To many, getting the diagnosis ADHD feels at first like a life sentence. To then have comorbities added sounds like a death sentence.

But there might not be any comorbidity. The so called “comorbid” condition could be the reason for the ADHD like behavior and there might not be any ADHD at all. A young child with anxiety or depression can act ADHD like, and hyperactivity or inattentiveness can both be the result of the thyroid gland not functioning as it should.

There are various conditions, physical, medical, mental and emotional which have some symptoms that mimic ADHD behavior. The usual ADHD checklists and the ADHD DSM-IV diagnosis (Diagnostic and Statistical Manual of Mental Disorders) do not differentiate between ADHD and ADHD behavior. In fact the definition of ADHD is by behavior, which also shows up in bi-polar, autism, anxiety, depression, foetal alcohol syndrome, allergies, abuse, neglect, etc., etc.

ADHD has evolved over the last century from a single condition, with variations of names based on various morbid moral defects, through a couple of brain damaged defects until it was split into ADD (attention deficit disorder) and ADHD (attention deficit hyperactivity disorder). Then in 1994 it reverted to one condition, but with three subtypes. This taxanonic revolution has not stopped. A new adjustment is due in two years time. . .

Over the last decade huge advances have been made in our understanding of neurobiology and the working of the brain. What has not kept pace with our understanding of biological and electro chemical processes is our common sense.

Reviewing the latest literature on ADHD, there are some excellent papers which have been published, but unfortunately most are stuck in some oversimplified model, digging frantically for the imaginary treasure of a magical ADHD cure. This idea that there is one or only a few causes for ADHD and therefore a simple cure, preferably a magical pill defies common sense.

The BAD NEWS is that ADHD is complex. If it were not, then we would have solved these questions some time last century.

The GOOD NEWS is that if we accept the fact that it is complex, then paradoxically it becomes easier to find a cure.

The reasoning is that it is easier to find a cause in a list of 50 or 100 possible causes, than to search for a figment of some academics’ limited imaginations devoid of common sense.

ADHD Causes are mostly treatable in some way. Medication is great for a tempoary fix, but a lousy cure if the real problem is lack of self esteem, diabetes or early onset bi-polar disorder.

Studies by the American Medical Association have shown that stress is the primary factor in over 75% of all illnesses medically treated today. Stress causes ADD ADHD like symptoms

Well now I am back on my post and posting the blog a few days late. This by the way was not an example of procrastination (I enjoy writing about this subject) it was distactability.

Before discussing ADHD further, it might be helpful to put the oversimplification of ADHD psychiatry in a scientific context. In a review article titled, “Toward a philosophical structure for psychiatry,” published in 2005 in the American Journal of Psychiatry, Psychiatrist Kenneth Kendler the co-editor-in-chief of Psychological Medicine wrote:

“We have hunted for big, simple neuropathological explanations for psychiatric disorders and have not found them. We have hunted for big, simple neurochemical explanations for psychiatric disorders and have not found them. We have hunted for big, simple genetic explanations for psychiatric disorders and have not found them.”

Kendler K.S. Am J Psychiatry 162:433–440.

The changing attitude from attention disorder to attention dysregulation is something I can accept. I cannot accept having attention “disorder” as I experienced attention hyperfocussing. This was one of my strengths, and together with my intuitive insight during hyperfocussing, these were two of my talents that I valued.

These are typical positive parts of the ADD/ADHD psyche. When ADHD is considered a “disorder” the positive aspects do not feature. This might not seem positive to a parent calling a teen to dinner, but the teen is not being disobedient, probably tuned out of this world and absorbed in something s/he finds fascinating.

The daydreaming, considered a “symptom” of the “disorder,” was also valuable to me, as this is where my intuitive insights came from. I am an ADD personality (sounds nicer than a neurologically disordered patient) as I am not physically hyperactive. I seem to inattentively daydream a lot. On the inside though, my mind is hyperactive, and is constantly ticking over in my waking hours.

Well at least the attention disorder is likely to be erased from the next DSM. The term dysregulation refers to the fact that we are not average, but are either easily distracted or able to hyperfocus. The average person is usually in the attention area between these two extremes.

Another difference not mentioned much among ADHD researchers hyperfocussing on some “disorder” is that the distractibility is much due to boredom intolerance. The average person can endure boredom and still focus. This gives the average person the ability to concentrate on any task at hand, while the ADDer is unable to concentrate on a task experienced as dull.

The ADDer being boredom intolerant has great difficulty getting down to a task perceived as boring. Others often see this as procrastination. It is not because of laziness the ADDer is procrastinating, it is due to boredom aversion. Boredom is so painful to the ADDer’s soul, that the mind desperately searches for some excuse to avoid it, thus the easy distractibility. This is also the reason for daydreaming. The daydream is far more stimulating than the boring task at hand.

The exception is in a time of crisis. This explains why the ADD/ADHD personality procrastinates till it is too late, and then suddenly is able to complete the task working through to the early hours in the morning of the deadline.

The attention dysregulation is an inability to decide that now I am going to concentrate on this boring task. It is not a lack of discipline, it is an inability. Also there is an inability to choose what to hyperfocus on. The hyperfocussed subject is what the ADDer is interested in, not something chosen for him/her. There tends to be a shift between these extremes and little activity in between where the average person lives.

So true ADD ADHD is not an attention disorder, but attention dysregulation and boredom intolerance.

If a family member, a friend or we ourselves have ADD-ADHD symptoms we need to understand ADD and have confidence in that understanding. We need to assess what the doctors tell us based on our own understanding of ourselves, and not on some abstract “average” individual.

There are over 100 causes of ADD/ADHD like behavior, one of which is having an ADD/ADHD personality. The consensus says coffee will make us active and keep us awake at night. Coffee relaxes me when I am stressed, and I can drink a strong cup of coffee at bedtime, and easily fall asleep. I do not believe I am unique; there must be many people out there in the world who respond to coffee like I do. Consensus refers to a theoretical average person, not a specific individual.

Firstly, the term by which this condition is called has changed over the years (or at least the last century). Mainly because it has been serially misunderstood by science over the last century. Is it any different today?

The latest standard by which the vast majority of health professionals anchor their opinion is now 20 years out of date. The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders 4th Revision) was published in 1994 (based on opinions that had to be at least a few years old to be considered consensus). The next revision, the DSM-V, is due out in spring 2012.

During the last decade there have been tremendous advances in technology enabling scientists to study the workings of the brain. These advances are not reflected in the current DSM-IV.  The new DSM-V will give a different standard than the current one.

This may be OK for a health professional shuffling checklists behind a desk. But where does that leave us ADDers? Our condition is not an academic debate, but something we live with daily.

The terminology used in the DSM-IV is suspect, as admitted in the DSM-IV itself; it is not based on a diagnosable disorder, but purely on subjectively perceived behaviour.
“There are no laboratory tests, neurological assessments, or attentional assessments that have been established as diagnostic in the clinical assessment of Attention-Deficit/Hyperactivity Disorder.”

(DSM-IV-TR, page 88)

Three of the latest scientific attitudes on ADHD are that it is:

• an attention dysregulation, not attention deficit
• that it is a neurological disorder
• it is genetic.

I will be continuing with these three points tomorrow.