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It has been aptly said that people with ADD forget to remember the future.
The major impairments of ADD—the distractibility, the hyperactivity and the poor impulse control—reflect, each in its particular way, a lack of self-regulation. Self-regulation implies that someone can direct attention where she chooses, can control impulses and can be consciously mindful and in charge of what her body is doing.
Attention deficit disorder is a prime illustration of how the adult continues to struggle with the unsolved problems of childhood. She is held back precisely where the child did not develop, hampered in those areas where the infant or toddler got stuck during the course of development.
Emotional Intelligence, Daniel Goleman, behavioral and brain sciences writer for The New York Times, defines this capacity as “being able to motivate oneself and persist in the face of frustrations; to control impulse and to delay gratification; to regulate one’s moods and keep distress from swamping the ability to think. . . ”[2] We have only to place a negative qualifier before the “being able” in that sentence, as in “not being able,” and we arrive at a succinct description of the ADD personality.
If some deeply unconscious anxiety is triggered, a person may respond with the lack of emotional self-regulation characteristic of an infant. A fully grown adult exhibiting the rage of an infant is terrifying and potentially dangerous.
We can probably localize much of the organic basis of ADD in what is called the right prefrontal cortex, the area of the brain just behind the forehead. The
Human beings injured here, so-called prefrontal patients, exhibit distractibility, poor regulation of impulses and other classic signs of ADD.
In other words, in the ADD group electrical activity in the cerebral cortex, or gray matter, slowed down just when it would have been required to speed up.
It may seem paradoxical to consider that hyperactivity of mind or body can be caused by an underactivity of the cortex. It would also seem odd to think of hyperactivity being stopped by a stimulant medication. The
The prefrontal cortex may be seen as that policeman. One of its major tasks is inhibition.
permission to the impulse or to cancel it.[4] One way to understand ADD neurologically is as a lack of inhibition, a chronic underactivity of the prefrontal cortex.
Recognizing that ADD is a problem of development rather than one of pathology takes us in a direction completely different from that dictated by a narrowly medical approach.
The answer to underdevelopment is development, and for development the appropriate conditions must exist. No
True or not, narrow genetic explanations for ADD and every other condition of the mind do have their attractions. They are easy to grasp, socially conservative and psychologically soothing. They raise no uncomfortable questions about how a society and culture might erode the health of its members, or about how life in a family may have affected a person’s physiology or emotional makeup.
Were we to adopt the medical model—only temporarily, for the sake of argument—a genetic explanation by itself would still be unsuitable.
The destruction of the Crees’ traditional physically active ways of life, the substitution of high-calorie diets for their previous low-fat, low-carbohydrate eating patterns and greatly increased stress levels are responsible for the alarming rise in diabetes rates.
We will see that in similar ways changes in society are causing more and more children to be affected by attention deficit disorder.
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 family atmosphere in which the child spends the early formative years has a major impact on brain development.
Given that emotional security is an absolute human need in infancy, it is astonishing that adoption is so often forgotten as a possibly crucial influence.
There is another environment that adopted twins have shared: nine months in the same uterus. Stress on the mother during pregnancy can unbalance the levels of hormones in her body, particularly of the stress hormone Cortisol (cortisone).
The vast majority of pregnancies ending in adoption occur in mothers under severe stress.
1982 study found that “the rate of adoption among ADD patients in the clinical population was 8 to 16 times the prevalence of adopted children in the population at large”[4]
“Whether these features become talents or problems depends, in short, on how the child’s nature is nurtured,” he writes.[5] The critical difference is the environments in which children are reared.
A view of ADD that recognizes the importance of the environment is inherently optimistic. If environmental causes are largely responsible for a problem, perhaps environmental approaches can be employed to help resolve it.
Environment has far greater impact on the structures and circuits of the human brain than was realized even a decade ago. It is what shapes the inherited genetic material. I believe it to be the decisive factor in determining whether the impairments of ADD will or will not appear in a child.
Historical studies of birth order have established it as an important influence on the shaping of the personality, comparable with sex.[6]
Even without world wars, revolutions and emigration, siblings growing up in the same home almost never share the same environment. More accurately, brothers and sisters share some environments—usually the less important ones—but they rarely share the one single environment that has the most powerful impact on personality formation.
all environments, the one that most profoundly shapes the human personality is the invisible one: the emotional atmosphere in which the child lives during the critical early years of brain development. The
A hidden factor of great importance is a parent’s unconscious attitude toward a child: what, or whom, on the deepest level, the child represents for the parents; the degree to which the parents see themselves in the child; the needs parents may have that they subliminally hope the child will meet.
It may be said that no two children have exactly the same parents, in that the parenting they each receive may vary in highly significant ways. Whatever the hopes, wishes or intentions of the parent, the child does not experience the parent directly: the child experiences the parenting. I have known two siblings to disagree vehemently about their father’s personality during their childhood.
If a mother has eight children, there are eight mothers. This is not simply because of the fact that the mother was different in her attributes to each of the eight. If she could have been the same with each. . . each child would have had his or her own mother seen through individual eyes. — D. W. WINNICOTT, F.R.C.P., Home Is Where We Start From
Of the various Oxford Dictionary definitions of sensitive, it will be useful to keep three in mind. Each is exquisitely apt as a description of the ADD child: 1. Very open to or acutely affected by external stimuli or mental impressions. 2. Easily offended, or emotionally hurt. 3. (As of an instrument) responsive to or recording small changes.
Some of the most sensitive people in terms of how they react may be the least mindful of the feelings of others.
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.
we may say truthfully that people with ADD have emotional allergies.
People’s pain tolerance is lower when they feel anxious or depressed, partly because of changes in stress hormone levels and in the levels of endorphins, the body’s innate painkillers.
Physiological differences in the human nervous system help explain differences in levels of emotional reactivity from one child to the other. In some children, the nervous system is always in a state of hair-trigger alert.
Abdominal cramps in sensitive children are often clues to unresolved tensions in the family environment. They are common and all too frequently misinterpreted. These are the children who go pale with “inexplicable” tummy aches and are dragged from doctor to doctor, from clinic to emergency ward, from specialist to specialist, subjected to examinations, tests, X-rays and over and over again are pronounced “perfectly healthy.”
We face no such difficulty if we see that what is being transmitted genetically is not ADD or its equally ill-mannered and discombobulating relatives, but sensitivity.
One of the most striking peculiarities of the human brain is the great development of the frontal lobes—they are much less developed in other primates and hardly evident at all in other mammals. They are the part of the brain that grows and develops most after birth. — OLIVER SACKS, M.D., An Anthropologist on Mars
Even though fully half of the roughly hundred thousand genes in the human organism are dedicated to the central nervous system, the genetic code simply cannot carry enough information to predetermine the infinite number of potential brain circuits. For this reason alone, biological heredity could not by itself account for the densely intertwined psychology and neurophysiology of attention deficit disorder.
The microcircuitry of the brain is formatted by influences during the first few years of life, a period when the human brain undergoes astonishingly rapid growth.
Attention deficit disorder results from the miswiring of brain circuits, in susceptible infants, during this crucial period of growth.
fully three-quarters of our brain growth takes place outside the womb following birth, with most of this increase occurring in the early years.
The bargain forced on our evolutionary ancestors was that the tremendously large human brain has to develop outside the relatively safe environment of the womb, highly vulnerable to potentially adverse circumstances.
Neural Darwinism means that our genetic potential for brain development can find its full expression only if circumstances are favorable.
Attention deficit disorder is also an example of how the neural circuitry and biochemistry of the brain may be held back from developing optimally when appropriate input from the environment is interfered with. What, then, are the optimal conditions for full brain development?
The three conditions without which healthy growth does not take place can be taken for granted in the matrix of the womb: nutrition, a physically secure environment and the unbroken relationship with a safe, ever-present maternal organism.
