ABOUT LIFE
Jim Delpino, MLSP, LCSW, BCD, is a psychotherapist in private practice for over 33 years.
Email: jdelpino@aol.com Phone: (215) 364-0139.
Jim Delpino, MLSP, LCSW, BCD, June 2014
When Your Brain Races Like a Lamborghini
ADD/HD is a prevalent and often misdiagnosed neurological condition. It’s estimated that one in ten children in the United States has ADD/HD. This amounts to 5.4 million children between the ages of 4-17. Statistics reveal that it is about 96% genetic, with the remaining 4% being attributed to head trauma and environmental factors. About 92% of the time it comes through the genetics of the father.
ADD/HD is a neurological condition that is defined as a “…reduced neuroelectric activity and reduced blood flow in the frontal lobe.” The frontal lobe is the area of the brain immediately behind the forehead. The job of the frontal lobe is to maintain focus and concentration as well as judgment. Judgment is clinically defined as the ability to project the consequences of words or actions into the future. When the frontal lobe has impaired function it presents as difficulties in paying attention, remembering, following directions, hyperactivity and impulsivity, which are all symptoms of ADD/HD. Of all these symptoms, impulsivity is the key or central symptom and presents many of the greatest concerns associated with ADD/HD.
There are subtypes of ADD/HD where certain symptoms present more seriously, such as hyperactivity or inattention. Like all medical conditions, it occurs with three possible levels of severity: mild, moderate and severe. On average, a child with ADD/HD presents as 20-25% less mature than their current age. Imagine a 16-year-old who is functioning at the maturity level of a 12-year-old with an impulse disorder learning to drive. The consequences and risks of undiagnosed ADD/HD can be quite severe.
People who work with or are in frequent contact with children are quick to surmise that bad behavior automatically means a child has ADD/HD. There are many reasons why a child might be misbehaving, not paying attention, etc. Because it is so prevalent, ADD/HD can be misdiagnosed or even undiagnosed. Inattentive subtypes are often dismissed and missed because they often do not present with hyperactivity or misbehavior. Whereas hyperactive children are often spotted and diagnosed earlier on because the hyperactivity is so clearly present and therefore easy to observe. The most important thing to do in a case where it is suspected that a child might have ADD/HD is to get a correct diagnosis.
Correctly diagnosing ADD/HD requires a good family history. Because it is 96% genetic, there should be family members, parents, grandparents, aunts and uncles or cousins who have demonstrated some or all of the symptoms of ADD/HD. It’s important that the symptoms were displayed at an early onset. Many times a review of school records and teachers comments on report cards will indicate early concerns about the child. It’s also important to have the results of a full battery of psychological and educational testing to review. Some conditions may mimic symptoms of ADD/HD but not be the result of this neurological condition. For example, depressed children can exhibit poor concentration and focus. The standard clinical protocol for diagnosis of any mental health disorder is three interviews on three separate occasions to correctly diagnose and formulate a treatment plan. Although some insurance plans may not cover three visits for a diagnosis, it’s more important to have a correct diagnosis than a quick one that could be incomplete or wrong. The human brain matures on average at about 25 years of age. In cases of ADD/HD the brain reaches full maturity at 30 years of age. As always, early diagnosis and treatment is the best way to treat ADD/HD.
The two most common concomitants—diagnoses that frequently appear alongside of ADD/HD—are ODD (Oppositional Defiant Disorder) and low esteem/depression. Low esteem and depression are often the results of feeling stupid in regards to academics. Not being able to concentrate when reading or having sufficient focus to understand things presented in the classroom often contribute to a lower sense of self. Being oppositional is often viewed as impulsivity but it may also stem from the inner frustrations of not being able to behave within social norms and reacting to the criticism received from such behaviors. Sometimes it’s the defiance that brings a child into treatment and a major underlying cause is found to be ADD/HD. In some cases impulsive behaviors that are high-risk draw the parents’ wish to seek treatment for their child. Sometimes teenagers come to treatment because they have self-diagnosed by taking the medicine of a friend with ADD/HD and being convinced the medicine worked for them. Taking someone else’s medications does reflect the poor judgment associated with ADD/HD, but a good clinician will have to rule out the possibility of the placebo effect and correctly diagnose the child.
A treatment plan is most often developed with a physician in concert with the therapist. Many times the physician is either a family doctor/pediatrician, psychiatrist or neurologist. Although some parents feel opposition to their children taking medication, studies indicate that appropriate type and dosage along with psychotherapy provide the best results.
Parents often feel responsible for ADD/HD and are frustrated with the kinds of challenges associated with raising a child with the condition. Family therapy with a focus on methods that are effective in helping a child do better at home and school is a good suggestion. Of course, there are many adults who have gone misdiagnosed or not diagnosed with ADD/HD who seek treatment because their functioning has been sufficiently impaired so as to affect their work, relationships, child-rearing and general organization in their lives. With the correct diagnosis and treatment plan most people with ADD/HD can show significant improvement in several areas of their lives.