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What's Up with ADD?

 You’re hearing about ADD all the time.  Is it a real or is it the disease of the month?  Why is it being diagnosed so often?  How do you know for sure?  Is Ritalin the only answer?  There is a lot of confusion and misinformation about this disorder. 

First of all, ADD has been around for a long time but it was known by other names.  When we (baby boomers) were in school these kids were labeled lazy or problemed and often ended up dropping out of school.  The medical-psychological  establishment knew ADD by other names.  More recently though, the ability to diagnose and treat ADD has improved, and that’s why you’re hearing so much about it.

  ADD can manifest in many types of symptoms; impulsivity, poor school grades, moodiness, defiance and distractibility, to name a few.  Some ADD children have hyperactivity, some do not.  Many students with ADD are very bright; many also have learning disorders.  When these kids reach their teens, ADD manifests differently.  So no wonder there is so much confusion about the disorder. 

  The similarity that ties these diverse symptoms together is an underlying difficulty with self-regulation; whether it is being able to inhibit impulses, focus on homework or control moods.  Brain imaging studies implicate the pre-frontal cortex (among other areas) in ADD disorders.  When the pre-frontal cortex is under-active, planning and regulation are deficient.  Incidentally, that is why stimulant drugs seem to help these children; the stimulant helps this brain center become more active.

  Unfortunately, ADD is both over-diagnosed and under-diagnosed.   It is over-diagnosed in that some kids have behavior problems or are anxiously depressed and they are wrongly considered as having ADD.  This is particularly common when adequate testing has not been done.  Sometimes too, some testing is done, but tests that rule out learning disorders are not used, and the true problem is missed.  Of course, if the child is treated for ADD, the symptoms may not improve. 

  On the other hand, many kids with ADD don’t get diagnosed until late in their high school careers.  This is most unfortunate, in that by this point they may have a poor GPA, a bad attitude towards school, and very low self-esteem.

  Treatment should not be limited to taking a pill.  Medication can be very helpful, but it is not the only answer, and it certainly isn’t enough alone.  (Incidentally, Ritalin is but one of the medications that are currently used.  There are many others that may work better, and sometimes antidepressants are used as well.)  What we know for sure is that frequent and close monitoring of the medication leads to much better results than if contact with the physician is minimal.  In  regard to the physical aspects of the disorder, there are also some promising results stemming from training the pre-frontal cortex with “neurofeedback.”

  The treatment team should also include a cognitive-behaviorally oriented therapist and often an educational remediation specialist as well.  The therapist can address the behavioral problems, the self-esteem, the self-regulation, while any educational deficits can be addressed by the remediation specialist.  In addition, coordination with the school is essential in creating a learning environment that is conducive to success. 

  ADD can be effectively treated with an interdisciplinary team.  But the first step is to get a reliable, accurate diagnosis, using a full range of tests. 

Marc Wilmes-Reitz, Ph.D. is the Director of Wilmes-Reitz Psychological in Calabasas.  He can be reached at 818.591-8270.

Wilmes-Reitz Psychological

23945 Calabasas Rd., Suite 202

 Calabasas, California  91302

(818) 591-8270






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