Attention Deficit Disorder (ADD/ADHD) and Avoiding the Problem of Medicating a Developing Brain

Attention Deficit Disorder (ADD) appeared first in the 1980 Diagnostic and Statistical Manual of the American Psychological Association. Today ADD means different things to different professionals, depending upon their field, their level of experience and medical knowledge, and their cultural beliefs about how children should act.

Parents are often surprised to learn that there is no particular medical or neurological abnormality present in individuals diagnosed with attention deficit. Instead, the diagnosis depends upon subjective assessments by parents, teachers, or professionals with little or no understanding of the neuroscience of learning and behavior.

In fact, the National Institutes of Health (NIH) issued a consensus statement in 1999 warning that the causes and treatments of ADD are only speculative. In a very real sense, the diagnosis itself is only speculative.

In spite of this, individuals and even very young children who are given a diagnosis of ADD are typically given a prescription for an amphetamine, usually methylphenidate. This amphetamine is very similar to cocaine in terms of its effects on the brain (see Volkow et al, 1995); both drugs compete for the same binding sites on brain cells, both are taken up into the same areas of the brain, and both produce similar psychological effects. Perhaps the major differences are that methylphenidate remains in the brain much longer and the psychological expectations associated with the drug are much different.

Both methylphenidate and cocaine affect the brain by increasing levels of dopamine in the frontal lobes, an area responsible for motor planning, learning, problem solving, impulse control, memory, attention, language, analytical thinking and social behavior, and the striatum, an area responsible for processing and integrating sensory information.

Increased levels of dopamine make the brain feel powerful and happy and can produce addictive behaviors and responses. Elevated levels of dopamine also alter other neurochemicals and affect control muscle movements, sleep/wake cycles, hunger and satiety, arousal, heart rate, blood pressure, and stress responses.

If these altered levels of neurochemicals persist for too long (e.g. several weeks), the brain begins to try to bring the levels back to normal. If a neurochemical has been elevated for too long, the brain will begin to shut down some of the receptors for that neurochemical and will begin to kill off some of the transporters that move the neurochemical through the brain. We call this effect "downregulation."

After about three weeks it is possible to see these architectural changes with the electron microscope; after about four months the changes are significant. Four months on methlyphenidate, for example, will result in the loss of about 75% of the dopamine transporters and 20% of the dopamine receptors in the striatum (Vles et al, 2003). The striatum is an area of the brain critical for sensory processing, learning and memory.

Downregulation can have significant effects on the developing brain long after the drug has been withdrawn. Early exposure to methylphenidate, for example, has been linked to decreased interest in sex, food, emotional experiences, and novelty, and an increase in anxiety and stress levels in adolescence and adulthood (Bolanos, et al, 2003).

Of course, the brain can also "upregulate" by growing more transporters or receptors or making the remaining receptorsor more sensitive. However, upregulatio takes time.

It is dangerous to abruptly stop taking a medication after downregulation has occurred, so following a weaning schedule is recommended. The speed at which an individual is weaned from a drug like methylpheidate is based on the length of time they have been taking the medication and the dosage that they were receiving. A physician familiar with the neurological properties of the drug should be consulted before attempting to wean someone off such a drug.

Regardless of the problems associated with medications used to "treat" attention deficit, the question remains as to why a child is having problems paying attention. There are a host of metabolic, immunological, neurolgoical sensory and psychological causes of inattention including: metabolic disorders, allergies, toxins, sleep disorders, vitamin or fatty-acid deficiencies, thyroid disorders, diabetes, depression, boredom intolerance, high intelligence, high creativity, frontal lobe dysfunction, auditory or vestibular processing disorders, and learning disabilities.

Correctly identifying the underlying cause of inattention can help parents and medical professionals avoid the problems of exposing a developing brain to medications that alter neurochemicals, produce downregulation or create long-term side effects that may be far more serious than inattention.

The author, Michelle L. MacAlpine, Ph.D., is a cognitive developmental neuroscientist specializing in the assessment and treatment of sensory processing disorders, attention deficit, and developmental, academic and cognitive delays.

More information can be found at http://www.braintraining.com

ARTICLE REFERENCES
Volkow ND, Ding YS, Fowler JS, Wang GJ, Logan J, Gatley JS, Dewey S, Ashby C, Liebermann J, Hitzemann R, et al. 1995 "Is methylphenidate like cocaine? Studies on their pharmacokinetics and distribution in the human brain." Arch Gen Psychiatry. 52(6):456-63.

Vles JS, Feron FJ, Hendriksen JG, Jolles J, van Kroonenburgh MJ, Weber WE. 2003 "Methylphenidate down-regulates the dopamine receptor and transporter system in children with attention deficit hyperkinetic disorder (ADHD)." Neuropediatrics. Apr;34(2):77-80.

Bolanos CA, Barrot M, Berton O, Wallace-Black D, Nestler EJ. 2003."Methylphenidate treatment during pre- and periadolescence alters behavioral responses to emotional stimuli at adulthood." Biol Psychiatry. 54(12):1317-29

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High Sensitivity is Everyone's Problem - Reduce Overstimulation and Increase Self-Respect

High Sensitivity (HS) in a nutshell has to do with the amount of information that a person has to process.

The highly sensitive individual has a cognitive style which permits more sensory information to enter and which also processes this influx of information in more detail. While HS is often related in the public's mind to sensitivity to sounds and smells and light, it also pertains to human interactions such as being aware of other people's emotional and physical responses and detailed processing of conversational or theoretical information as well.

For example, Highly Sensitive people (HSP'S) often feel that they have to work harder than others to participate in fast moving conversations. They might say that by the time they have thought to their satisfaction about what one person has said, two others have already added more ideas to the mix. It may sometimes feel impossible to keep up. For the highly sensitive, the world often seems to be moving very fast. Even a hundred years ago in the time of Model-T Fords and telegraph wires a very sensitive individual might have complained that the world was running incomprehensibly fast.

Environmental sensitivities and ADD... we are all becoming "too sensitive" But sometime in the last thirty years or so our technology and speed of life has surpassed the ability of even the non-sensitive among us to keep up. More and more as a culture we are becoming overwhelmed and over-stressed by the pace of life around us.

Workers in call centers are required to speed up the pace of their calls. Technology makes it unnecessary to spend even the few seconds needed to key in a phone number manually. High powered executives rise at 2 am to check the stock market opening in Europe or field calls from subsidiaries in Asia. More and more children and adults are suffering from environmental sensitivities and sensory integration difficulties as the world moves faster than any of us can process. In fact, neurologist and George Washington University professor Richard Restak suggests, "As a result of increasing demands on our attention and focus, our brains try to adapt by rapidly shifting attention from one activity to another--a strategy that is now almost a requirement for survival. As a consequence, attention deficit disorder is becoming epidemic in both children and adults." It might even be more accurate to propose that our attentional capacities are not "deficit" but instead overwhelmed.

Every week-end it seems the local news paper sends us a double message. "There are so many exciting, necessary or possible things to do in your life". At the same time the health pages teem with other articles reflecting on the damaging effects effects of fast paced life on the family and in the workplace. Articles appear about over-scheduled children and stress on pets. My neighbor is no longer just over the fence. I can Skype her in her hotel room in Bejing to ask her if I should water her garden.

When the speed of life increases unreasonably, our physical bodies suffer and we become aware of this. We may look for reasons in the environment for the way we are feeling and may try to eliminate the "environmental dangers" we feel we can control such as the chemicals in the photocopier, additives in our food and our neighbors perfume. While this may be a natural response we may sometimes be barking up the wrong tree if other relevant interpersonal, emotional and arousal-related pressures are not also addressed.

A personal experience...

In New York City I dined at a table for 16 in a room with 250 other diners. The noise level was incredible. We followed it up with a "leisurely" stroll through busy New York streets and ended up at 11 pm in Times Square, surrounded by flashing lights, story-high electronic billboards and thousands of people moving chaotically. The cumulative effect of that now "normal" stimulation was to leave me feeling overwhelmed, panicky and wishing to escape to my hotel room to digest the experience. I had reached my "subjective limit" of overstimulation and I wanted out!

The subjective experience of overstimulation is the same for everyone.

Highly sensitive or just ordinarily sensitive, we can all reach the point of being overstimulated and when we do the internal experience is exactly the same for all of us... aversion, irritation, blame of self or others and a panicky wish to escape.

As our social and physical environment becomes increasingly complex and fast-paced, more and more of us are reaching moments or levels of overstimulation which are hard to tolerate.

As the world speeds up around us, we are all beginning to respond as if we are "Highly Sensitive Persons" because we all live constantly too close our personal edge of overstimulation.

Whenever we reach our personal point of overstimulation, and when that experience becomes increasingly frequent, our choices become identical to those of the highly sensitive person. We can melt down and hope that others take care of us, we can behave badly and coercively in an attempt to change or control the situation, we can lash out in anger, flee, or isolate ourselves too rigidly.

Alternatively we can respond by acting consciously and responsibly to reduce our immediate level of stimulation or proactively by working to reduce the general level of stimulation to which we expose ourselves

The skills of the Highly Sensitive Person become relevant to all of us.

The idea that we might wish or need to set voluntary limits on ourselves... the wisdom to track our own responses, physical and emotional, the requirement to be be responsible for our own self-care, our willingness to accept that we may not be able to do everything, do it all the time or as fast or for as long as some other people do.... needs to be strengthened.

We need to become more attuned to our own natures and those of others around us. We need to learn to recognize the signs of overstimulation and stress in ourselves and in those we love. We need to become willing to control and reduce our level of stimulation and that of those around us.

Reduce overstimulation--increase self-respect.

Reducing the stress caused by overstimulation requires a special kind of discipline, an inner willingness to "buck the trend" and to enforce limits on ourselves. It may even mean having the personal strength to risk appearing "slow" compared to others at times. At the same time, being willing to respect one's own realistic limits is an act of great self respect.

As a result, taking a stand and asking others to respect your individual limits in terms of rstimulation increases feelings of control, efficacy and leads directly to increased feelings of self-esteem.

References:

Restak, R. (2003) The New Brain, How the Modern Age is Rewiring Your Mind, Emmaus, PA., pg 45

Susan Meindl, MA, is a licensed psychologist in private practice in Montreal Canada. She has a special interest in Jungian ideas and practices a Jungian approach to psychodynamic psychotherapy

http://therapists.psychologytoday.com/rms/59983

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