Dyslexia

As an educator for over thirty five years, I have taken special notice of the number of children who are labeled “learning disabled” “dyslexic” or are placed in “special education classes”. In most cases the problem is an inability to read.

Professionals tell the parents that a brain abnormality “dyslexia” is the cause of their child’s reading inability.

Dyslexia is a fancy word, that comes from the Greek dys, meaning ill or bad, and lexia, meaning words. It is a term that is used in the United States to describe at least eight percent of school age children.

Dyslexia, say the experts is a problem in the language arts part of the brain that comes to a parent s attention when the child fails to gain literacy in the early grades. What parents are not told is that in over sixty years of research nothing has been able to confirm that a defect of any sort exists in the brain of a child who has been labeled as dyslexic.

Isn t dyslexia a scientific term?

There are no well-defined reading behaviors that can clearly distinguish a dyslexic from other poor readers whose difficulties stem from limitations in experience or developmental delays. There are no distinguishing clinical patterns to determine a dyslexic person.

In 1989 the Council of Scientific Affairs of the American Medical Association concluded that “consensus has yet to be reached on a practical operational definition of the disorder and, while an organic etiology is often presumed, clear identification has not yet been made”.

Instead of screening and identifying dyslexia in pre-school and kindergarten and early elementary school children we should examine how these children are taught. Example schools such as the San Diego Unified School District showed an alarming drop in their reading scores. Why? During this period they changed reading methods- phonics was replaced by the whole language reading program. In 1990 51% of the students in San Diego scored above the national median. In 1991 only 25% did. Did an epidemic of dyslexia hit San Diego between 1990 and 1991?

To label someone as dyslexic is convenient. Labeling absolves everyone from any responsibility. The person/victim is blamed not the methodology or lack thereof.

Psychology

Psychiatry and Special Education to the Rescue???

Special education has grown from serving about 2% of the population of children to now serving over 20%. Is this labeling improving our reading or academic scores-no. Why not? Because the focus has been and is on labeling and trying to blame the victim rather than on the problem-curriculum and doing something about it.

You should know that this “disease” dyslexia has never been confirmed and that no test of proven validity to verify it exists is available.

We should demand that all practices and labels which cannot be scientifically validated be stopped.

It is time we look at the real culprits of the cause/etiology of “dyslexia” and that is improper curriculum for teaching many children and lack of knowledge in knowing what readiness activities need to be taught to prepare many of our children to learn how to read. Also improper methods of teaching are contributing to this misdiagnosis.

We need to focus on training parents and teachers how to teach their children and what to use to teach them so they can be successful.

Every child deserves the right to be able to learn how to read!!! They can learn- maybe not all to college or graduate level but they can learn to read. In over thirty years I have not seen one individual with an IQ over 25 that has not been able to read. Is Psychology A Science?

No psychology is not a science. To qualify as a science there must be the possibility of not only refuting theories but also predicting future events. You must be able to reproduce results obtained and control what is observed.

The cause and effect relationship so evident in the physical sciences is largely not found in the “social sciences”. Instead of statistically significant cause-effect relationships the social science relies on covariation/ that is events or relationships which appear together but are not necessarily related.

No one is able to cite even one true expert, that is a philosopher of science, a distinguished professor or Nobel Laureate who will state and write that psychology is a pure science.

If psychology is not a science what is it?

Psychology studies behaviors, attitudes, morals and values. What is that? That is not a scientific study. It is the study of religion. In the case of psychology it is the study of secular humanism.

Psychology is founded on eight false premises that are all humanistic from the core.

I will be writing on this in the next issue.

The faith, the solutions once delivered to the Saints is being displaced today by a substitute faith disguising itself as psychology, Christian psychology, psychiatry but is based upon the above foundations which are in direct contradiction to the holy Bible.

We as Christians sit idle and do nothing while the church is being destroyed from within. The prophets have warned us of this.

The Annotated Symptoms of ADD/ADHD

A Typical ADD person . . . . .

1. The ADDer is unable to get organized.

For a child, this might mean that he cannot find his pencil, or his homework or his coat or anything else that is not attached to his little body. In fact, sometimes even having the object attached to his body is not enough! In adults, there are complications that are more serious. We can’t find the checkbook. We lose cash and credit cards.

If ever lost, the ADDer is easily tracked by the trail of clutter left in his wake. Offices are “organized” not by files, but in piles. In short, the chaos of ADD thinking and thought processes is made manifest in the physical environment.

The converse side of this disorganization is that ADDers tend to be pack rats. Having often been in the position of needing something but being unable to find it, they may reach a point of never throwing anything away because “you never know when you might just need that.” Of course, it could be argued that putting something into a trash can is in itself an act of organization, which further explains this pack rat phenomenon. This contributes to the clutter and makes organization even more impossible.

2. The ADDer is easily distracted.

An ADDer may enter the kitchen with the intention of making a sandwich. As he walks to the stove, he sees a bottle of Pepsi on the counter and decides to have a drink. As he is pouring, he sees the morning paper and starts to read. Maybe he spies an open bag of chips to munch on. He then carries the drink, chips, and paper to the table to read but can’t sit down because there is unfolded laundry in the chair (how did that get there!). He then begins folding laundry, but first calls a friend to talk to while doing this arduous chore. After dialing, he notices that the dishes in the dishwasher are clean, so he begins to unload the dishwasher.

You can substitute money for time and get the general idea of what happens when an ADDer has to make a financial decision. Such is the life of an ADDer. In conversation, such easy distractability is misconstrued as inattentive, or worse. The wife of an ADDer may be pouring out her heart about what a bad day she had at work, only to hear a response of “Did you know you have a stain on that shirt?” The wounded spouse then accuses the ADDer of not listening. So the ADDer repeats back everything that she said just to prove that he, in fact, was listening, and “listening has nothing to do with the fact that you still have a stain on that shirt, and by the way, what should we have for dinner?” So she accuses him of not caring about her day… You get the picture.

3. The life of an ADDer may be marked by chronic under achievement.

It is not unusual to find ADDers with measured IQs of 120, 130 or even higher still working for minimum wage at entry level jobs even into their 40’s or older. This would be all right, if they indeed found satisfaction in these positions, but after several years of being paid and treated like a teenager, it can get frustrating. They watch as their friends advance, get promotions, move into nicer homes and more adult-like lifestyles, and they stay behind. These employment frustrations often spill over as marital and family difficulties as well. The ADDer may be under-employed because he lacks the organizational skills to advance. However, in many situations, the ADDer has chosen underemployment as a way of avoiding yet another failure. The old adage “nothing ventured, nothing gained” becomes “nothing ventured, nothing lost” in the mind of an ADDer. He had his share of failure all through school and does not care to repeat the experience. Regardless of his intelligence, talent, or ability, the ADDer often does not trust himself to be able to advance. His potential is limited by his perception.

4. The ADDer has difficulty prioritizing his time, attention and resources.

In the real world, we cannot always depend on someone else to help us decide what is important and what is not. Face it; we wouldn’t want to be around such a person. In the mind of the ADDer, all things are just about equal. Someone coughing during a concert receives just as much attention as the music you paid to hear.

5. The ADDer will often have several projects going at once.

It is also just as possible that these activities are exactly what they appear to be- totally unrelated whims of a stimulus- seeking ADDer. My grandfather used to say, “If you want something done, get a busy man to do it.” This holds true for many ADDers. They tend to work best when there is a lot going on, provided they do not overload and max out. By having several projects going at once, the ADDer is making the most of his tendency to be easily distracted. The fast paced, packed schedule of this type of individual allows him to spend a little time with each task– not enough to get bored with any one operation. To the casual observer, it may seem that the overall productivity of the ADDer would rise if he would learn to do only one thing at a time. However, this type of highly motivated ADDer actually does perform best when he is going from task to task. By “stacking” his work in such a way that when one thing is finished there are five more to take its place, the ADDer is able to avoid some of his “completion anxiety.”

6. The ADDer has trouble with follow through and completion of tasks.

This is closely related to #5 above. With so many projects going at once, the ADDer has trouble giving adequate time and attention to any one of them. He is also likely to get distracted at any time and never get back to the original purpose of what he was working on.

Boredom is intolerable to the majority of ADDers. In fact, ADDers seldom experience boredom because their attention naturally is diverted away towards some new area. This is especially frustrating when the ADDer truly wants to complete a task, but finds his mind drifting away on tangents or being distracted by any number of competing stimuli, such as extraneous sound, or even something as seemingly insignificant as the way his shirt feels against his skin.

Remember that sometimes, either consciously or on an unconscious level, an ADDer does not want the project to be over and will avoid completion. These ADDers love the process more than the product. Having a goal gives us focus, a truly holy grail that the ADDer is constantly in search of. Reaching the goal means that focus is gone. For these individuals, the joy is not in the destination, but in the journey. Having accomplished what he set out to do, the goal itself becomes anti climatic, an unfortunate side effect of the true purpose, the journey. Again, I refer you to the story of my friend’s patent above.

This trait of avoiding completion does not mean that the ADDer cannot make significant contributions to large projects. You can make this work to your advantage. One ADDer I know loves to write but is no good at rewriting or editing his work. He also tends to avoid completing reports and really has no concept of deadlines. (I also firmly believe that no work is complete until the writer is dead.) However, his written communication skills are excellent.

His supervisor recognizes his ability to write. She also recognizes his weaknesses in organization and deadlines. A smart woman, this supervisor makes the most use of the ADDers talents without risking important deadlines. How? She makes the reports an immediate priority, often giving next day deadlines when practical and never more than a few days notice at best. These deadlines are always far enough in advance of HER deadline that she has time to make her own commitments. This capitalizes on the ADDers tendency to work best under pressure. She tells the ADDer that she wants everything that he can write about the subject at hand, and provides outlines or guides if possible or if the document needs to be in a specific format. She makes the ADDer feel as though what he is doing is important and that it is important that he does it. In this case, it is true. This ADDer is a good writer. After receiving the report from the ADDer, she edits and finishes the document.

Some of the more rigid among us might balk at this, saying that it is ridiculous for someone to have to complete the “homework” of a grown man. However, his supervisor does not feel that way. She would rather be able to assign this work to him, with the knowledge that she will have to edit and finish it, than have to write the entire report by herself. She also recognizes that this ADDer is a stronger and more effective written communicator than she. For the supervisor, it is just a good means of maximizing efficiency. Its just good business.

More typically, however, the scenario is like this: Sue, an adult ADDer who sings with the worship team in her church, wants to have a more active role in the music ministry. The pastor is sensitive to this, so he asks her to pick out the songs for next Sunday’s worship service, a small responsibility, but one that Sue feels is important. In fact, she feels honored. On Friday, the church secretary calls to see if Sue has the list yet, which of course she does not. Sue promises to have the list in time. She also volunteers to do the list herself on her home computer so the secretary will not have to type it up. (This particular church uses song sheet handouts that are typed up for each week.) By Saturday evening, Sue has it ready. She calls the secretary to tell her that the list is done, only to be told that the pastor had given up on her and did it himself. Sue feels that she missed her opportunity to contribute. To make matters worse, when she offers to give the list to the pastor on Sunday so it could be used next week, she is told that it will be someone else’s turn next week. Sue feels guilty and ashamed. The pastor gives a yet another lecture on responsibility. Unfortunately, there is no one to give the pastor a lecture on love, compassion, or patience.

7. ADDers tend to engage in high risk activities more often and with less concern than their non-ADD friends.

They tend to drive too fast, to push the limits too far and too often. They seem to seek out the thrill of a near-death experience. Or perhaps its because they don’t stop to consider all of the risks involved. In any case, this can be one of the most life threatening aspects of having ADD. They tend to be gamblers, both in the game room and in life.

High risk equals high stimulation, and high stim equals (you guessed it) high focus. Driving their car 90 mph is a focused experience. There may even be biological reasons for these dangerous activities, as chemicals produced by the brain flood through them in times of such high stimulation.

Sadly, these high risk behaviors often include substance abuse. ADDers tend to have more problems with addictive behaviors than most. Some of these addictions are crude attempts at self-medication, with the goal not of ADD management, but simply to take away the pain of failure and frustration. Some are simply thrill seeking experiments gone bad.

8. Just like kids, ADDers will “say the darndest things

(Thank you, Art Linkletter. ) Impulsivity, which defeats the inhibitions of squirming and other classic hyperactive behaviors, defeats the inhibitions that govern speech as well.

The ADDer is likely to say anything that comes to mind. This can be very interesting, extremely funny, and also very embarrassing. I really like the music of Billy Joel. (Hey, I am allowed to have a few vices.) One Sunday after church, my wife and I were walking into the restaurant for lunch, and the background music was of a Billy Joel song, “Shameless.” Great tune. Then the vocal came on, and it was some country-western singer (somebody named Garth something) doing a remake. I literally said aloud, apparently too out loud, “UGIIH! What HAVE THEY DONE TO THIS TUNE?!” This embarrassed her, made people look at me, further cemented the notion that I somehow do not respect the local culture (which apparently holds this Garth person in high esteem), and apparently had all kinds of far reaching implications. As I recall, the earth actually reversed its rotation momentarily. If you want an honest opinion, just ask an ADDer! While this is a funny example, this blurting out can be a real problem. The ADDer may reveal things about himself that he later wishes he had not. He may voice opinions that may offend others.

9. The ADD person is not very punctual. He is either consistently late or early–very early.

The entire concept of time is a priority system. Most people can mentally arrange events in terms of past, present, and future. All of us can experience time travel, of a sort. By recalling an event, we can experience the sights, sounds, and other sensations of a fondly remembered summer evening. It is cliche, but true: God gave us memory so we can smell roses in December.

Most folks can anticipate expected events and can gauge how far into the future these events will occur by using a clock or a calendar. Such prioritizing is precisely what the ADD brain is not designed to do. As Dr. Ed Hallowell said, “Time parcels moments out into separate bits so that we can do one thing at a time. In ADD, this does not happen. Time becomes a black hole. To the person who has ADD, it feels as if everything is happening all at once.” (Hallowell, Newsletter of the Concord Special Education Parent Advisory Council, 1993, Concord, MA)

Hallowell’s “black hole” of time has much farther reaching implications than simply arriving late for work. Planning involves estimating how long it is until something happens, having some kind of “feel” of how long an hour or a week is. While the average person hears a countdown as “10, 9, 8, 7, etc., the ADDer might as well hear “10, 9. 100, 4, 3, 16, 0 Blastoff!” The ADDer simply does not have the ability to accurately judge distances where time is concerned. He has a poorer short term memory than most people, which can make recent memories “feel” like memories of long ago, and vice versa. Without a dependable feel for the past, he has no dependable yardstick with which to gauge the future. He may try to guess, but since guessing again involves memory, he may not be very accurate. He even has trouble estimating how much time has passed during an activity, especially in hyper focus. So, on the first day of a new job, the ADDer is likely to show up literally one hour early for work. This really impresses the boss. Of course, on the next day, when he is running through the door ten minutes late, the boss is not so impressed.

10. ADDers behave as if the rules don’t apply to them.

This one seems to really get to non-ADDers the most. It is not so much that the rules do not apply, as they just are not remembered. If they are remembered at all, they aren’t internalized very well. Often, because of blinking or other processing problems, the ADDer may not be completely aware of the rules. At other times, procrastination causes him to miss deadlines. Because of the unique ADD perception of time, deadlines that others see coming from a distance may hit the ADDer head on without much advance warning. His search for novel ways of doing things may cause him to circumvent standard procedures.

In other cases, the ADDer may simply be complying with his own “script” for his life. The script for the ADDer has him in the role of the “absent minded professor”, and calls for him to be unorganized, chronically late, and forgetful. This is the role which he has performed all of his life, and he has received much attention and reinforcement (both positive and negative) for it. Thus, he has become typecast in his own mind.

11. ADDers may seem extremely insecure.

The ADDer often puts less faith in himself than do those around him. Because of his low self-esteem, he is usually genuinely surprised to discover how much influence he has in the opinions and even lives of others. He may not understand why someone would love him, and is therefore doubtful that they really do. He doubts that many ideas he may have could be useful.

You hear ADDers say, “I don’t know” a lot when asked how something happened or why they did something. Often they really don’t know. It seemed like a good idea at the time… This lack of a cause and effect relationship between effort and reward, behavior and punishment, and other inconsistencies casts a pall of doubt over the decision making process. Because his judgment has gotten him in trouble so many times, he probably does not trust it himself.

12. ADDers are usually creative, talented and intelligent.

list of confirmed and suspected ADDers reads like a “Who’s Who” of creative geniuses: Walt Disney, Albert Einstein, Beethoven, Alexander Bell and many more. In the same seminar cited above, Dr. Hallowell makes the following observation about ADD children. It holds true for adults as well.

They have a feel for things, a way of seeing right to the heart of matters while others have to reason their way along methodically. This is the child who can’t explain

how he thought of the solution, or where the idea for the story came from, or why suddenly he produced a painting, or how he knew the short cut to an answer, but all he can say is, he just knew it, he could feel it…. Where most of us are blind, they can, if not see the light, at least feel the light, and they can produce answers apparently out of the dark.” (Hallowell, quoted in the Newsletter of the Concord Special Education Parent Advisory Council, Concord, MA)

One stereotypical image of the ADDer is the “genius” that “just doesn’t have any “common sense”. This is neither a true nor a fair portrayal. He does have “common sense. He is simply distracted and unable to apply it. I watched one day as a student played an incredible rendition of Beethoven’s Moonlight Sonata. His classmates were spellbound. As Bill was playing, and as everyone was standing there entranced, he became so engrossed in his playing that he didn’t realized he was drooling until his hands became wet. Of course, those watching quickly forgoe his musical genius.

Between 50% and 80% of ADDers are estimated to have some kind of learning disability along with their ADD. (Dr. Larry Silver, cited in Adult ADD, Whiteman & Novotni, Pinon. 1995. p207) While some would consider ADD with a leaning disability to be redundant, it really is not. ADD IS NOT a learning disorder, although it can make learning more difficult for those who have it. Learning disorders, such as dyslexia, perceptual handicaps or processing problems all interfere with the brains ability to receive and process information. ADD, in contrast, has a greater effect on information that is already in the brain. Reception is not a problem, unless there is a coexisting learning disorder. Because of the often narrow ways we as a culture measure intelligence, such as performance on standardized tests, these students may be perceived as less intelligent than they actually are. Sadly, many of them will perform only up to these perceptions. One other comment on this: Our schools are not set up to encourage or reward creativity. In fact, the school often discourages such creativity, both by peer pressure and by curriculum. I can remember feeling so odd in elementary school when artwork was displayed. The other Easter eggs would all be such pretty pastel colors, like something right off the Pezz package itself. Mine had polka dots, Or plaid. Other projects had similar differences. Now, I try to encourage those kinds of things in my own students. I have to work to not make the “normal” kids feel weird.

13. The ADDer exhibits mood swings.

As a result of emotional flooding and other factors, the mood changes in an ADDer are more intense and happen much more quickly. The ADDer blows up, often for no apparent reason to those around him. He can just as quickly become excited and elated about something that pleases him, again, often for no apparent reason to those around him.

14. One of the few consistent things about the ADDer is his inconsistency.

Many ADD children suffer because they appear to have a rather selective attention span. They are unable to focus on the lesson about frogs, but will really “tune in” to the lesson on minerals. This infuriates teachers, because it shows “just what that kid can do when he wants to.” Adults are really not that much different. We can really let many things slide, and then do something truly amazing if we are interested in it. We are told we have a lack of self discipline; we are just being lazy, and all sorts of wonderfully edifying things.

Actually, we could do that well at all things. The teacher was only partially incorrect in her assessment about what “that kid” could do. It’s not a matter of wanting to; it’s a matter of being able to stay focused. When we are presented with a task that we find interesting, we are able to maintain focus longer because we can lock on. On the other hand, chores which are not inherently inspiring do not lock our rapid-fire neurology goes back into random access mode, scanning for something new to focus on. Non-ADDers do not realize that this inconsistency frustrates the ADDer as well. There are few things more frustrating than wanting to complete a task, or wanting to listen to what someone has to say, and having to fight your way through all this other stuff to do it. It feels as though their mind is about to split; one part will try to maintain what focus it can, and the other part scurries off to scan the horizons.

The child who cannot sit still long enough to do his math homework yet can watch TV for hours at a time is misleading.

The search for a biological basis is the heart of the debate on whether or not ADD is a legitimate diagnosis. The problem has been that until recently, results have been inconclusive and in some cases contradictory.

Research by Zametkin, who pioneered the use of PET imaging in ADD patients, seems to indicate that the ADD brain has a strong right brain predominance.

Brain scan images produced by positron emission tomography (PET) (see image below) show differences between the brain of an adult with Attention deficit Hyperactivity Disorder (right) and an adult who is not ADD (left).

These scans showed promise in the search for a biological marker for ADHD. However, Zametkin reported in another study on Brain metabolism in teenagers with affention-deficit hyperactivity disorder that similar scans did not statistically differentiate between normal adolescents and those with ADHD. Zametkin was unable to replicate the previous results.

More research into the biology of ADD, using magnetic resonance imaging (MRI), scans which revealed left-sided brain differences in ADHD and other abnormalities in the ADD brain.

A paper presented at the NIH ADHD Conference titled “Biological Bases of Attention Deficit Hyperactivity Disorder. Neuroanatomy, Genetics, and Pathophysiology” (presented by James Swanson, Ph.D., and F. Xavier Castellanos, M.D.) cites reduced size in specific neuroanatomical regions of the frontal lobes and basal ganglia in the brains of ADHD subjects. They conclude their presentation by saying that “Overall, the recent investigations in these areas have provided considerable evidence of multiple biological bases of ADHD/HKD.”

Even more recently, in a paper made public on November 23, 1998, researchers at Stanford using Functional MRJ (fMRJ) on ADD children reported to have found a biological marker for ADHD specifically in the response of the brain to being medicated with Ritalin, With ADD brains responding differently to Ritalin medication than the brains of Non-ADD control groups.

Finally, genetic evidence of the disorder indicates a strong possibility of ADD being a hereditary condition.

What Are the Symptoms of ADD?

Symptoms must have persisted for at least 6 months. Some of these symptoms need to have been present as a child, at 7 years old or younger. The symptoms also must exist in at least two separate settings (for example, at school and at home). The symptoms should be creating significant impairment in social, academic or occupational functioning or relationships. Also, the individual must not be suffering from any condition or mental disorder that could explain the symptoms.

Symptoms of Inattention

Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.

Often has difficulty sustaining attention in tasks or play activities.

Often does not seem to listen when spoken to directly.

Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).

Often has difficulty organizing tasks and activities.

Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework).

Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools).

Is often easily distracted by extraneous stimuli.

Is often forgetful in daily activities.

Symptoms of Hyperactivity

Often fidgets with hands or feet or squirms in seat.

Often leaves seat in classroom or in other situations in which remaining seated is expected.

Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults may be limited to subjective feelings of restlessness).

Often has difficulty playing or engaging in leisure activities quietly.

Is often “on the go” or often acts as if “driven by a motor.

Often talks excessively.

Symptoms of Impulsivity

Often blurts out answers before questions have been completed.

Often has difficulty awaiting turn.

Often interrupts or intrudes on others (e.g., buffs into conversations or games).

While these symptom lists are the official symptoms as listed in DSM-LV, there are also other lists that describe these behaviors in various terms.

What’s in a Name?

Is it ADD or ADHD?

In a recent issue of Attention Magazine, CHADD says that from now on they will be using the name AD/HD when discussing Attention Deficit Hyperactivity Disorder. They state that since this is the official name, and they are the “largest organization for people with AD/HD” they feel that they should use the correct name.

One “Disorder”, Many Names

“AD/HD” is only the latest of several name changes over the years. The problem with labels is that they are a better reflection of the level of knowledge at a given time than they are a reflection of what is actually going on. In 1902, these children were said to have a “Lack of Moral Control”; by the 1960’s, they were “Minimally Brain Damaged”. We now know that neither term is fully accurate.

What is AD/HD?

The Official Diagnostic Criteria for AD/HD divides symptoms into two groups: symptoms of inattention and symptoms of hyperactivity/impulsivity. However, AD/HD has “unofficially” been divided into several subtypes by various doctors and researchers. The most common practice is to separate Attention Deficit Hyperactivity Disorder from ADD/WO, or Attention Deficit Without Hyperactivity, also called “ADD, primarily inattentive type”. These patients have trouble with focus and inattention, but lack the hyperactivity. An online test by Dr. Daniel Amen divides ADD into Six Subtypes.

These categories include:

1. Classic (DSM-IV) combined type, in which both inattention and hyperactivity are present;

2. Classic (DSM-IV) predominantly hyperactive type – meet requirements for hyperactivity but shows LESS THAN SIX examples of inattention;

3. Classic (DSM-IV) primarily inattentive type, or ADD/WO;

4. Overfocused type, in which the patient “brainlocks” onto specific tasks at the expense of everything else;

5. Depressive subtype, which combines ADD and Depression;

5. Explosive subtype (10-15% of ADD people) including violent acts up to and including homicide.

Three Fingers and a Thumb?

Ever notice that Mickey Mouse is always drawn with only three fingers and a thumb?

In practice, AD/HD and all of its subtypes been lumped together under the umbrella term of “ADD” (pronounced: “A – D – D”). This has happened for several reasons, not the least of which is that people who write about ADD tend to get tired of having to type that stupid /H all the time. But perhaps the more compelling reason is that regardless of hyperactivity, the basic problems are the same – an inability to sustain focus on a required task.

For those of us who live with it. ADD has also come to mean a number of other things as well. There are a lot more “symptoms” common to ADD people than the DSM-IV would state.

To me, it makes sense to use the umbrella term “ADD” until something better comes along. Everybody should be able to name their “disorder”.

A Brief History of ADD

The first doctor to do research about Attention Deficit never actually knew the disorder by that name. George Fredrick Still described the syndrome in a series of lectures to the Royal College of Physicians in 1902. In these 20 lecture, Still spoke of children who were aggressive, defiant, resistant to discipline, excessively emotional or “passionate”. Showing little “inhibitory volition”, lawless, spiteful, cruel, dishonest, impaired in attention, overactive, prone to accidents, and a greater threat to other children due to aggressiveness. According to Still, these children displayed a major, chronic “defect in moral control”.

Also, in what appears to be an almost prophetic foreshadowing of the work of Dr. Russell Barkley, Still speculated that the children had a decreased threshold for inhibition of response to stimuli. In keeping with the prevailing mindset of the time, Still labeled his patients as having a “Defect of Moral Control“, although he did recognize a hereditary link in the disorder. This idea that behavior could have an organic cause rather than simply being a result of “bad parenting” was a radical concept in the early 20th century. The fact that these findings were published in the British medical journal Lancet did give some credibility to this new theory.

One ocean away and a little more than a decade later, American doctors were discussing children who had problems similar to those described by Still. The one thing that many of these children had in common, other than their ADD type symptoms, was that they were survivors of the encephalitis epidemic in 1917- 1918.

Interestingly enough, this is the same encephalitis epidemic which was the setting for the movie Awakenings with Robin Williams and Robert DeNiro.

Numerous papers describe children with “post encephalitic behavior disorder” as impaired in attention, regulation of activity, and impulse control. Like Still’s patients, these children were also socially disruptive and many had memory problems.

This connection between encephalitis and a “Defect of Moral Control” further verified that not all behavior was an act of the will. However, it also brought about a rationale for ADD that went something like this: “The Encephalitis outbreak left these children with brain damage; because other children who had not been exposed to the outbreak also exhibited some of the same symptoms, they too must have been brain damaged in some way as well.” The term Brain Damaged was used to describe some of these children.

In a move towards a “kinder, gentler diagnosis”, and the recognition that many of these children, although quite different from their peers, were still too bright to have been brain damaged to any great extent, the term “Minimal Brain Damage” became popular. This diagnosis became so popular that it was assumed that even if there was no obvious brain damage, or at least none that could be measured by objective medical testing, it was thought that the child must STILL be brain damaged anyway.

Another problem was that this label was too broad to be effective. For example, children who today would be described as learning disabled, developmentally delayed, ODD or ADD were all grouped under one heading, MBD.

Another important event in the era of MBD was the discovery in 1937 that amphetamines (stimulant medication- also keep in mind that Ritalin is a stimulant medication) reduced disruptive behavior in many of these children- specifically in those who were hyperactive and/or impulsive.

Hyperactivity was first described by Laufer and Denhoff (1957) and Stella Chess (1960). This description came to be generally accepted by the psychological community as the correct name for the disorder. The category of Hyperkinetic Reaction of Childhood was used in the Diagnostic and Statistical Manual of Mental Disorders (2nd ed.) (DSMII; American Psychiatric Association [APA], 1968).

While this new term certainly had validity for those who had symptoms of what would later be called ADHD, it still seemed to ignore the fact that many children exhibited attention deficits without any signs of hyperactivity. It was still apparent that more research was needed even on something as seemingly simple as what to call these behaviors.

By the 70’s, over 2,000 studies were published on hyperactivity. The defining features were over activity, inpulsivity, short attention span, low frustration tolerance, distractability, and aggressiveness. Overactivity was thought to be the primary feature. It was commonly believed that these symptoms would disappear by puberty.

Although Chess and other researchers kept pointing to biology rather than environment as the cause of these symptoms, others were not so sure. The Feingold~ Association was the most prominent of several groups who began to look at environmental toxins as a cause of Hyperactivity and other learning and behavior disorders.

In 1965 Dr. Ben F. Feingold began his observations of the link between certain foods and additives and their effect on some individuals’ behavior and ability to learn. It was not until June, 1973, that he presented his findings to the American Medical Association. Although these theories developed a significant popular following, they have not yet been openly embraced by the Mainstream Medical community.

In 1972, Virginia Douglas, in a Presidential address to the Canadian Psychological Association, presented her theory that deficits in sustained attention and impulse control were more likely to account for the difficulties of these children than hyperactivity. She argued that hyperactive children were not necessarily more distractable than other children and that sustained attention problems could emerge under conditions where no distractions existed. Thus the focus and research began to shift from hyperactivity to attention issues.

Douglas’s colleague, Gabriel Weiss, engaged in long-term follow-up studies and showed that as children reach adolescence, the hyperactivity may diminish, but the attention and impulse problems persist. This also was a new idea. Previously the general consensus had been that ADD was a childhood disorder that somehow “disappeared” in adolescence, and certainly by adulthood.

The DSM-III, published in 1980 recognized these new developments. Perhaps the most controversial change from the DSM-II was the subdivision of the previous category of Hyperkinetic Reaction of Childhood. This resulted in the following two categories: Attention-deficit with hyperactivity (i.e., ADHD) and Attention-deficit Disorder Without Hyperactivity (ADD/WO). Thus, it became possible to diagnose a patient as experiencing an impairment of attention without his or her actually being hyperactive.

In subsequent revisions, DSM-III went on to further subdivide the category. DSM-III-R used the term “Undifferentiated Attention-deficit Disorder” (UADD) and restricted its use to disturbances in which the prominent feature is the persistence of developmentally inappropriate and marked inattention that is not a symptom of another disorder, such as Mental Retardation or Attention-Deficit Hyper-activity Disorder (ADILD), or of a disorganized and chaotic home environment. The DSM-III-R also substituted two disorders, Attention-Deficit Hyperactivity Disorder (ADHD) and Undifferentiated Attention deficit Disorder (UADD), for the previous ADD terms (Goodyear & Hynd, 1992).

In the decade from 1980 to 1989, thousands of new research studies were published, making ADHD the most studied childhood psychiatric disorder of the decade, and most likely in the entire history of pediatric psychology.

Not only was ADHD the most studied of childhood disorders, it is perhaps the most labeled. DSM-IV (American Psychiatric Association, 1994) defines the disorder into subtypes based on the predominant symptom pattern. The syndrome that was once covered under the blanket term “Minimal Brain Damage” now has an entire menu of divisions and subtypes:

Another important development in the mid 1980’s was the outlining of Attention Deficit Disorder, Residual Type in an article by David Woods, MD, which appeared in the January 1986 edition of Psychiatric Annals. The idea that ADD continued on into adulthood, rather than somehow disappearing as the child got older, was accepted relatively quickly by the psychiatric and medical communities. Even more interesting is the manner in which this concept was so quickly accepted by the general public, especially among people in the United States. Public interest mushroomed in the 1990’s and seemed to become hyperfocused.

Dr. Russell Barkley’s book, simply titled Attention Deficit Hyperactivity Disorder, is perhaps the best history of ADD up to this time. In a more popular vein, the book Driven to Distraction by Dr. Edward Hallowell and John Ratey was published in 1994. This book became standard reading for many parents of children with ADD.

As these parents read about the disorder their children lived with, they began to recognize more and more of these symptoms in their own lives. Thus, the popularity of research and books dealing with Adult ADD increased dramatically.

With this increased interest of ADD in general and Adult ADD in particular, attention Deficit Disorder expanded from being only an educational issue to one of employment and eventually law. Perhaps the culmination of this was the inclusion of ADD as part of the Americans With Disabilities Act and other legislation on local, state and federal levels.

Increased public awareness led to increased controversy about the diagnosis during the 1990’s. Charges that Ritalin and other medications were being over-prescribed were followed by the law suits. At the same time, validity of AD/HD as a serious disorder was confirmed by Mental Health: A Report of the Surgeon General and continued research.