diagnosis. Two of the three siblings of ADD boys showed some Ritalin enhancement of the striatum, as did their affected brothers.

"This would lend some support to the idea that ADD may involve atypical genetic influences on dopamine modulation," Vaidya said, but more studies would be necessary to establish a genetic influence.

Because of the widespread interest in ADD, the researchers also were careful to point out other limitations of their study. A fraction of people diagnosed with ADD have not responded to Ritalin treatment, and this study did not include such children, they said. It also did not attempt to investigate possible changes in brain activation that might occur with the drug over time. The ADD boys did show a different brain activation level when not on the drug, but all of them had been taking Ritalin previously as part of their ongoing treatment.

Despite these limitations, the study points to new directions for research into brain function that could improve individuals' performance.

"This is one of the few studies to examine brain function in children, and to further our knowledge about normal and abnormal brain development," Gabrieli said. "It suggests that FMRI is a powerful tool to examine brain and behavior in the context of both normal and abnormal development."

Currently, ADD impairs the function of an estimated 3 to 7 percent of youngsters in home and school, and the long-term consequences include lower educational and vocational accomplishments for them as adults as well as an increased risk for drug abuse and other risky behaviors.

The study was funded by a grant from the El Camino Hospital District Board in Mountain View, Calif.

Note: This story has been adapted from a news release issued by Stanford University.
Source: Stanford University
Date: November 24, 1998

This book section: What is ADHD?

Douglas Cowan, Psy.D., MFT is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

ADHD : What is "Working Memory"?

A common ADHD characteristic is the difficulty in getting back to work, returning to the task, once having been distracted by the shiny thing in the room, or outside of the room. People with ADHD don't return to the task that they just left, they just move on to the next thing. Even when having been distracted people without ADHD can keep in mind what they have been working on and why. This is referred to as "working memory" which is different from either long-term memory functions or short-term memory functions. Working memory is remembering what you need to do, and how to do it, so that you can get it done before it's too late and while it still matters.

People with ADHD have impaired working memory. They have trouble keeping the information in mind that they need for the task so that they can complete the job or reach the goal. So they just wander from thing to thing, task to task, without ever completing anything really. This is a "working memory" deficit in ADHD. This is a time problem, a focus problem, a remembering what it takes to get the job done problem. And yes, it is what you see in older people as their working memory and executive functions begin to wane. In this sense ADHD is not a problem from a lack of skills or knowledge. It is a deficit of results - and results matter. It is a problem with performance.

Here's a good resource developed by some researchers at Harvard to help improve working memory. Its a computer based program to improve working memory in children and teenagers.

Working memory deficits also impact one's ability to tell time. Not as in looking at a clock and knowing what time it is, but rather being aware of how long something will take to do, or how long it has been since leaving for school, or whatever. ADHD causes an awareness of time deficit. ADHD causes people to live in the moment (which has now passed), without really thinking much about the future. Things in the future simply have little value when compared to what is happening right now. As a result it is common to see people with working memory deficits from ADHD to be unprepared when the future does arrive. Homework is not finished, the report not done. Preparations for winter not made. Its not procrastination as much as living in the "now". Both past and future have little value compared to the present.

This book section: What is ADHD?

Douglas Cowan, Psy.D., MFT is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

Do executive function deficits differentiate between adolescents with ADHD and oppositional defiant/conduct disorder?

A neuropsychological study using the Six Elements Test and Hayling Sentence Completion Test

J Abnorm Child Psychol 2000 Oct;28(5):403-14
Clark C, Prior M, Kinsella GJ
School of Psychological Science, La Trobe University, Victoria, Australia.
[Record supplied by publisher]

Two neuropsychological measures of executive functions--Six Elements Tests (SET) and Hayling Sentence Completion Test (HSCT)-were administered to 110 adolescents, aged 12-15 years.

Participants comprised four groups: Attention Deficit Hyperactivity Disorder (ADHD) only (n = 35). ADHD and Oppositional Defiant Disorder/Conduct Disorder (ODD/CD) (n = 38), ODD/CD only (n = 11), and a normal community control group (n = 26).

Results indicated that adolescents with ADHD performed significantly worse on both the SET and HSCT than those without ADHD, whether or not they also had ODD/CD.

The adolescents with ADHD and with comorbid ADHD and ODD/CD were significantly more impaired in their ability to generate strategies and to monitor their ongoing behavior compared with age-matched controls and adolescents with ODD/CD only.

It is argued that among adolescents with clinically significant levels of externalizing behavior problems, executive function deficits are specific to those with ADHD.

The findings support the sensitivity of these two relatively new tests of executive functions and their ecological validity in tapping into everyday situations, which are potentially problematic for individuals with ADHD. Executive Function Differences in Adolescents with ADHD vs Oppositional Defiant Disorder

This book section: What is ADHD?

Douglas Cowan, Psy.D., MFT is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

Executive functions their role in developmental psychopathology.

In this paper, we consider the domain of executive functions (EFs) and their possible role in developmental psychopathologies.

We first consider general theoretical and measurement issues involved in studying EFs and then review studies of EFs in four developmental psychopathologies: attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), autism, and Tourette syndrome (TS).

Our review reveals that EF deficits are consistently found in both ADHD and autism but not in CD (without ADHD) or in TS.

Moreover, both the severity and profile of EF deficits appears to differ across ADHD and autism. Molar EF deficits are more severe in the latter than the former. In the few studies of more specific EF tasks, there are impairments in motor inhibition in ADHD but not in autism, whereas there are impairments in verbal working memory in autism but not ADHD. We close with a discussion of implications for future research.

J Child Psychol Psychiatry 1996 Jan;37(1):51-87
Pennington BF, Ozonoff S
Department of Psychology, University of Denver, CO 80208, USA.

Confirmation of an Inhibitory Control Deficit in Attention-Deficit/Hyperactivity Disorder.

Author/s: Russell Schachar
Issue: June, 2000

The objective of this study was to determine whether deficient inhibitory control distinguishes children with a diagnosis of attention-deficit/hyperactivity (ADHD) disorder, conduct disorder (CD), and comorbid ADHD + CD from normally developing children.

Participants were rigorously diagnosed children (age 7 to 12 years) with ADHD (N = 72), CD (N = 13) or ADHD + CD (N = 47) and 33 control children (NC). We studied inhibitory control using the stop-signal paradigm, a laboratory task that assessed the ability to inhibit an ongoing action.

The ADHD group had significantly impaired inhibitory control compared to NC, CD, and ADHD + CD children.

These results indicate that children with ADHD have deficient inhibition as measured in the stop-signal paradigm and that ADHD occurring in the presence of ADHD + CD may represent a phenocopy of CD rather than a variant of ADHD.

View full article here
on Inhibitory Control Deficit in ADHDThis book section: What is ADHD?

Douglas Cowan, Psy.D., MFT is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953