Attention Deficits
Causes & Cures

 

As early as 1937, stimulants were found to have calming effects on

disruptive behavior. Although this ultimately led to the widespread use of
medications such as Ritalin to treat hyperactivity (ADHD), it did not explain
the paradox of stimulants slowing down children who were constantly in
motion. The advent of brain imaging technologies in the 1980s began to
make sense of the mystery with a surprising discovery.

The frontal cortex (surface) of brains of people with Attention Deficit
Disorder (ADD) and ADHD were found to have more difficulty using glucose
(blood sugar) and to have less blood flow than the frontal region of people
without ADD.

PHYSICAL CLUES LEAD TO CURES

The above finding gives new meaning to other well-known facts.
Thoroughly understanding these helps make sense of treatments for ADD
and strategies that minimize it:

The prefrontal cortex (a) inhibits impulses, (b) initiates behavior, and (c)
controls working memory. Underactivity in the cortex would reduce the
ability to:

• Inhibit movement and screen out irrelevant stimuli, which might be
  thought of as an ability to attend to everything rather than a “lack of
  attention.”

• Regulate the motivation system, causing staying on task to be
  difficult without constant rewards, and explaining why video games
  that provide rapid and constant feedback are very engaging for
  people with ADD.

• Automatically control concentration, causing people to compensate
  by learning to overconcentrate, which makes it difficult to let go of
  enjoyable tasks.

Dopamine and norepinephrine, the body’s natural stimulants, are abundant
in the prefrontal area of the brain. An underactive cortex may (a) be less
able to use these chemical messengers, or (b) have fewer dopamine
neurons that connect the lower brain to prefrontal cortex. It may be a lack of
input from the brain stem that decreases energy in the frontal cortex.
Therefore:

• Constant motion and risk taking may be an attempt to energize the
  brain.

• Stimulants could be an effective treatment because they increase
  levels of dopamine and norepinephrine. Antidepressants, which
  increase the activity of norepinephrine, would give an additional
  boost to a “sluggish” cortex.

Slow brain waves seen in deep sleep (when less energy is being used)
dominate the waking states of people with ADD. As children age, low-
frequency (slow) brain waves decrease and the cortex becomes better
regulated. “Low-energy” brainwaves (measured by EEG) in people with
ADD may be further evidence of decreased blood flow and glucose use in
the cortex. EEG biofeedback training claims to help people eliminate
problems with ADD by increasing higher frequency (alert) brain waves.

Decreased blood flow in the right hemisphere is also detected by brain
imaging in some people with ADD. This side of the brain manages cause-
and-effect relationships, spatial perception, and decision making. An
underactive right hemisphere may cause trouble with seeing the whole
picture, poor spelling, getting lost or losing things, and difficulty adapting to
unexpected situations.

Heredity appears to account for some of the physiological and maturation
differences between people with and without ADD. A particular combination
of genes creating the full syndrome is strongly suggested by statistics. At
least 30% of parents of ADD children have (or had) the disorder
themselves. Only 4% to 6% of the general population has ADD. Fetal
exposure to lead, alcohol, cocaine, or nicotine could also be factors.

TREATMENT FOR ADD

In mild cases, people can learn to manage ADD symptoms by learning
behavioral strategies. However, failing to consider medication for people
who may have an energy shortage in the brain cortex can handicap school
or work performance. Stimulants reduce symptoms in 75% to 80% of people
with correct diagnoses. Although their effects are immediate, it can take
months of trial and error to determine the right dose. Certain
antidepressants help approximately 70% of those who do not respond to
stimulants. Other drugs also help ADD or increase the effectiveness of
medication:

MEDICATION GUIDELINES

• Start with the minimal dose and increase in small increments until
  benefits are seen. Responses vary greatly. Some people need much
  more or less than the usual amount.

• A “rebound effect” of irritability is seen in 30% of people taking
  stimulants as medication wears off. Smaller doses in the afternoon or
  time-release formulas can reduce this.

• Have a trial of both Ritalin and Dexedrine to see which is the more
  effective (10 mg of Ritalin = 5 mg of Dexedrine). Once the correct
  dose is set, time-release forms can be tried.

• Use “drug holidays” for a week every 6 months to find out if
  medication is still needed. Stopping drugs over the summer gives
  children time to catch up on any (rare) growth loss.

• Others may notice improvement in behavior before people with ADD
  do.

• Stop stimulants immediately if tics are noted and try antidepressants.
  Antidepressants are also helpful when moodiness or poor social skills
  accompany ADHD.

References

    
Statistics and information on the physiology of ADD from Driven to
Distraction by Edward Hallowell and John Rately (Simon & Schuster, 1994).

For further information on EEG training, contact EEG Spectrum, 16100
Ventura Boulevard, Suite 10, Encino, CA 91436-2595, www.eegspectrum.
com.