Attention Deficit Disorder: Practical Coping Methods Barbara C. Fisher, Ph.D. and Ross A. Beckley, Ph.D. © 1999 by CRC Press LLC Acquiring Editor: N. Frabotta Project Editor: Sylvia Wood Marketing Manager: Becky McEldowney Cover design: Dawn Boyd Library of Congress Cataloging-in-Publication Data Fisher, Barbara C. Attention deficit disorder: practical coping methods / Barbara C. Fisher and Ross A. Beckley. p. cm. Includes bibliographical references and index. ISBN 0-8493-1899-0 1.Attention-deficit hyperactivity disorder. 2. Adjustment (Psychology) 3. Biological psychiatry. Neuropsychology. Beckley, Ross A. II. Title. [DNLM: 1. Attention Deficit Disroder with Hyperactivity. 2. Biological Psychiatry. Neuropsychology. WS 350.8.A8 F533ab 1998] RC394.A85F57 1998 616. 85’ 89—dc21 DNLM/DLC 98-7960 for Library of Congress CIP This book contains information obtained from authentic and highly regarded sources. Reprinted material is quoted with permission, and sources are indicated. A wide variety of references are listed. Reasonable efforts have been made to publish reliable data and information, but the author and the publisher cannot assume responsibility for the validity of all materials or for the consequences of their use. Neither this book nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage or retrieval system, without prior permission in writing from the publisher. The consent of CRC Press LLC does not extend to copying for general distribution, for promotion, for creating new works, or for resale. Specific permission must be obtained in writing from CRC Press LLC for such copying. Direct all inquiries to CRC Press LLC, 2000 Corporate Blvd., N.W., Boca Raton, Florida 33431. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are only used for identification and explanation, without intent to infringe. Cover illustration: Matthew T. Rivard © 1999 by CRC Press LLC No claim to original U.S. Government works International Standard Book Number 0-8493-1899-0 Library of Congress Card Number 98-7960 Printed in the United States of America 1 2 3 4 5 6 7 8 9 0 Printed on acid-free paper © 1999 by CRC Press LLC Preface This book has been rewritten no fewer than five times in an effort to keep abreast of current information. It is a compilation of personal/professional experiences, notes, anecdotes, research and hopes that have been stored and shared over the past decade. New research is occurring constantly and this disorder, which has been historically looked upon as a disorder of child- hood, is now being widely accepted as one that spans the lifetime. It is a dis- order that one is born with, and it does not end with childhood, instead, symptoms develop and change commensurate with the developmental cycles of adolescence, adulthood, middle age and advanced age. This book is meant for parents, children, teachers and ADD adults who are tired of searching and are ready for answers to their many questions about this very diverse and complicated disorder. Our goal is to demystify the vast amount of information that has been gener- ated and to present this rather confusing disorder in a manner that is both understandable and applicable by providing what we have learned that is helpful in addressing this disorder in the individual’s everyday life. This books addresses the questions of why Ritalin does and doesn’t work, why ADD is not just a childhood disorder, why ADHD is being over-diagnosed and why so often the person diagnosed and treated with medication is not cured and the story is far from over. The presence of ADD has broken up marriages, prevented many from attending college, fulfilling their potential, or following the career path that they truly desire. It has made people feel stupid and incompetent. With new perspectives, changes can occur, and people can create the life they want and deserve; they can fulfill their dreams. ADD is a disorder with far-reach- ing consequences, however, it is also a disorder that can be treated and spe- cific symptoms can be managed. We prefer to think of ADD as a challenge that can be met with good physical health, nutrition, specific coping mecha- nisms, medication, and, most of all, education and understanding. A good diagnosis identifying all of the various disorders that can complicate the sit- uation is absolutely imperative. What we provide to the reader in this book in the way of knowledge about ADD has been field-tested in a variety of settings—households, schools, clinics, businesses, colleges, hospitals, and classrooms. © 1999 by CRC Press LLC Authors Barbara C. Fisher, Ph.D, is a fully licensed psychologist who has specialized in neuropsychology for the past 19 years. She approaches Attention Deficit Disorder from a brain-behavior viewpoint and utilizes her knowledge of the brain and neuroanatomy to understand, diagnose, and explain specific symptoms of this disorder. Dr. Fisher is the author of Reasons for Misdiagnosis, Approaching ADD from a Brain-Behavior Neuropsychological Perspective for Assessment and Treatment, and co-author of We Are Not Getting Older, We Are Just Coming of Age.. She also spe- cializes in the diagnosis of head trauma, as well as Alzheimer’s Disorder and Dementia. A well-known speaker, Dr. Fisher has presented at various workshops with her husband, Ross Beckley, including radio and television, on such varied topics as ADD, Depression and Anxiety, and Comorbid Disorders. She con- ducts custody evaluations; neuropsychological evaluations; alcohol assess- ments; and psychological, education, and achievement evaluations. Trained in hypnosis, she is a member of the American Society of Clinical Hypnosis. Ross Beckley, Ph.D, is a former school teacher, special-education teacher, and teacher consultant for the learning disabled, the emotionally impaired, and educable mentally impaired. Dr. Beckley holds a Ph.D. in Clinical Psy- chology, a degree in Elementary Education, Master’s degrees in Reading and Learning Disabilities, and Marriage and Family Therapy. He also has a spe- cialist degree in Administrative and Organizational Studies. More impor- tantly, Ross is stepdad to an ADD child. Both Fisher and Beckley are members of the National Physicians Consor- tium for Attention Deficit Disorder, American Psychological Association, Association of Family and Conciliation Courts, and various support groups for Attention Deficit Disorder. They have been speaking for the past several years on ADD and currently run a successful parent-training program. Together, they operate United Psychological Services and the Attentional Deficit Disorder Clinic in Clinton Township, with a satellite office in Lansing, Michigan. © 1999 by CRC Press LLC Acknowledgments In the completion of this project, we would like to recognize the following individuals for their direct or indirect contribution to this project. Special recognition is due to: God, the source Mr. Phillip Fisher: accountant/bean-counter extraordinaire, father, father- in-law Mr. Donald Beckley: organizer, critic, cheerleader Blythe VanderBeek: partner, editor, and friend Dr. Edna Copeland: expert in ADD and renowned author who first said, “Why don’t you two write a book?” Greer Huntley: typist, proofreader, who always believed in this project Janine Thomas: M.S.W., colleague, idea person, truth teller Don Santilli, Chuck O’Connor, Utica Community Schools Nick Simkins, attorney specializing in head injury Dr. Akemi Takekoshi: neurologist Dr. David Villanueva: psychiatrist The many pediatricians and neurologists for their insightful knowledge of clinical aspects of this disorder Dr. Douglas Davidson: The Union Institute, Western Michigan University And, last but never least, Laura and Jeff, relentless partners in questions, answers, worries/fears, love, honor, and stars © 1999 by CRC Press LLC Contents 1. What Is Attention Deficit Disorder? 2. The Two Subtypes Of ADD: ADD without Hyperactivity and ADHD 3. Looking At ADD without Hyperactivity 4. Over-Focused Subtype of ADD without Hyperactivity 5. ADHD Revisited 6. Comorbid, Associated Physical Disorders 7. Comorbid, Associated Emotional Disorders 8. Assessment and Why it is So Important in Diagnosing ADD 9. After the Evaluation: How Tests or Clinical Findings are used to Develop Coping Mechanisms to Address the Symptoms of ADD 10. How to Tell your Child about ADD: What It Is and Isn’t and Why Take Medication 11. Adolescence and ADD: A Class by Itself 12. The Impact of Attention Disorders within the Family System 13. Living with an ADD Adult: How Does ADD Affect a Marriage? 14. ADD in the Workplace 15. Legal Information: IDEA, Section 504 and ADA 16. How to Work with the Schools to Get What You Need © 1999 by CRC Press LLC 17. Medications 18. Treatment Does Not Mean Just Medication 19. ADD and Brain Damage: Does it Make a Difference? 20. Summary of Issues Critical to Understanding ADD Bibliography © 1999 by CRC Press LLC 0-8493-????-?/97/$0.00+$.50 © 1997 by CRC Press LLC 1 What is Attention Deficit Disorder? 1.1 What Attention Deficit Disorder (ADD) Was Once Thought to Be Historically, when Attention Deficit Disorder (ADD) was discussed, we were referring to Attention Deficit Disorder with Hyperactivity (ADHD). At that time there was no awareness of ADD without hyperactivity. It was thought that ADD was a psychological or behavioral problem viewed as a disorder of childhood. The symptoms were hyperactivity, overactiveness, and attention deficiency, hence the term ADD. The theory was that the disorder was the consequence of a system in the brain not being mature — perhaps due to early birth or damage to the brain. That underdeveloped system in the brain was thought to be the Reticular Activating System (RAS), which is involved in general arousal and alertness. In that underdeveloped or immature state, the result was overactive or hyperactive behavior on the part of the child. As this system developed, the symptoms of ADHD and its hyperactive or overactive component would dis- appear. It was believed that because the system was immature it produced the overactivate and inappropriate behavior characteristic of hyperactivity, a motor-driven activity. Therefore, ADD was not understood as a disorder involving the thought pro- cesses but as a disorder linked to behavior with symptoms such as a child who “ran but did not walk” and was continually distracted, not focused, or could not attend to task. These children were seen as behavioral problems as they did not respond to directions, but did as they pleased without obeying the rules and regulations of the family household. The attention disorder was viewed as ADHD; a rather disruptive behavioral problem that was expected to go away once the child reached the later stages of adolescence and the RAS matured and began to function as it should, and no longer produced overactive behavior. The problem was that ADD and the systems seen did not make sense. Some- times the behavior would be there and sometimes it would not. There seemed to be no rhyme or reason. It was difficult to diagnose unless the disorder was © 1999 by CRC Press LLC severe and there were clear symptoms for the doctor or psychologist to observe. Parents did not see symptoms of the disorder but teachers did. Chil- dren who should have been able to function better and lead productive lives after adolescence still had problems. ADD children, once they became adults, still had problems and were not like their peers. 1.2 If the Disorder was Over, Why Wasn’t It Over? What was not understood was that ADD was a thinking disorder involving the higher-level portions of the brain, or higher-level functioning of the brain. Fur- ther, on reaching adolescence and adulthood this disorder does not go away. Rather, it persists throughout the life span and through the aging process. In fact, we have tested individuals in the age range of 70 to 80 years and found clear symptoms of an attentional disorder that had been impacting their lives. Now we realize that, first, ADD does not go away and, also, there is another disorder with the absence of hyperactivity (or motor overactivity) entitled Atten- tion Deficit Disorder without Hyperactivity. 1.3 How is this New View or Theory of ADD Known? Recent research was conducted in which researchers found evidence of hypo- frontality — a lack of activity in the frontal area of the brain when it should have been activated. Using a computerized technique called the PET scan, researchers were able to measure the brain’s use of energy. The PET scan allows the activity of the brain to be measured in response to some sort of task performance. Testing diagnosed ADHD individuals who performed tasks that necessarily require the frontal area of the brain. Hypofrontality was dis- played because frontal regions of the brain were not aroused as they should have been for the task performance. This can also be seen on SPECT scans, which measure how the brain is utilizing its energy. Hypofrontality was then linked to the deficiency of dopamine and norepi- nephrine, two neurotransmitters or brain messengers. 1.4 Defining Neurotransmitters or Brain Messengers The brain contains structures geared to performing specific jobs. All of these structures must be able to communicate with one another to allow thinking © 1999 by CRC Press LLC and acting to be a smooth operation. It is like a giant communication system, e.g., the Internet or the information highway. The brain transmits messages to itself — it talks to itself; therefore, the brain structures can work only if its communication system is in order. EXAMPLE For a car to run, you need fuel and spark. You can have a perfectly fine automobile, but it will not go anywhere unless it has a full tank of gas and a charged battery. The same is true of the brain. The brain can be fine and intact, however, it will not work unless it has fuel and a spark. The brain talks to itself using two systems, chemical and electrical. When either of these communication systems breaks down, there is potential for a whole host of problems ranging from emotional disorders to physical disor- ders to damage to the brain. When people cannot think, or they can’t walk or talk or act appropriately or make the right decisions, something has hap- pened to one or both of these systems. 1.5 ADD Has to do with the Way the Brain Talks to Itself Chemically When the brain talks to itself chemically, it does so through what we call neu- rotransmitters or brain messengers. These neurotransmitters allow the commu- nication system or information highway to transmit messages between different brain structures. Each brain structure has a specific job that allows the body to walk, talk, think, learn. The brain structures are connected by neurons. It is the neurotransmitters or brain messengers that allow informa- tion to travel from one neuron to another. When defining neurons, see the brain activity as a series of steps: 1. Neurons are composed of a cell body connected to an axon that connects to another cell body that connects to an axon and so on (Figure 1.1). 2. The neurons have projections called dendrites, or branches, whose primary function is to receive information from other cells and pass this information along to the cell body. 3. Electrical changes occur in the nerve membrane that result in infor- mation being passed along the axon to the nerve terminal located at the end of the axon. 4. It is the change in membrane permeability at the nerve terminal that triggers the release of the neurotransmitter substance. © 1999 by CRC Press LLC