You Mean I'm Not Lazy, Stupid or Crazy?!: The Classic Self-Help Book for Adults With Attention Deficit Disorder (5 page)

Heightened interest and a belief in one’s ultimate success improve the quality of attending. With an inability to maintain focus, many ADDers require intensely stimulating situations to maintain alertness and attentiveness. Without this stimulation, attention wanders, and many of us are told we’re unmotivated.

We’re not unmotivated! Our problems with selective attention compromise our abilities
to stay focused and productive. So it looks as if we don’t care and won’t try! In reality, we have to exert many times the effort of non-ADDers to maintain adequate levels of motivation.

Impulsivity

Impulsivity is a failure to stop and think. Being impulsive means that many of us act and react with astonishing speed and with little thought about the consequences. Our brains don’t control behavior
the way they should, so we say and do things rashly.

When we were children, we might have violated classroom rules, insulted our parents or run into the street without looking. As adults, we might blurt out confidential information or share intimate details with relative strangers. We might pull out from our driveways without checking the rearview mirror or leave work two hours early to enjoy
a beautiful spring day. Controlling impulses is tough for many ADD adults!

Impulsivity plays out in other, less obvious ways. It can affect the quality of work on the job. The ADDer often rushes through tasks with little preplanning and many careless errors. He might get into debt with impulse buying, discard an important document or ruin a new piece of equipment because it takes too long to
read the instructions.

“He knows the rules, but breaks them anyway.”
“His work is careless because he won’t try.”
“He’s wasting his ability.”

These comments reflect a misunderstanding of the impulsive words and actions of ADDers. Most of us
know
the rules. We
know
our work is neater when we work slowly. We
know
we are capable of more accurate work. Knowing these things, however, doesn’t mean we can easily control the impulsive behaviors. People who make faulty assumptions about us don’t understand the enormous effort we expend keeping
our impulses in check.

Hyperactivity

Hyperactivity is probably the first symptom people think of when they talk about ADD. They might immediately conjure up an image of an overactive child bouncing off the walls and hanging from the light fixtures! Without question, this random, excessive activity can be a primary symptom of ADD. But it describes only one part of a larger activity dysregulation
that includes a wide range of behaviors.

Rather than moving too much, some ADDers talk too much! Barely pausing for breath, they talk so much and so fast that no one else has a chance to say anything. The speech has a driven quality to it as if the words have been bottled up for centuries and are desperate to get out!

PR:
“At a recent conference, I congratulated myself for sticking to my schedule.
Just in time for our break, I shared some information about my own symptoms. I commented that, unlike my son, I wasn’t particularly hyperactive.

“A member of my audience stopped me at the coffeepot and shared her observations of my presentation style. She said, ‘You might not be hyperactive, but do you know how fast you talk? I have attended lots of workshops, but have
never
learned the quantity
of information I just learned! And one more thing. Do you know how many times you took the top of your pen off and put it back on again?’ At the end of the workshop, she thanked me profusely for the wealth of material I
had shared, so I guess I didn’t overwhelm her too much with my nonhyperactivity!”

This anecdote has two messages. First, we can never stop learning about our behavior, even when
we think we have a good handle on it. Second, it points out that hyperactivity can manifest itself in more subtle ways than physical overactivity.

These subtle behaviors reflect the generalized restlessness and impatience many of us experience. We may have learned to stop sky diving from the top bunk and snowboarding down the banister, but we might still feel uncomfortable when we have to sit
still. So we fidget, tap our fingers or twirl our hair. Relaxing can be impossible, so we might take on numerous hobbies, work second jobs or run marathons on the weekend.

There is a final thing we should mention. Hyperactivity can be either a deficit or an asset, depending on the quality of the behavior. If the activity is purposeful, hyperactivity can help us get more accomplished.

Some researchers
have studied hyperactive individuals who don’t have any of the other symptoms of ADD. These folk are extremely active but don’t seem to have problems with attention, mood swings or any of the other roadblocks that interfere with productivity. The issue for hyperactive ADD adults is that much of their activity is dysregulated, random and unproductive.

But … Why??

ADDers are curious folk. They
are rarely able to let anything go by without asking, “But why?” You may be asking this question about your symptoms. “I am inattentive, impulsive and hyperactive—
but why
do I have this baffling disorder?” If we could give you a tidy answer to your question, researchers would herald our discovery. Since no one knows for sure what causes ADD, the best we can do is examine possibilities.

To get
started, you’ll need a crash course in the Neurology of the Brain and the Central Nervous System. Don’t close the book yet! We promise to make this as painless as possible. But it’s difficult to understand ADD without knowing some of the “whys” of the disorder. Why is your ADD different from each of ours? Why do your symptoms seem to change so much? Why do your symptoms sometimes cause little or
no problem? Without some basic knowledge, it’s easy to assume that this disorder is your fault. So, here goes.

Research Tools

As knowledge about ADD has grown, research has increasingly focused on the possibility that the ADD brain and central nervous system are somehow
wired
differently. Testing some of the theories is tricky because researchers can’t open up an ADDer’s skull to study his brain!
Even if they could, it would be nearly impossible to isolate and examine a particular chemical or a specific portion of the brain. The human brain is simply too complex, with many interrelated parts.

Instead, scientists are using sophisticated imaging devices to scan the brain.
Brain Imaging
is a promising technique that has provided some information about the differences in ADD brains. MRIs
produce clear and detailed pictures of brain structures, while PET scans allow us to observe blood flow or metabolism in any part of the brain when a person is active. The SPECT scan is similar to the PET scan except that the SPECT scan generates images of a person at rest. Generally, these imaging methods are not used as diagnostic tools, although Dr. Daniel Amen has done pioneering work using SPECT
in his clinical practice.

Scientists also use drug responses to study brain activity indirectly. They know that certain drugs increase the quantity of neurotransmitters in the brain. A positive drug response suggests an insufficiency of the neurochemical affected by the particular drug.

How does this fit into the theories about the possible causes of ADD? Let’s take that crash course in neurology
to get a better understanding of the “why’s” of your disorder.

The Basics of Neurology

The brain and other parts of the central nervous system (CNS) function as a wonderful and intricate Command Center. This command center coordinates all systems of the human body through a messenger system. It sends messages and receives those sent from various parts of the body and from the outside world. It
also regulates and controls behavior.

The messenger system of the CNS consists of millions of nerve cells. These are cell bodies with long, thin projections called
axons
and
dendrites
. Impulses are carried along the length of a nerve cell and jump from one cell to another in much the same way electricity travels through a wire.

“The Brain’s Postal System”

Messages are first received by receptors in the nerve cell’s dendrite. The message, in the form of an electrical impulse, travels from the dendrite through the cell body and the axon. At the end of the axon is a synapse, a gap between the nerve cells. The electrical impulse, or message, is conducted across the synapse by chemical messengers called
neurotransmitters
. These chemicals carry the message across the gap from one cell’s axon to another’s dendrite.

You might be familiar with some of these neurotransmitters.
Endorphins
are the pain-relieving neurotransmitters that act as the body’s own morphine. An outpouring of endorphins during vigorous exercise causes the marathon runner’s “high.” This increase protects his body from feeling the pain of stressed
muscles and joints—an athlete is often unaware of an injury until he rests.
Epinephrine
, better known as adrenaline, is the neurotransmitter that mobilizes the reaction to danger. This activates the
fight-or-flight
response. The heart beats rapidly and the breathing passages become wider so one can either run or fight an enemy.

That wasn’t too bad, was it? Now let’s use this information as we
consider some theories that have emerged from research.

Current Theories About the Key Players in ADD

Since the command center is so complex, it isn’t surprising that there are conflicting theories about the causes of ADD. Although there isn’t consensus, many researchers agree that this interrelated system is dysregulated in some fashion. The following discussion examines some of the theories
about this dysregulation as well as an assortment of other proposed theories.

Neurotransmitters

Researchers have used indirect drug response research to conclude that an insufficient supply of the neurotransmitter
dopamine
plays an important role in ADD. It is known that the
stimulant drugs used to treat ADD increase dopamine levels. Of course, any problem in the brain is far too complex to
be the result of a single neurotransmitter malfunction. At the very least, the interaction of multiple neurotransmitters is suspected, with the most likely culprits being dopamine,
norepinephrine
and
serotonin
.

Brain Structures

Using an MRI to scan the brains of children with ADD, researchers found that four brain regions were smaller than those in children without ADD—the
frontal lobes
, the
corpus callosum
, the
basal ganglia
and the cerebellar
vermis
. When we look at the functions of these brain parts, it makes sense that they may play a role in the symptoms of ADD. The frontal lobes are critical to many of the brain’s executive functions, including planning, initiative and the ability to regulate behavior. We also know that actual frontal lobe brain damage causes impulsivity, mood
swings, disinhibited behavior and sometimes hyperactivity.