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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
wrpsych@aol.com
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