Chapter III

     Throughout this book we will be making reference to the DSM IV: The Diagnostic and statistical Manual of Mental Disorders, published by the American Psychiatric Association. This book is the authority and standard by which most American psychiatrists and psychologists diagnose their patients for clinical and insurance payment purposes. It's only short reference to ADD in adults is described under the label: Attention Deficit Disorder: Residual Type.

     So, in plain language, what does having ADD-RT mean? For starters, the DSM IV says you or the person who care about (which is why you are reading this book) must have once met the criteria or set of symptoms for ADHD (Attention Deficit with Hyperactivity Disorder), which probably happened in childhood. It gets better because, as an adult, you no longer have to meet that "hyperactivity" part. Of course, we all do slow down with age. On the bad news side, though, it says that other signs of the disorder have continued to be a problem, namely "attention deficits" and "impulsivity", such as hassles in concentrating, organizing and completing work tasks, getting distracted easily and making impulsive decisions without much thought to their consequences. To top it off, these problems need to hold you back from being your best at your job or family or social responsibilities. That's it. If that sounds like you or someone you care about, you are looking at ADD-RT or AADD, Adult Attention Deficit Disorder.

     Rate yourself or the person who care about with Paul Wender's study of adults who once met the ADHD criteria*: Restless, always doing something (100%); anxious (87%); short-tempered (80%); poor self-esteem (77%); had problems with concentration (73%); were irritable (73%); were impulsive (67%); were unhappy with life in general (67%); were very demanding (60%); had problems seeing other people's viewpoints (47%). Do you or the person you care about fit into these high percentages?

     Now is a good time to get something else straight: Probably everything you read about ADD or ADHD mostly pertained to boys. Indeed, the gene that produces this disorder is mostly expressed in males under the age of 17 years. However, once turned adult, the women's equality movement (deserving as it is in political and career arenas) expresses itself in AADD. Yes, boys' hyperactivity tend to become a concern to those who must manage them (parents, teachers, etc.) and this draws the attention of school officials and other professionals, leading to more ADD diagnoses for males than females. But, as we mentioned, hyperactivity reduces with age and seems to burn out. Result? When professionals evaluate people with problems in focusing on tasks, with being impulsive and moody, males and females come out about equal.

     Interestingly, mature adulthood is also the time when males and females equal in their statistics for developing alcoholism. About 35% of adult alcoholics meet the criteria for AADD**. Children with ADD or ADHD often have had problems in achieving in school. So have children of alcoholics. Is that due to bad genetic loading or the neglect that alcoholic parents have toward their kids? Robert Cloninger*** described a difference between what he calls two types of alcoholism: I and II. Type I defined what is typically understood as alcoholic behavior: Developing symptoms of alcoholism after 25 years of age; more binge drinking; higher tolerance to alcohol intake; more guilt feelings about their drinking; no great tendency for sensation or reward seeking. Type II, however, reflected ADD behavior: Alcohol abuse before 25 years of age; greater incidents of fighting, recklessness, legal problems and hospitalizations; greater tendency toward risk taking, sensation seeking and impulsiveness.

     This leads us right into the consideration of what the DSM IV describes as "Antisocial Personality Disorder". People who fall into this category generally violate the rights of others and used to be termed as "psychopaths", exhibiting behaviors such as the inability to sustain consistent employment, inability to maintain consistent productive parenting, and the incapacity to hold lasting and positive relationships with family or friends. The DSM IV also describes "Histrionic Personality Disorder", affecting mostly females, resulting in behavior characterized by flamboyant dramatics, overreactiveness, and the "wounded princess" syndrome. Even minor events can trigger their emotional excitability and penchant for drawing attention to themselves. They are quick to establish relationships but then easily and readily get demanding and egocentric and become hungry for constant reassurances due to their feelings of helplessness and dependency, resulting in some very stormy and shaky friendships or marriages.

     We flooded you with information and we must help you put it all together into an overall understanding. ADD and ADHD are most often diagnosed in childhood, but children do grow up and, in a sense, so their disorders. Note that we didn't say their disorders go away, although perhaps one-third of them do "burn them out" or "outgrow" them. The remaining 65 - 75% continue to express the genetic loading they inherited in some form. ADD and ADHD isn't about describing a group of troublesome children who present difficult-to-manage behaviors for their parents and teachers. In the majority of individuals, it is a life long problem which often expresses itself in antisocial and addictive behaviors in males and histrionic behaviors, as described above, in females, although the expressed symptoms in both genders become more similar with age.****

What's Happening?

     Let's start with your brain. No doubt you heard how the brain is divided into two halves, from front to back. The cerebral cortex covers the entire brain and is well developed in humans. The part of the cortex that controls your mouth, tongue, muscles of your voice box (larynx) and face is on the left side, so it's that side's job to do the talking, and also the listening. So the left part of your brain winds up being in charge of handling verbal input and output, in figuring things out with language and logic (including mathematics), in making sense of the world. That leaves your right side in charge of nonverbal jobs, such as enjoying and responding to music, creating art and movement such as in dancing, skiing, driving a bike or a car and nonverbal ideas which sometimes feel like intuition.

     Some valuable and interesting demonstrations of the right and left halves or hemispheres have come from studies of people with brain damage by disease or traumas and from surgery where the corpus callosum had been cut. The "corpus callosum" is the connection between the two halves. Some people with damage to the right hemisphere, for example, could not dress themselves while still able to talk perfectly. Those with damage to the left hemisphere might typically lose their ability to add numbers but could still play football or a musical instrument. But most interesting were the results of those whose corpus callosum was severed, leaving no communication between the two halves of their brains. For example, if such a person were to close her eyes, then given a pen to hold with her right hand, she could easily describe it since the right side of the body is controlled by the left hemisphere, along with speech. But switch the pen to her left hand, which is controlled by the right hemisphere, she could not describe it at all or even know what it was.

     The corpus callosum can be considered to be a kind of brain switch, the gatekeeper between the two halves. There are many tasks which require a high degree of cooperation and communication between the two brain hemisphere. Suppose a person is in a store and sees something that he really wants to have. His right brain is already getting his body muscles ready to take it and the eyes are already scanning the area to see who else is around. His left brain is thinking logically, "If I take this and get caught, I'll be in trouble. Besides, it's wrong to steal." The connection between the two halves is strong and the logical, left half communicates to the impulsive right half to cool it and he walks away. Now suppose there is a switching difficulty and the corpus callosum isn't keeping the connection strong. Impulse takes over and the man steals the item. Later, as he walks out the store his left brain hemisphere is talking to him, telling him he is bad for stealing it and he feels guilty but nonetheless his right half keeps his legs moving away.

     Men are considered more impulsive than women and interestingly, ADD, at least in early life, affects more males than females. Also interestingly, females have an anatomically larger, more developed corpus callosum than males. If we postulate that ADD, at least in part, could be a result of a poor connection job by the corpus callosum, then it would help to explain the higher levels of diagnoses in male students. The ADD boy taking a math test is very smart. However, his right brain hemisphere is moving his feet and paying attention to every sound in the room, hallway and outside. The left brain hemisphere doing the math is slowed down by the distractions and he doesn't do well or even doesn't finish the test in time. He then feels frustrated and gets down on himself, confidence lowers, self esteem suffers, all of which makes it even more difficult to perform well on the next test. Life becomes a struggle.

Try Experimenting with Your Brain

     Your eyes, which are directly connected to the brain by the optic nerve, will shift as the brain retrieves information or performs tasks. Think of what a car would look like with twelve tires instead of four. (Right brain imagining.) Generally, your eyes will look up toward the right. With some people, their whole head will turn up to the right. Now think of what a three headed, three tailed dog would look like, but this time force your eyes to look down and to the left. Is that picture harder to imagine? Can you imagine it at all as long as you keep your eyes down and left?

     Now try to remember the color of your first bicycle or the color of your room when you were about 5 years old or so. Chances are your eyes shifted up and left. Try remembering something of the past (left hemisphere logical memory) while keeping your eyes down and to the right. Notice how difficult it is? Most people when thinking of what they are going to say move their eyes straight and to the right. (Right brain creativity.) When trying to remember sounds or songs, the eyes tend, even if it's just a second, to move straight and to the left. (Left brain auditory memory retrieval.)

      If we asked you to tell us how you are feeling (not what you are thinking) right now, your eyes will probably look down and to the right. (Right brain search of non-verbal information.) Now how about when you are talking to yourself? (We all do!) Notice how the eyes tend to gravitate down and to the left? (Left brain verbalization.)

     Now here's how to "short circuit" the corpus callosum's work in connecting the right and left brain hemispheres. Sit in your chair, put your hands on your lap, feet flat on the floor, look straight ahead, don't move anything, not even your eyes. Now, in that position, without moving even your eyes, try to remember what you had for dinner yesterday, or, what you were doing this time a week ago. Bet you had a tough time of it! We trust your picture and understanding of how important a strong connection between the two brain hemispheres are becoming more clear. You can also better appreciate how a problem with this corpus callosum gatekeeper (along with associated neurology and the many neurotransmitters we will discuss later) can lead to the kinds of thinking and behavior seen in AADD.

Educating the Right Hemisphere

     Traditional schooling primarily trains the left hemisphere with its emphasis on logic, analysis and linear thinking. Very few people receiving such education can solve this problem: Connect the nine dots below with only four straight lines without lifting your pencil or pen from the paper. Try it! People in more primitive cultures can solve it almost immediately. (After trying it, check out the solution on the reverse of this page.)

                                        .                     .                     .

                                         .                    .                      .

                                         .                   .                       .

     As long as you keep seeing a square, as you were trained to by modern education, you limit yourself to working the solution within that square. But there is no square! Your left brain hemisphere is hallucinating it, in a sense. Also, there is no triangle or circle on this page. Just dots. Your brain is filling in between them and thus creating a limitation that really is not there. Other cultures might label you "learning disabled"!

     As mentioned, western educational approaches generally train the verbal, intellectual left brain hemisphere which is probably one of the reasons why ADD is rarely recognized or acknowledged except in industrialized nations. ADD symptoms reflect difficulties in left brain functioning and in the connection between the right and left. This is the reason why part of our treatment plan for AADD includes educating the right brain hemisphere, which is largely ignored by western educational systems. The two major ways we have used to learn about the world and ourselves, the scientific/logical and the intuitive/non-linear both need equal attention. "Intuition", the right brain mode, comes from the combination of two Latin words, "in" and "tueri", meaning to "enter inside". In the Zen tradition, "kensho" means the same thing, which is its term for "enlightenment". In Yoga, breathing exercises and doing a routine of postures (called asanas) directly target and address the right hemisphere as do the ritual movements of Tai-Chi of the Chinese. In industrialized societies practices which were once considered "out of the mainstream" are increasingly being accepted and prescribed by mainstream psychology, such as bio-feedback, dream work, meditation, "teaching" stories, art therapy, adventure experiences, all help develop the strength of the right brain hemisphere. Let us look at these more closely and therefore understand why some of these techniques and others are included in our treatment of AADD and how they work so well.

Continued here...

John S. Hilkevich, Ph.D.
www.prayergear.com

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