ADD Smackdown


EDIT: Apologies to any readers that have come by to read this post.  I was having a discussion with another blogger that necessitated me to check some links here and some have changed–thus requiring some further edits and notes.

Alright, this has been a real bugbear as it’s been sitting as a Draft for what feels like forever. And it may not even be fit to be written on several sheets of bog roll. And I think I need some more tea before I even attempt to look at again to “ADD” some more things?

So to open, what is the source or cause of ADD? Oh dear. What to say? Rather complicated to be sure.  It runs the gamut of so many theories. I’ve read a lot of things, some of which seem rather…interesting?

A genetic link, neurochemistry, smoking during pregnancy causing hypoxia resulting in brain injury/trauma, drug use during pregnancy, diet issues due to it/people being poor, children being “addicted” to milk caused by peptides that result in a poor ability to digest whey protein and lower levels of fatty acids in the body. Also, Sleep Apnoea and head injuries in general. I think the one that made me laugh truly was lead exposure during pregnancy! This was on some doctor’s blog. Unfortunately, the link talking about it resulted in a 404 error–no kidding, right? Can you say quack?

Now of course, all of these things have been unconfirmed but in my “esteemed” opinion, I prefer the two former? I suppose as far as genetics go, I think a lot of our head messiness can be passed on from other family members who are also mentally ill. There is also so much cross over between a lot of illnesses/disorders where again, there are strong genetic links that have been possibly shown. Neurochemistry? Well, the ADD meds seem to help a lot of people so a strong possible link there. And I’m a big fan of science so maybe my bias is showing.

Whoops! Better tighten my belt and pull up my pants a little!

Now, meet Dr. Daniel Amen. He’s rather interesting. He performs SPECT scans on your brain for “malfunctions” and claims that you can do several things to heal your brain and take care of it to get better. Lots of additional things besides meds–lots of “healthy” things. He’s also into some brain injury stuff as cause. He has rather a huge following and has been doing the scans since 1999. He’s also rather expensive…

He does have an interesting and fairly decent online self test here. It delves a bit into the types of ADD and areas of the brain where some things happen. He suggests some meds that may assist that he feels work best and also some natural and dietary solutions. The test also explains in some brush strokes about the brain areas and how they may function.

I did this a long time ago and in doing it again, I scored the same if memory serves. Except, for “Temporal Lobe: Not Probable” which is kind of ridiculous as I have a seizure disorder, although not defined as TLE (Temporal Lobe Epilepsy.) However, Topamax, the good ol’ Temporal Lobe drug, did a lot for my seizures but not quite enough. That tells me that something was probably going on there.

But whatever. I probably inadvertently scored myself lower as I’m on meds for some of those questions? Or Amen’s got it all wrong on his questionnaire. However, one thing that he did make clear in his results that is basically correct, is that girls who tend to have ADD Inattentive Type (me) and a lot of others as well, get missed in the diagnostic process. We’re just not so freaky hyper and more day dreamy and out of it. Nonetheless, we’re just as screwed up. Thanks Danny boy, for recognizing our little spaced out clan–much appreciated as half of the time we’re not listening anyway.

EDIT: I must stress something about Amen’s test and all tests in general.  Due to changing the dead link, I “tested” the test.  Also, you need to take a “Subtype Test” to get any “results.”  It came out incorrectly as per my actual dx.  So people, please do not take these things as gospel.  Also, I have removed another, second self test, as it now leads to a bunch of videos! Good lord!

Now, please meet Dr. Harriet Hall who wrote this on quackwatch.org. regarding Amen. Okay, now we’re getting into an ADD smackdown! She doesn’t like him at all.

I have a book called “Scattered Minds A New Look At The Origins And Healing Of Attention Deficit Disorder” by Gabor Mate M.D. Dr. Mate actually has ADD–as do his three children. Now, I love it when physicians admit that they have an illness and are open about it.

He has some interesting takes on causal factors. He isn’t opposed to any sort of genetic link but he is clear that may only be part of the picture. And he highlights that there is a difference between genetic predisposition and predetermination. This is certainly quite the obvious but perhaps sometimes people may think otherwise or forget due to the connection that they may seem to have and see with such frequency around them. He has some suggestions on environmental causes.

On the origin of ADD, he posits the idea of “attunement” with the primary caregiver (usually the mother) and infant. What this means (roughly) is that the infant bonds early and emotionally with the mother. Her actions, speech etc… reflect her internal mood states unconsciously. Anything that rocks the boat with Mommy may to mess up the kid’s head. And further it is the bonding and sharing of the emotional space that is most important with attunement.

This was tested with the “double TV experiment” as Mate calls it (apologies, I can’t find any links other than abstracts.) What happened was, the infant was shown a live feed of the mother interacting in a positive and happy way. The infant responded favourably. Within about a minute, it was played back and the infant responded as negatively or unfavourably as a mother with a “flat face,” (i.e. no positive response.) So basically, the infant needed more than happy, visual signals.

Further, the mother can’t fake it either. Due to “emotional sensory radar” that has not developed or been “scrambled” as Mate states, they pick up the false positive signals from the mother. This probably makes sense in a developing brain? Early brain formation and development is extremely plastic when younger. As an infant, with no other communication skills and a brain that is just in its infancy…it would just absorb everything like that on a different level? As adults, our “radar” has evolved and changed–along with our ability to communicate and process that communication. We can miss the cues all the time in our degrees of perception.

With attunement, the infant basically leads the “dance” as it is often called. It’s not like the mother can control the infant’s behaviour and its need for attunement in the symbiotic, emotional connection that it is. The mother needs to respond to the infant in appropriate ways based upon the infant and how it behaves, what it does etc… A stressed, anxious mother may lead the infant to not be able to understand or pick up the cues. Also, if the attunement is broken off with the infant and the mother tries to push, it can lead to too high arousal levels in the infant and that causes problems. Either way, the dance is completely thrown off.

Now, I believe the key to the issue of the arousal levels being thrown off as he mentions is that the infant brain doesn’t get a chance to “cool off” before the attunement “dance” repeats the cycle. The kid’s brain is still a bit hairy and not ready to “readjust” to start leading the dance again.

Theoretically, without proper attunement, people grow up to feel alone, isolated and that no one understands them. Attunement is the beginning of a larger issue called Attachment. That is the feeling to belong and a need for closeness to other people. These are some of the issues that people with ADD face–so says Mate. And the “Attunement/Attachment Theory” really isn’t new. Mate is simply applying it to ADD.

Okay, I sure feel alone, isolated and that no one understands me! Well, maybe they do but I don’t understand them? Or…erm… Nevermind. Well, I know I don’t understand myself. Okay, on with more Mate.

I found an interview with Mate online that further fleshes things out past the infant stage and how to “heal” ADD. This is good because the book is 323 pages long as I sure as hell couldn’t read it to write this post. You’d be waiting for ages! Crap, I’m just moving on from Dr. Seuss and getting back to reading newspaper articles. That I haven’t been able to do for months.

So as things move on, Mate still stresses that environment is still key. It’s not like after the attunement process with the infant has been completed (or rather screwed up) with your ADD kid that’s it, over, finito, bye bye. You need to create that proper environment in order to treat ADD symptoms. He states that emotional self-regulating circuits can still develop in childhood and even in adulthood. So, provide the right conditions, create development, ADD gets better–or it can.

Okay, maybe I’ve smplified things but that’s more or less it. But fear not. He isn’t anti-med.

And of course, the book is filled with all sorts of other things about ADD. Discussions with patients, lots of observations and insight to the disorder. Mate certainly understands it. And I certainly will not disagree that children with ADD need nurturing, supportive and (further to the attunement theory) a non-stressful environment to grow up in.

I’ve found it a rather good and interesting read. And I do also find his theory about attunement, attachment, infant development and ADD interesting as well. Boy, I sure know that my mother was a mess when I was an infant. There may have been a possibility of Postpartum Depression going on there? And her own mental illness(es) for sure. But I don’t know…I was just a baby. Who may have never received proper attunement from her!

But before I close, an interesting line about how he closed “Scattered Minds…”

If we can actively love, there will be no attention deficit and no disorder.

Well. At the end of the chapter there is mention about extending oneself to others or oneself in order to nurture on the basis of M. Scott Peck’s writing in “The Road Less Travelled.” On this basis, it is a difficult thing to do and particularly difficult for ADD adults. But I do find the above a rather interesting statement and it sort of makes me chuckle a bit.

Indeed, Dr. Mate…if there were more love in the world it would be a better place…

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  1. I’m suspicious of theories involving developmental factors. It’ll take a bit of explaining as to why, but an analogy might work.

    Humans have far less DNA than frogs. This is surprising because humans are undoubtedly a lot more complicated than frogs are. But it makes sense. A frog develops in a situation that’s highly variable. Frogspawn floats in rivers that can be warm or cold, acidic or alkaline. It hatches into tadpoles that are faced with similar problems. Subject a developing human to the same factors and things go very wrong. That’s why frogs have more DNA: It can select different developmental paths based on local conditions. Instead of having DNA that deals with huge variation in developmental conditions, humans (and most mammals) have taken a different approach. Humans develop in conditions that are very stable. Rather than DNA to cope with variation, we develop in wombs. We’ve taken most of the chance out of physical development.

    Now, most animals have much simpler behaviours than humans do. Human behaviour is very, very complicated. There’s a few universals in terms of culture, but variation is the rule, not the exception. Because we have culture, our brain development has to deal with vastly more variation than a frog, a sloth, a marmoset, or even a chimp brain.

    So, in the same way that frogs have DNA that adapts to wide variation in conditions, it’s reasonable to assume that human brains have developed to cope with wide variation in parental behaviour. Obviously in truly extreme situations this breaks down (humans who aren’t exposed to language at key points have significant developmental problems, for example, but this is a very unusual situation), but most situations aren’t quite that extreme.

    Now, to address attachment specifically, childcare varies considerably. In rural Africa, for example, it’s not uncommon for young children to take large roles in the care of infants. The modern Western model of childcare with a primary caregiver (usually the mother) is probably quite unusual. There’s not huge amounts of research on this, but shared childcare done by whoever isn’t otherwise occupied is probably a more common method of childcare than the Western version that the attachment theorists seem to have assumed to be the one true way.

    (See what I mean about large variation in the developmental environment?) Unless everyone raised outside the normative Western model has developmental disorders, the attachment theorists have a fairly large gulf to explain.

    So, as far as I can see, there’s good reasons to believe that infant brains and minds aren’t anywhere near as fragile as most developmental psychologists seem to believe, and that most of their theories are based on some rather egregious assumptions.

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  2. Hi chimpy…sorry about the delay, sweets. Yesterday was horrid at work so finally getting ’round to my blog. And last night I got derailed and was out late–so back at a computer today!

    You make some very good points. Do humans really have less DNA than frogs? Huh. Okay, looked some stuff up but we have more genes?

    I do get the distinctions between physical development and brain development due to yes, culture and being more complicated as humans. For sure.

    And I do agree with you about the Attunement/Attachment theorists. They only really say mother but it can apply to any primary caregiver. However…you are very correct in that it is a Western model. Other cultures do raise children in other ways so…yes, how do we gauge ADD there?

    So yes. You seem to have added to the “Smackdown” yourself! Excellent!

    Another “criticism” I read of Mate online (or a dig, smackdown, whatever…) was that his parents were Holocaust survivors so there was a lot of ingrained guilt and trauma or some such. Oh goodness…

    So yes…poor Mate did not get his Attunement either?

    Again, like I said in the beginning, I like my genetic and/or neuro possibilities. Or at least the latter these days? That’s maybe the Concerta talking *grin*

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  3. The dirty secret of biology is that nobody’s quite sure what a gene actually is. Or rather, there’s several different definitions that are useful in various contexts. For example, in one context, a gene is a section of DNA that encodes a single protein, while in another context, a gene encodes a single characteristic. This gets complicated, because some proteins can fold in different ways for different effects, or can affect multiple characteristics.

    Most pop-genetics books/tv shows over the last 20 years or so got caught between the bit where the geneticists were going “DNA! It’s a blueprint of life!” and the bit where they started to say “DNA! Uh… We’re not entirely sure…”

    Which isn’t really relevant, but is hopefully interesting…

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  4. damewiggy

    wow chica, you have a lot of info sources and possible contemplations in this one.

    such a smart cookie. ;)

    i don’t know squat on the subject, but i’m a big believer in genetics, and i’ll tell ya why. my mama was a bitch and my father was a fair man — and i’m a fair bitch, man. it’s like making milkshakes. really!

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  5. Hi chimpy, you know I don’t care about “relevance” or people straying wherever they wish on this blahg in my comment section. And you always write interesting things.

    Hi damewiggy, thank you for your compliments on this post and calling me a “smart cookie.” You are sweet.

    And I like milkshakes. Yum.

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  6. An Oracle

    You really need to start actually reading a bit of the medical literature if you are going to post sarcastic remarks about it.

    ADHD is a cellular redox problem – a lack of adequate scavenging of respiration-associated free-radicals in over-active brains. A good starting point would be read about brain excitotoxicity caused by excess glutamate. Without going into the boring biochemistry behind the condition, ADHD may be associated with of excessive stress reactivity – a maternally “programmed” function. Another way to look at it is poor stress coping reserves OR a very low threshold for stress-damage (eg, you don’t make sufficient free-radical scavengers – antioxidants).

    That condition arises primarily as a function of lifestyle. Shitty diet, lack of exercise, poor stress coping mechanisms (procrastination, OCD-like fixation on problems, etc).

    Dr Amen is WAY ahead of the pack. He understands that a brain must have balance between key function centers. When various causes put certain centers on hyperactivity and make others underactive, then you have an essential “map” that is unique for each common neurological disorder (including, interestingly, sociopathologies).

    So you see, both them are correct. The TENDENCY towards developing ADHD is dictated by maternal stress response mitigating capacity, but the disease condition develops due to a primary dietary lack of antoxidants and key minerals (associated with fresh foods), inadequate hydration and poor sleep coupled with a sedentary lifestyle.

    You reap what you sow, eh?

    Fixing this problem is remarkably simple. Improve the diet – remove excess sugars/starches, salt and animal fats, add vegetables (roots and greens) and fresh fruits (in moderation), axe the caffeine and add water. Adopt a habit of daily walking, meditation, and make sure you adhere to a healthy sleep habits.

    In a matter of weeks, sometimes, days, that fog will start to lift and, with meditation (that conditions the brain towards focused activity rather than scattered over-activity) practice, you should see a dramatic improvement in your condition, such that you may be able to reduce and eventually cease reliance on medication.

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  7. Hi An Oracle, thank you for your comment. I re-read my post and I didn’t think I was posting any sarcastic remarks as you say. Unless you take issue with my use of humour? I do use that a lot on my blog and it is generally applied to myself. However, I also think it is “healthy” for those of us who are mentally ill or disordered to take a step back and try and laugh a little bit at our lives for if we do not, we certainly will perish!

    As they say, “Laughter is the best medicine?”

    What you have stated is, yet again, another hypothesis for AD(H)D. Now, as I stated in the beginning, I only listed some of the hypotheses that I had read. And yes, they were actually found on the internet. Part of this was to show that a) there are lot of hypotheses and b) there can be a lot of silly thinking on the internet!

    Further, I could not list everything. For it may not be out there, new studies are being done all the time and I need to keep my posts within a reasonable length–and of a variable calibre for my audience. I do not know who is reading so I like to keep it balanced.

    I find it interesting in your comment that you chose the word “may” after not going into the “boring biochemistry.” This indeed states that it is a hypothesis that you are speaking of? Also, you did not provide me with any links to any scientific studies done to actually prove that AD(H)D is a cellular redox problem?

    I had a peek and found one study regarding TAS (Total Antioxidant Status.) Actually, it was the only one I could find. Here’s the link to the page where I found the citation on Ray Sahelian M.D.’s page:

    http://www.raysahelian.com/glutathione.html

    Here’s the study:

    Redox Rep. 2006;11(4):163-72. Department of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic.

    Unfortunately, I couldn’t find the study online.

    But back to Sahelian’s page. In a comment he made regarding his study with the kids, he actually stated that:

    In the pathogenesis of ADHD genetic and non-genetic factors play an important role. It is assumed that one of non-genetic factors should be oxidative stress.

    Hmmm. Now, there is someone that agrees with what you are saying about too many free radicals (or the possibility that may be a cause) but…also that genetic factors may be a cause.

    In his work he looks Glutathione. It’s slightly different than Glutamate in its molecular chain structure. But suffice it to say, it probably has stronger antioxidant properties?

    He used Pycnogenol in his study. If you look at Pycnogenol on the site Drugs.com it states that you can try it but:

    “…the effectiveness, safety, and toxicity of pycnogenol for these disorders have not been tested adequately in clinical trials…”

    It also states some more AD(H)D stuff with a wee bit more study information.

    Another US patent was issued for a regimen and composition for treating attention deficit hyperactivity disorder (ADHD) by the use of proanthocyanidin with and without a heterocyclic antidepressant and a citrus bioflavonoid. 13

    A letter to the editor describes the treatment of over 100 patients with ADHD, using nutritional supplements similar to pycnogenol. 14

    The author found that the most important improvements noted by patients were in the areas relating to sustained attention and distractibility. 14

    A case report showed that a 10-year-old patient with ADHD demonstrated improvement when treated with pycnogenol. 15

    In most cases of children with ADHD, the common practice is to combine pycnogenol with dextroamphetamine (eg, Dexedrine ). 16

    I had to break it up a bit as I’d like to make some comments about this study information. And if anyone is confused, the numbers after the points are citations to footnotes on the website (the link to the page will follow after my comments here.)

    Footnote 13: Proanthocyanidin is a tannin that can act as an antioxidant. Bioflavanoids (or flavanoids if you prefer) also act as antioxidants. However, interesting that an Antidepressant would be added. Now for me–no dice. I have Bipolar and ADs make me completely nuts. But more to your thoughts on the matter…neurochemistry! A med would be helpful in the matter, as suggested.

    Footnote 14: The second part really is basic and doesn’t say much but a letter to the editor? Who wrote that letter? And wow… Over 100 patients?! Now in a study, that means nothing. For one thing, either the original population sample was way too small or the findings are worthless because 100 out of a proper sample study is peanuts!

    Footnote 15: Okay, again…a numbers problem with a study. A single 10-year-old patient had success. What about the rest?

    Footnote 16: Ah…in most cases, it works best with Dexedrine. And interestingly enough, Dex. is pretty much the “last resort” AD(H)D prescribed med. M.D.s usually like to go with a form of Ritalin or Adderall first.

    http://www.drugs.com/npp/pycnogenol.html

    As far as the various M.D.s involved in my post, all I did was present their sides as far as I am concerned. I stated some of my own feelings and opinions on causal factors but I certainly am allowed to do that! They are my feelings and this is my blog! And I am certainly allowing you to share yours.

    However, I will maintain that at this point, nothing is proven completely about the cause of any mental illness or disorder. If that were to be true, we would have “cures” or definite ways to solve everyone’s ailments. I won’t disagree that your suggestions are invalid or say that they are falsehoods. They may very well help someone with AD(H)D but I won’t say that they will work for everyone.

    There are no panaceas in this area.

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  8. Rob

    I believe there often tends to be some oversimplification of both ADD and ADHD.
    However, I found Oracles comments interesting especially in light of an interview with Dr Daniel Amen I recently read at http://www.webmd.com/content/article/79/96235.htm in which he breaks the condition down even further listing 6 different variations of ADHD.

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  9. Hi Rob, thanks for your comment and welcome. I think your statement is well posed in the “oversimplification” of AD(H)D and I feel, also many other mental illnesses/disorders. Everyone is different and can experience things in different ways. For a long time, I have “argued” that Bipolar is really a spectrum–not something that can be categorized neatly into “Types.”

    Amen’s perspectives are indeed interesting. No argument there. So are Mate’s.

    I had read about Amen’s variations–when you do the online quiz you get a breakdown of the system.

    I have been curious about Amen for a long time regarding my own brain and what one of my scans would look like since I have so many comorbidities! Not to mention, the AD(H)D types he mentions…either due to my comorbidites or well…I fit into a few of those categories!

    Thanks for the link.

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