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This realization may be called the stage of ADD epiphany, the annunciation, characterized by elation, insight, enthusiasm and hope. It seemed to me that I had found the passage to those dark recesses of my mind from which chaos issues without warning, hurling thoughts, plans, emotions and intentions in all directions.
ADD seemed to explain many of my behavior patterns, thought processes, childish emotional reactions, my workaholism and other addictive tendencies, the sudden eruptions of bad temper and complete irrationality, the conflicts in my marriage and my Jekyll and Hyde ways of relating to my children.
It also explained my propensity to bump into doorways, hit my head on shelves, drop objects and brush close to people before I notice they are there. No longer mysterious was my ineptness following directions or even remembering them, or my paralytic rage when confronted by a sheet of instructions telling me how to use even the simplest of appliances.
My path to diagnosis was similar to that of many other adults with ADD. I found out about the condition almost inadvertently, researched it and sought professional confirmation that my intuitions about myself were reliable.
I took Ritalin in a higher than recommended initial dose on the very day I first heard about attention deficit disorder. Within minutes, I felt euphoric and present, experienced myself as full of insight and love. My wife thought I was acting weird. “You look stoned” was her immediate comment.
have always advised patients against self-medicating. Such striking imbalance between intellectual awareness on the one hand and emotional and behavioral self-control on the other is characteristic of people with attention deficit disorder.
The Ritalin soon made me depressed. Dexedrine, the stimulant I was next prescribed, made me more alert and helped me become a more efficient workaholic.
The hallmark of ADD is an automatic, unwilled “tuning-out,” a frustrating nonpresence of mind. A person suddenly finds that he has heard nothing of what he has been listening to, saw nothing of what he was looking at, remembers nothing of what he was trying to concentrate on.
To begin with, there is a profound reluctance to discard anything—who knows when you might need that copy of The New Yorker that has gathered dust for three years without ever being looked at?
That is not what is very difficult. What can be immobilizingly difficult is to arouse the brain’s motivational apparatus in the absence of personal interest.
Teachers may conclude that the child is willfully deciding when or when not to buckle down and work diligently. Many children with ADD are subjected to overt disapproval and public shaming in the classroom for behaviors they do not consciously choose.
The second nearly ubiquitous characteristic of ADD is impulsiveness of word or deed, with poorly controlled emotional reactivity. The adult or child with ADD can barely restrain himself from interrupting others,
Classically, it is expressed by trouble keeping physically still, but it may also be present in forms not readily obvious to the observer. Some fidgetiness will likely be apparent—toes or fingers tapping, thighs pumping, nails being chewed, teeth biting the inside of the mouth. The hyperactivity may also take the form of excessive talking.
One Grade 2 boy was called Talk Bird by his classmates, so incessant was his chatter. His parents, too, were often after him to be quiet. It’s as if such a child is saying, I’m cut off from people, so anxious that if I don’t work overtime to establish contact with them, I will be left alone. I only know to do this through my words. I know no other way.
The individual with ADD experiences the mind as a perpetual-motion machine. An intense aversion to boredom, an abhorrence of it, takes hold as soon as there is no ready focus of activity, distraction or attention.
As long ago as 1934, an article in The New England Journal of Medicine identified a distressing quality to some people’s lives, which the authors called “organic drivenness.” I, for one, have rarely had a moment’s relaxation without the immediate and troubling feeling that I ought to be doing something else instead.
The restlessness coexists with long periods of procrastination. The threat of failure or the promise of reward has to be immediate for the motivation apparatus to be turned on. Without the rousing adrenaline rush of racing against time, inertia prevails.
said. Surges of initial enthusiasm quickly ebb. People report unfinished retainer walls begun over a decade ago, partly constructed boats taking up garage space year after year, courses begun and quit, books half read, business ventures forsaken, stories or poetry unwritten—many, many roads not traveled.
in early childhood most of them literally climb all over adults and generally exhibit an almost insatiable desire for physical and emotional contact. They approach other children with a naive openness, which is often rebuffed. Impaired in their abilities to read social cues, they may be ostracized by their peers.
Fueling skepticism about its actual prevalence is the fact that no feature of ADD is so unique that it cannot be found, to one degree or another, in any number of people among the non-ADD population.
The long-term social consequences of massive drug intake in the treatment of depression, ADD and a host of other conditions are yet to be known. I, too, am concerned about this, even though I prescribe medications to others and continue to take one myself.
Environment does not cause ADD any more than genes cause ADD. What happens is that if certain genetic material meets a certain environment, ADD may result. Without that genetic material, no ADD. Without that environment, no ADD. The formative environment is the family of origin.
It was virtually impossible for me to say no to any request for help, no matter what the cost to my personal life. In honoring this overwrought sense of responsibility toward others, I neglected my responsibility toward the only people for whom I really was indispensable.
She felt abandoned. She felt, too, that I saw her own calling as a painter as something of secondary importance.
As I will discuss in a later chapter on relationships, couples choose each other with an unerring instinct for finding the very person who will exactly match their own level of unconscious anxieties and mirror their own dysfunctions,
I may have to be somewhere, miles away, at 9:00 a.m., but as long as it is not yet nine, I fully believe I have time enough. I am scheduled to attend ward rounds with nurses and other physicians at Vancouver Hospital. At 8:50 I leap into the shower, still confident: there is space between the big hand of the watch and the hour marker, so I am not late.
The ADD mind is afflicted by a sort of time illiteracy, or what Dr. Russell Barkley has called “time blindness.” One is either hopelessly short of time, dashing about like a deaf bat, or else acts as if blessed with the gift of eternity. It’s as if one’s time sense never developed past a stage other people leave behind in early childhood.
Ask people with ADD how long it will take to perform a particular task, and they will notoriously underestimate.
Or, a wife will complain bitterly that living with her husband is like living with a young child. “Sometimes it feels like I am his mother. It’s as if I have three children: two preschoolers and one aged thirty-two.”
Monkeys deliberately lesioned in the right prefrontal cortex lose their ability to read social cues and to participate in socially essential activities such as mutual grooming. They are soon ostracized by other members of the group. When separated from mother, infant monkeys similarly lesioned become hyperactive, as do rats lesioned in this area of the brain.
MRI pictures have shown smaller than normal structures in the right prefrontal areas of ADD patients.
Studies do show that if parents or siblings have ADD, a child in that family will have a greatly increased statistical risk for having ADD as well. ADD is also found more commonly in people whose first-degree relatives are alcoholics or suffer from depression, anxiety, addiction, obsessive-compulsive disorder or Tourette’s syndrome.
The older sibling has to suffer the pain of seeing parental love and attention directed toward an intruder. The younger sibling may need to learn survival in an environment that harbors a stronger, potentially hostile rival, and never comes to know either the special status or the burden of being an only child.
would not have registered at levels most people would define as yelling. The daughter’s reaction, however, is genuine. She picks up, senses, experiences the tension in the father’s voice, the edge of controlled impatience and frustration. That is what is translated in her brain as “yelling.” She is feeling exactly the same fear and outrage as another child would if shouted at in an angry manner. It is a matter of sensitivity, of the degree of reactivity to the environment. This child is emotionally hypersensitive. The
People with ADD are hypersensitive. That is not a fault or a weakness of theirs, it is how they were born. It is their inborn temperament. That, primarily, is what is hereditary about ADD. Genetic inheritance by itself cannot account for the presence of ADD features in people, but heredity can make it far more likely that these features will emerge in a given individual, depending on circumstances. It is sensitivity, not a disorder, that is transmitted through heredity. In most cases, ADD is caused by the impact of the environment on particularly sensitive infants.
Sensitivity is the reason why allergies are more common among ADD children than in the rest of the population. It is well known, and borne out again and again in clinical practice, that children with ADD are more likely than their non-ADD counterparts to have a history of frequent colds, upper respiratory infections, ear infections, asthma, eczema and allergies, a fact interpreted by some as evidence that ADD is due to allergies.
My wife and I learned to recognize our daughter’s moods and behaviors as real-time, instantaneous computer printouts of the psychological atmosphere in our home. If we wanted to know how we were doing as individuals or as a couple, we needed only check the facial expressions and emotional responses of our daughter.
The word matrix is derived from the Latin for “womb,” itself derived from the word for “mother.”
Because the formation of the child’s brain circuits is influenced by the mother’s emotional states, I believe that ADD originates in stresses that affect the mothering parent’s emotional interactions with the infant.
Within minutes following birth, the mother’s odors stimulate the branching of millions of nerve cells in the newborn’s brain. A six-day-old infant can already distinguish the scent of his mother from that of other women.
Summarizing a number of British studies, Dale F. Hay, a researcher at the University of Cambridge, suggests “that the experience of the mother’s depression in the first months of life may disrupt naturally occurring social processes that entrain and regulate the infant’s developing capacities for attention.”
A loving parent who is feeling depressed or anxious may try to hide that fact from the infant, but the effort is futile. In fact, it is much easier to fool an adult with forced emotion than a baby. The emotional sensory radar of the infant has not yet been scrambled. It reads feelings clearly.
The ADD child’s difficulty reading social cues likely originates from her relationship cues not being read by the nurturing adult, who was distracted by stress.
Infants whose caregivers were too stressed, for whatever reason, to give them the necessary attunement contact will grow up with a chronic tendency to feel alone with their emotions, to have a sense—rightly or wrongly—that no one can share how they feel, that no one can “understand.”
As an example, in troops of monkeys the dominant, most successfully aggressive males have been found to have less serotonin than the others. This would seem to prove that low serotonin levels cause aggression.
On occasion, when I probe the history of their child’s earliest months and years a parent may say, “Oh, but the divorce didn’t come until my son/daughter was eight years old”—an interpretation that misses something important. It is not divorce per se that is emotionally most wearying for the child: it is the long-term tensions and emotional heaviness that precede every divorce.
Among the recurrent themes blighting the childhoods of adults I have seen with severe cases of ADD are family strife and divorce; adoption, depression—especially in the mother; violence—especially from the father; alcoholism; and sexual abuse.
Like many adults with ADD, Anthony has very few recollections of childhood events before the age of eight or nine, although a number of relatives have told him that he had been psychologically abused in the family home. His father, it seems, was mercilessly critical of him and played “mind games” at his expense.
ADD children are far more likely than other children to have parents who have suffered major depression, about 30 percent compared with 6 percent.
When I first took an antidepressant in my mid-forties, I was amazed at the difference. Curiously, I felt much more like myself. It was as if a fog had evaporated and I saw that for years previously I’d had only periodic glimpses of a life not burdened by negative feelings.
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