Growing up, I have heard the phrase ADD / ADHD tossed around in mundane conversations to describe just about anything and everything one may find to be boring or distracting. The normalization of the phrase convinced me that this in fact was another made up thing to justify absent mindedness. Attention Deficit / Hyperactivity Disorder more commonly referred to ADD / ADHD, is much more than being sidetracked; it is one of the best and worst things that has happened to me.
The earliest documented cases of this disorder were in the late 1800s in England; this disorder was originally dubbed under the umbrella term nerves. It was believed to be caused by trauma sustained to the head during infancy. Over a hundred and fifty years later, that notion was believed to be the origin and published in the DSM-II. It wasn’t until 1957, when Dr. Maurice W. Laufer went on to study the inconsistencies and concluded trauma was not a criterion.
It has long been recognized and accepted that a persistent disturbance of behavior of a characteristic kind may be noted after severe head injury, epidemic encephalitis and communicable disease encephalopathies, such as measles, in children. It has often been
observed that a behavior pattern of a similar nature may be found in children who present no clear-cut history of any of the classical causes mentioned. This pattern will henceforth be referred to as hyperkinetic impulse disorder. (Laufer et al. 1957)
When the DSM-III came out, Hyperkinetic Impulse Disorder was revised and revamped. Under the rebranded title of Attention Deficit Hyperactive Disorder, many doctors felt as though it did not encompass those who did not have the hyperactive component. And so, the DSM-IV recognized both ADD and ADHD.
According to the Attention Deficit Disorder Association (2018), this disorder is a highly genetic, brain-based syndrome that has to do with the regulation of a particular set of brain functions and related behaviors. One key phrase I want to emphasize is how it is brain-based; therefore, the signs, symptoms and severity will differ from one person to the next. Although definition explained the overall location and effects of the disorder, we will focus on the etiology next.
A major contributor is heredity due to the role of the DRD4 gene. The D4 receptor is known to be responsible for dopamine intake in the brain (NIH, 2018). Variants of this gene have been proven disrupt the pathway of dopamine from reaching the correct sensors. When these pathways are interfered with, it affects the mesolimbic system of the brain; which in turn is responsible for reward, attention and emotions. This gene has also been linked to traits of risk taking, substance abuse, novelty seeking and impulsivity (Ebstein et al., 1996; Benjamin et al., 1996; Li et al., 2004; Reiner and Spangler, 2011).
Along with genetics, there have been various causations believed. These included: sustained trauma as mentioned before, diet and environment. While research is still being done in all aspects, studies have shown this disorder present in just about every population. With the recent changes in diet due to variety of foods being more available, GMO’s (genetically modified organisms) and travel becoming more accessible; researchers have begun to focus on new potential links (San Mauro Mart?n, I et al., Nutritional Neuroscience, 21(9), 641“647).
Seeing that we have covered background information on this disorder such as: history, how it operates and potential links; I am going to dive into the signs, symptoms, and severity. I will now share my experiences.
In order to complete enrollment for 1st grade, I was required to get a physical; this was my first unofficial diagnosis. As my parents filled out the paperwork, the doctor observed my behavior before nonchalantly asking if they had ever had me tested for learning disabilities other than Attention Deficit Disorder. Just as quickly as he asked, he changed the subject leaving my parents stunned. It was done in such a manner of stating facts, rather than a generalized question.
The second landmark incident happened two weeks into my new school year. Due to my inattentive nature, a teacher assumed that I couldn’t speak English. Granted I was listed as a transfer student and was falling behind in some areas, she began making an action plan. Almost immediately a parent-teacher conference with a translator was scheduled. Looking back, I see why my family found this funny; all they could say was You got someone to translate Canadian-English?.
That meeting lead to my enrollment into cognitive behavior therapy and modification skills, however, I would continue to fall under the radar. Due to my average grades and lack of hyperactivity, I wasn’t walking stereotype of what Attention Deficit Disorder looked like. And so, I wouldn’t address the underlying issue for 15 years.
As we covered before, since this is a brain-based disorder, it will appear differently in everyone. The best way to describe my Attention Deficit Disorder is imagine you are going to Target for toilet paper. However, once you enter you end up in every isle except the one that you need to be in. You’re walking along -oh, there’s that thing you forgot last time. Suddenly, you freeze, you can’t recall what you’re forgetting because your thoughts are racing like a VHS tape on double time. Before you know it, you’re at the check-out and the total is in the triple digits. BOOM! You forgot your wallet in the car, but you’re in luck because you installed Apple Pay. While pulling out the parking lot you’re stuck in traffic, that’s when it dawns on you. You forgot to buy the toilet paper. Now imagine that 24/7 and that was my life in a nutshell.
When it comes to diagnosing ADD / ADHD there are three major clusters: hyperactivity, inattentiveness and impulsivity. While mine tends to manifest predominantly inattentiveness and impulsivity; some can have a mixture of all three. These cluster take place in behaviors such as: procrastination, lack of focus, moving from one unfished task to the next, overlooking details, excessive talking and lack of organization.
While there are certain things to look out for, diagnosing often takes more than one visit. Undiagnosed ADD / ADHD can lead to cases of insomnia, varying degrees of depression and anxiety; however, the same can be said for misdiagnosing. Due to this, many healthcare provides use various rating scales pertaining to behavior, academic and workplace. Some may even go as far as to use third party observations and finally neuropsychological and psychoeducational testing.