010 - Attention Disorders Exist
Post date: Nov 11, 2015 5:52:11 PM
Counselor Notes 10
October 21, 2013
Attention Disorders Exist
Welcome to the first edition of Counselor Notes for the 2013 - 2014 school year. I have allocated the whole year to addressing the issue of attention problems. This means a lot of material on Attention Deficit Hyperactivity Disorder (though I would add that not all problems with attention stem from ADHD).
Those parents that are hopeful that I can provide a simple way of eliminating attention problems may as well stop reading now. I don’t have any simple answers. I would expect though that the information I will send out this year would help minimize issues. Unfortunately, completely eliminating a true case of ADHD is not something that I can do. (Other cases misdiagnosed as ADHD there can often be a lot done for.)
Children didn't ask to have these challenges though so let’s hang in there.
For this issue, I want to establish that there really is such a thing as attention deficit disorder. I know there are those that say the whole issue with attention problems is generated by the drug companies. Well, I for one would have to differ with that. There is something going on with far too many children these days. In my mind there are a host of factors that contribute to it. (More on them later.) At this point I would seek to establish that the disorder exists and there are actual measurable brain differences for kids who get lumped into the ADHD group. It is going to contain a good bit of biology and technical terms, but you don’t really need to understand all that to come to see there really is something going on. Here's my argument:
Dr. Daniel Amen did single photon emission computed tomography (SPECT) on people with ADHD. (SPECT is a “nuclear medicine study that evaluates brain blood flow and activity patterns.” Amen, p. 44) Amen found that there were six distinct types of brain scans (Healing ADD by Daniel Amen, M.D. p. 61 – 66):
1. Classic ADD – normal brain at rest, but when concentrating, there is “decreased activity in the underside and lateral prefrontal cortex.”
2. Inattentive ADD – normal brain at rest, but there is “decreased activity in the lateral prefrontal cortex” during periods of concentration.
3. Overfocused ADD (“trouble shifting attention, frequently gets stuck in “loops of negative thoughts or behaviors, obsessiveness, excessive worrying, inflexibility, frequent oppositional and argumentative behavior.”) - “at rest and during concentration there is increased activity in the anterior cingulate gyrus. During concentration there is also decreased activity in the underside and lateral prefrontal cortex.”
4. Temporal Lobe ADD ('inattentiveness, irritability, aggressiveness, dark thoughts, mood instability, learning problems, inattention and impulsivity.”) - “at rest and during concentration, there is decreased and infrequently increased) activity in the temporal lobes. During concentration there is also decreased activity in the underside and lateral prefrontal cortex.”
5. Limbic ADD (inattentiveness, chronic low-grade depression, negativity, 'glass-half-empty' syndrome, low energy, and frequent feelings of hopelessness and worthlessness.”) - “at rest there is increased deep limbic activity (thalamus and hypothalamus) and decreased activity in the underside and lateral prefrontal cortex. During concentration there remains increased deep limbic activity and decreased prefrontal cortex activity.”
6. Ring Of Fire ADD (Inattentiveness, extreme distractibility, anger, irritability, oversensitivity, moodiness, hyperverbal, and extreme opposition) - “at rest and during concentration (often worse during concentration) there is patchy increased uptake across the cerebal cortex with focal areas of increased activity, especially in the left and right partial lobes, left and right temporal lobes, and left and right prefrontal cortex. In addition there is often increased activity in the cingulate gyrus.”
If there was noting going on then these types would not have similar brain scans. There is more though.Ten days ago, this article was in the news also indicating brain differences: http://www.healthline.com/health-news/mental-brain-scans-reveal-differences-in-ADHD-subtypes-101113
Harvard Medical School’s Edward Hallowell M.D. and John Ratey, M.D. write in Delivered From Distraction:
• “…ADD is associated with slight but significant differences in specific regions of the brain.” (p. xxxv)
• “Four different studies done in the past decade using MRI (magnetic resonance imaging) all found a slight reduction in the size of four regions of the brain: the corpus callosum, the basal ganglia, the frontal lobes, and the cerebellar vemis…. The frontal lobes help with organization, time management, and decision making, all areas that people with ADD struggle with. The basal ganglia help to regulate moods and control impulsive outbursts, which people with ADD also struggle with. And the cerebellum helps with balance, rhythm, coordinated movements, language and other as yet to be proven functions.” (p. 8)
• “…PET (positron emission tomography) scan study published in The New England Journal of Medicine showed differences in glucose metabolism in the brains of adults who had ADD compared to adults who did not.” (p. 55)
• “In patients with ADHD, parts of the cerebellum are smaller in volume and don’t function properly, so it makes sense that this could cause disjointed attention.” (p. 151)
• “The molecule that transports dopamine is called DAT, which stands for dopamine transporter…. Using a brain scan and a radioactively labeled molecule called altropane, scientists have measured the concentration of DAT in adults who have ADD and adults who do not.” (p. 154)
• “DAT turned out to be 70% higher in adults who have ADD than in those who did not.” (p. 154) Note: “High levels of DAT are also associated with a high risk for developing addictions of various kinds.” (p. 154)
Carla Hannaford Ph.D. writes in Smart Moves that:
“PET scans of children who were labeled ADD and ADHD showed substantially lower dopamine levels and smaller brain volumes than normal children, particularly in the gray matter in the right front area having to do with movement and integration of ideas. Also, two regions in the front of the corpus callosum were found to be smaller in these children: one region connects to the part of the brain involved in suppressing the impulse to fidget, the other activates the proper production of dopamine.” (p. 220 – 221
I also once went to a conference on ADHD where the presenter (Marilyn Thatcher Ph.D.) noted that a true ADHD person has:
· an average of 10% less total brain volume than normal (Note: the brain volume difference doesn't mean that they are unintelligent though - remember Einstein had a rather small brain.)
· right hemisphere differences
· a reduced hippocampus volume
· atypical development of cerebella vermis.
For those interested, here are two good sites on the facts vs. myths of ADHD check out:
Last summer, Psychology Today had an interesting article on raising a child with a disability. The article focuses on a child with autism, though some of the stresses and strains on finances, marital relationships, etc. would overlap to a degree with parents of a A.D.H.D. child. It is worth reading: http://www.psychologytoday.com/articles/201306/love-in-the-time-autism
We have parent – teacher conferences this week from 3:30 to 6:30 on Tuesday and Thursday. I will be in Room 405 (green striped hall, past the cafeteria) if any parent should wish to see me.
Please feel free to email these notes to people you think might find them of use.
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Next issue, I am going to launch into a series of notes on diet and attention. It will be of a similar “flavor” to this email. I have heard an unconfirmed report that Eden's Bounty (Waverly Court Square) will have a speaker from NY discussing using diet to help control ADHD symptoms tomorrow at 6:30. This is unconfirmed. I will send along more information tomorrow (if the presentation time & topic are confirmed).