The History of ADHD
ADD has been a hotly debated topic since the early 1900’s when pediatrician Sir George Still recognized “an abnormal defect of moral control in some children.” Although these children had difficulty controlling their behavior, they were still just as intelligent than other children who did not display this “defect of control.” The condition was later added to the DSM-II and was called “Hyperkinetic Reaction of Childhood.” Later, in the 1980 DSM-III, the condition was renamed ADD or Attention-Deficit Disorder.
In an article in Time magazine Dr. Richard Saul explains that in the last decade, diagnosis of ADHD and use of ADHD prescription medications have skyrocketed. Every day doctors see a cascade of people coming in claiming that they have trouble paying attention at school or work. This leads them to believe that they are suffering from ADHD. Dr. Saul has come to believe that the generally accepted definition of ADHD as currently defined by the DSM, as well as understood by the public does not exist. This story went viral on social media and people were chiming in from all over the world.
We are a society driven to distraction with ever increasing ease of access to the world through technology. Everyone has had that 2 hours of their life that seem to disappear in a matter of minutes by clicking on one YouTube video. You are then led down the rabbit hole to hours of endlessly juicy entertainment and information. Even for those who have a sense of control over their concentration, staying focused can still be a challenge in our ever-emerging age of distraction.
To get to the meat of this subject of whether ADHD is “real’ or not, it’s best to understand that the name ADD was applied to a myriad of negative symptoms.
Some individuals experience these on a daily basis when trying to simply live life, like a “normal” person. These symptoms range from being fidgety to having difficulty sitting still. We all know those people who can’t stop swinging their leg or tapping their pen in class…..that person may be you!
The inability to pay attention to conversations leads to embarrassment and social anxiety because important parts of the story are missed…like the person’s name. Social cues are difficult to pick up on because the distracted individual is taking in an overload of information all at once. It is difficult to categorize the data as fast as it comes in. Being easily bored with school and work makes it difficult to succeed because one is commonly looked at as a failure or just lazy. These are just the minor issues that ADHD encompasses.
A person with symptoms of ADHD is bombarded by their heightened awareness of normal stimuli in their environment. It is extremely difficult to filter out the unnecessary details.
People with ADHD tend to be disorganized and messy, starting projects that never get finished. They are easily bored and rebellious when asked to follow a routine. Many people with this disorder are highly intelligent but tend to underachieve because of their difficulty concentrating and sustaining an interest in what they started. They live their lives under so much stress that they cannot tolerate frustration. When they get set off, anger usually comes suddenly and explodes like a volcano shooting out hot lava.
Standing in line…do not even go there! Those with ADD don’t want to wait, they hate being delayed and impatience makes them impulsive. They tend to be accident prone, always on the move, and restless. The impulsivity and leaping into action without thinking it through can lead to negative consequences in most situations.
This can also be a gift, as those with ADD can make great first responders since they tend to jump into action easily. But in other cases, driving too fast, using possibly dangerous equipment carelessly, running and jumping off a cliff into a lake without stopping to think of the depth of the water…just a few things that could end horribly.
Most females are never diagnosed as children and live their lives struggling to understand why they feel different than other girls.
Girls with ADHD are often considered daydreamers, loners or outcast because of the difficulty paying attention to details and picking up on social cues. Symptoms differ by gender and studies have identified at least three to seven different types of ADD. Girls and women do not tend to be as hyperactive as boys so they are less likely to be identified at a young age.
These attention related issues listed above spiral into more serious psychological issues as time goes on. Some people with the symptoms of ADD begin to believe that they are incompetent due to the feedback they receive from others. Depression, anxiety and low self-esteem can start to take hold as early as 5 years old!
Ok, so back to the question – is ADHD real or not?
Firstly, ADD is just a common term we use to refer to a group of symptoms that are experienced by an individual. Call it whatever name you want. These symptoms are very real to the person living with and suffering physically, mentally and/or emotionally from them.
Second, according to scientific research on ADD in the fields of molecular genetics, biology, psychology and neuroscience, a trend in ADD symptoms that correlate to specific genetic markers has emerged.
What does this mean for the diagnosis of ADHD?
A large consensus of data points to a dysfunction in the “brain reward cascade” most notably in the dopamine system. Dopamine is the pleasure reward neurotransmitter or chemical in our brain. When we do something that we enjoy, dopamine is released and we feel rewarded, happy and generally all fuzzy inside. It feels so amazing that we are constantly driven to do things to set off dopamine.
Unfortunately, for those with ADD, it takes a lot to set off that dopamine rush. Genetic research has found that some people are born with an inherited gene that can cause fewer dopamine receptors to be formed in reward sites in the brain. This means that it takes more dopamine than is commonly released in most people to activate the reward centers in the brain of someone with ADD.
For those with low dopamine activity, the risky behavior comes in. They are the adrenaline junkies, always looking for their next rush.
This genetic “defect” (maybe it’s not a defect?) drives these people to participate in behavior that will increase the release of dopamine in order to flood those few receptor sites. Gorging on carbs, sugars, and alcohol creates a dopamine flood in the brain. So does the use of other drugs like cocaine, meth, nicotine, and caffeine.
Most of the ADD medications available are a form of methamphetamine. Makes sense, right? These stimulants release a large amount of dopamine to the few reward receptor sites available. The issue with these medications is that they cause many, serious, adverse health issues.
What are people with ADHD concerned about?
Browsing the ADD thread on WebMD one can see that most of the questions raised are about how to deal with the negative symptoms of ADD medications. On the one hand, for the person with ADD, the medication is great because they can finally focus, get their work done, and communicate more effectively.
But, the caveat is that the medication causes heart palpitations, anxiety, psychosis, insomnia, nausea, vomiting, lack of appetite leading to undernourishment and nutritional deficiencies. And these are just the mild symptoms.
Although this issue goes into much greater depth, this is a very simple explanation of how the symptoms of ADD correlate with genetic research related to dopamine and the reward cascade system in the brain.
Next weeks topic:
How to reduce the symptoms of ADD with natural supplements, diet, exercise and lifestyle recommendation.