ADD/ADHD

ADD and ADHD

Attention deficit disorder (ADD) and Attention deficit disorder with hyperactivity (ADHD) are very common disorders typically identified in childhood. Often, however, ADD is diagnosed in adulthood after those afflicted have suffered for decades.

I have been treating ADD successfully in children and adults for decades. I do this without drugs or medications. I use EEG neurofeedback to train the brain and nervous system properly. The success rate—with this treatment alone—is about 80%. When I provide additional interventions, the success rate rises to about 95%.

ADD affects 15-25% of school-age population. Its symptoms vary and occur in clusters: poor attention and concentration, behavior problems, distractibility, poor listening and lack of follow-through, restlessness, fidgeting, hyperactivity, impulsivity, moodiness, sleep problems, defiance, poor school performance, disorganization, social difficulties, aggressiveness, lack of friends.

In adults, attention deficit disorder frequently manifests in similar symptoms such as poor concentration, problems with sleep, getting things done, and often in managing relationships. Though some adults with ADD manage effectively, many find their condition interfering with achievement, personal satisfaction, and health. Common adult ADD symptoms include disorganization and procrastination, difficulty following through on time, meeting deadlines or forgetfulness. ADD is a significant risk factor for addictions; many adults endure years of “self-medication” to keep going, to feel better, and to subdue their symptoms.

What is ADD/ADHD?

Attention deficit disorder is not a disease; it is a disorder of self-regulation. This means that the person’s brain and nervous system do not adequately and consistently regulate or control the internal “housekeeping” functions that allow focus, mood stability, alertness and relaxation, performance consistency, awareness of time, sensitivity to the needs and communication of others, and a myriad of other tasks we take for granted when the brain is working properly.

My book, ADD: The 20-Hour Solution, describes five core characteristics of ADD/ADHD:

• Disregulation of the arousal system
• Poor integration with environmental demands
• Perceptual focus problems
• Stressed brain syndrome
• Compromised flexibility

When you consider what ADD really involves, you will understand why properly training the brain may be the best solution.

Treatment Considerations

Effective and enduring treatment trains the brain to become better at what it needs to do. This is how we treat people with these symptoms: we train their brains using computers. This method is proven, safe, natural, and long-lasting. It is a method called EEG biofeedback, also called EEG neurofeedback. It is drug-free.

You may have been told that medications are the best or most appropriate way to treat ADD. Actually, medication is the only treatment offered to most people. This is a sad and misleading way to address the complicated and stressful issues surrounding ADD. Though medications may be helpful in the short-term (and not for many sufferers), they have many disadvantages. Medications have side-effects: loss of appetite, stunted growth, liver problems, sleeplessness, and many others. Among the most destructive effects are the loss of enthusiasm and personality that frequently accompany these drugs. Additionally, many people experience “rebound” effects: when the medication wears off, they become, irritable, cranky, and less focused. Essentially, medications produce a cycle of withdrawal that develops a dependency upon them. This escalates into higher and higher dosages (with more side effects and less main effect) until eventually the medication no longer works. It is a vicious and unnecessary cycle, perpetuated by pharmaceutical commercial interests, lack of education and information, narrow-mindedness, and a poor understanding of how the brain works and the factors involved in human development.

Doctors talk of “chemical imbalance” or “receptor sensitivity” to explain and justify the continuous use of powerful drugs (controlled by physicians and the pharmaceutical industry) to rectify the supposed biochemical deficiency.

However, there are alternative methods to treat ADD effectively. These methods are natural, free of harmful side effects, and enduring. They work by enlisting the natural abilities of the brain to regulate the so-called chemical imbalances.

EEG neurofeedback is a highly effective method of training the brain and nervous system to relieve depression. Using this method, patients train their brainwaves using computers. This method takes advantage of the brain’s natural neuroplasticity by providing feedback that subclinically enhances the brain’s flexibility in manipulating the timing mechanisms underlying states of arousal and feeling.

Neurofeedback is a brain exercise that has pervasive and lasting effects. It enables the brain to find, develop, and restore its own “comfort” levels for maintaining good mood, calmness, and equanimity. Neurofeedback is effectively used for many conditions. Since it directly influences nervous system control, it almost always dissipates depression. After a training regimen, the brain continues to exercise the control it has learned. Focus and mood stability continue because the brain learns to maintain self-regulation.

The Chemical Imbalance Theory

The current political sway and much of the medical establishment (influenced by the powerful pharmaceutical industry) would have us believe that ADD is caused by biochemical imbalances—and thus the “cure” depends upon finding the right chemical agents (which keep changing as their flaws become apparent) to balance the deficiency. However, this simplistic model overlooks this basic fact: that life is a series of imbalances. Hunger, fatigue, sexual desire, cell repair, growth and aging—these are all cyclical imbalances that require adjustments and on-going corrections. This is the fabric of living. The body and mind detect, assess, respond to, and evaluate challenges regularly. These challenges involve routine biochemical functions (even maintaining body temperature), as well as perceptions of, accommodations to, and integrations with the environment. The distinct and persisting difficulties many people have in regulating these imbalances (including mood) comprise vulnerabilities, not necessarily diseases. (For more detail, see Steinberg & Othmer, ADD: The 20-Hour Solution, 2004, especially Chapter 8: The Cult of the Neurotransmitter).

Other Factors in ADD/ADHD

In addition to training the brain to self-regulate (on its own, without drugs), there are several important factors to address to normalize the ADD person. These include:

• Behavior modification
• Educational and work accommodations
• Diet
• Self-control skills

I provide effective and proven natural interventions that integrate these factors into improved brain function to assist people of all ages in functioning and feeling better.

• Disregulation of the arousal system 

Just as the human body has systems for respiration, digestion, circulation, cell rebuilding, etc., it also has a system for managing arousal.  Arousal refers to states of excitation and relaxation that are in constant relationship with each other.  Think of picking up a cup and then setting it down and letting go.  Your muscles must tense to grip the cup, and must relax to release your grip.  The nervous system performs similarly with regard to excitation and relaxation.  This continuous feedback loop is described technically in terms of the activity of the central nervous system, in particular of the voluntary nervous system.  This is aided and abetted by the involuntary, or autonomic nervous system, involving both the sympathetic and parasympathetic branches.  Collectively, this regulatory activity controls states of attention, wakefulness and sleepiness, impulsivity, mood, awareness, and also contributes to behavioral inhibition and disinhibition.

The arousal system manages or regulates a person’s appetites, perceptions, and abilities to control, soothe, gear up, and modulate oneself.  It may be likened to a biological thermostat that regulates internal housekeeping.  When this thermostat malfunctions or works only intermittently, the resulting glitches in the continual and automatic adjustment of arousal functions give rise to unpleasant symptoms and functional disruptions.

This fluctuation and irregular management of arousal is at the core of ADD, and it results in a variety of behavioral, emotional, and physical symptoms (such as anger, moodiness, difficulty concentrating, anxiety, sleep problems, etc.).  It also leads to inconsistencies in performance.

The aspect of arousal regulation is so important that all of ADD revolves around it.  Indeed, a more precise term than attention deficit disorder would be arousal disregulation disorder.

Neuroscientists describe brain function in terms of activation.  A brain that is calm, alert, and processing functionally is said to be activated.  A de-activated brain exerts less differentiation over its electrical activity, its neurotransmission, and, consequently, its self-management and outward responses.  A disregulated brain has trouble activating and resting, recognizing cues for change, and shifting from a de-activated state to an activated one, and back again.

ADD is characterized by disregulation in brain activation, often reflected in the inefficient activation management of the EEG.  Although the EEG may not typically show morphological abnormalities (marked deviations in the type or structure of the brainwaves), the EEGs of ADD people are often less differentiated, less activated, and less responsive to internal and external cues requiring shifts in activation states.

• Poor integration with environmental demands

A common complaint about ADD children is that they do, in fact, pay attention, but mostly to what interests them. Usually they can sustain attention for prolonged periods when they are engaged in activities of their choice. Perhaps you’ve heard or echoed the refrain, “It’s amazing how he can sit and play video games for hours, but he can’t pay attention to his work for more than two minutes!”
Disregulation of arousal predisposes people to become drawn to (possibly fixated or “stuck” on) highly stimulating, novel, and even risky activities because the activity stimulates their brains and makes them feel involved, even more normal. (This is also why stimulant medications work to make people pay better attention.) When the nervous system is underaroused, substances or activities that boost arousal become desirable, and may become addictive.
People with ADD have atypically inconsistent performance. This is due to fluctuations in arousal management. By contrast, what is notable is their consistently better performance on tasks they select and on time schedules that suit them. Realistically, most of us are more interested and involved in activities we prefer. The difference with ADD folks is that their performances on tasks they choose are markedly better than on those delegated to them. This selective attention factor (so entwined with arousal) also reflects in the difficulty ADD individuals have with schedules, deadlines, timeliness, and conformity. People with ADD tend to function at much higher levels when they choose what they will do and when they will do it. Schedules, specifications, and demands imposed from the environment (even routine cues like bed time and waking time) can present huge problems in handling daily life.
Parents and teachers often notice that ADD children have trouble transitioning or shifting from one activity to another. This, too, is a manifestation of disregulation—taking cues from the environment and integrating its demands requires fluidity of arousal. The brain has to shift gears and modify brainwaves — something usually quite difficult for the ADD person.

• Perceptual focus problems

A hallmark of ADD is distractibility, the faltering of attention and its ready disruption by random stimuli unrelated to the intended focus. Many ADD people are overly sensitive to sounds and other stimuli that intrude in their consciousness and vie for their attention.
Whether or not distractibility is an overt problem, the disregulation that underlies it invariably causes perceptual differences that throw the ADD person off track. Thus, novel stimuli or unique components elicit selective attention. While this can result in refreshing creativity and original perspectives, it frequently leads the ADD person to focus on unconventional, less relevant, and less productive aspects of a situation or problem. This leads to greater peripheral activity and reduced goal attainment.
Disregulation sponsors idiosyncrasies in perception that make less important details seem salient. It promotes a perceptual style that predisposes the ADD individual to attend to the urgent rather than the important. It can cloud judgment and boost impulsivity. Perceptual anomalies can also color information processing and make it more arduous and inefficient.
Perceptual distortions are much more likely when you study postage stamps from across the room, or you watch a movie with your nose pressed to the big screen. Though these may seem like metaphorical exaggerations, they typify the perceptual idiosyncrasies to which the ADD mind is prone.
We refer to this phenomenon as the “zoom lens malfunction.” On a video camera, the zoom apparatus allows you to zoom in for detail and zoom out for the bigger picture. Our brains have to do this, too. Otherwise, we lose perspective, over-focus, miss important details, miss social and nonverbal cues, and leave ourselves exposed and vulnerable. Get the picture? Most ADD people struggle mightily with the zoom lens function.

• Stressed brain syndrome

A very familiar scenario routinely occurs for those with ADD: The person applies himself to a task… and gets stuck! Some people freeze up, some become frustrated or angry, some give up easily, some redouble their efforts. The effect is ironically similar: The harder the person tries, the more his brain stresses and the less efficient his performance becomes. (This has been documented repeatedly by medical imaging studies of the ADD brain under challenge conditions.)
This inordinate brain stress response is indeed a defining characteristic of ADD. However, since the average person can’t see this relationship, its repeated occurrence often brands the ADD person as lazy. This is both tragic and inaccurate. The reality is that normal brain function depends upon the intermittent recurrence of the resting response within a period of exertion or challenge. Because the ADD brain has not learned to rest when challenged, it goes into overdrive and stalls or freezes. People who recognize this episode sometimes term it “brain lock.” Most ADD people simply experience the discomfort, restlessness, and shame of not measuring up to the challenge. Then, the avoidance or release mechanisms kick in, and the task gets abandoned while the person gets criticized.

• Compromised flexibility

Flexibility involves the ability to change set or perspective, to view things from different vantage points, to shift gears when necessary, to vary one’s repertoire. It is essentially “the ability to drive at the speed appropriate for the conditions.”
By definition, flexibility involves making adjustments; and, making adjustments presupposes a functional frame of reference and adequate monitoring and evaluation. Disregulation throws a monkey wrench into these works. When the gearshift gets jammed, it’s hard to make timely adjustments. This is the situation that poorly regulated ADD people face every day.
One tool and one speed will only carry you so far in a world with plentiful variation, complexity, changing circumstances, and demands. Compromised flexibility is a liability that the ADD person can ill-afford, but often harbors.

"My Bipolar Son"

(From "Reaching the Unreachable Child")

My son Nick is currently 21 years old. Nick was a beautiful, happy infant who loved to be held. A precocious child, he began talking in complete sentences before he was one year old. One day, I found him picking out tunes on a toy piano when he was 4 years old. He had perfect pitch. Nick, however, became more difficult as he grew older. During his fifth grade teacher conference, his teacher broke down in tears. New to teaching, she sobbed that maybe she had gone into the wrong profession. Nick had worn her out. It was difficult to get baby-sitters for Nick; even his grandparents would make excuses why they couldn't watch him. One day I took him to a children's karate school. After one session, the karate instructor said he could not come back and that I should take him home and beat him. During a long distance bus trip with the Scouts, the parent chaperones wanted to send 10-year-old Nick back on a plane. They had had it with his impulsivity. They actually started a fund to buy his ticket. Nevertheless, at times he could be incredibly charming, loveable and sweet. Nick was neither mean-spirited nor angry. Some teachers could see past his problems, and loved him dearly. His younger sister adored him. Nick had a heart of gold.
Nick continued to get more difficult as he got older. In seventh grade. he started slowly downwards, and it was the beginning of disaster. Grades declined, and impulsivity increased. Having already broken a couple of bones, he broke three more bones in nine-month period. In high school, his impulsivity continued to increase. He started dyeing his hair unusual colors. Waking up and going to sleep became more and more of a power struggle. He wanted to stay up all night and sleep during the day. He could get by with very little sleep. We started getting telephone calls and letters from the school more and more frequently. In tenth grade, he crashed. His grades dropped to a 0.7 GPA. He went from detentions to suspensions and finally to expulsion. The school wanted him medicated for ADHD, but, because he had tics, we refused. My wife, a physical therapist, said she had seen too many children develop severe tic disorders who only had mild tics before the medication.
Nick was expelled from school on a Wednesday. I was going to an out-of-town EEG Biofeedback workshop on Thursday. I decided to take him with me. At times, such as traveling, he could be a delight to be with. I believe that divine intervention was involved. When we got there, the instructor wanted a volunteer, so I quickly volunteered Nick. The instructor (Professor Joel Lubar), who originated using EEG Biofeedback for ADHD back in the seventies, did a diagnostic evaluation known as brain mapping. During the break, he asked me if I knew that my son was ADHD and bipolar, with an addictive personality. Even though my father and my brother were bipolar, it had never crossed my mind that my son could possibly be bipolar — although, with the increased use of stimulants and antidepressants, very young children are now being diagnosed as bipolar. My father was not diagnosed until he was in his 50’s, my brother not until his 40’s.
I knew that Nick was ADHD, and we had second-mortgaged our home to buy the EEG Biofeedback equipment to treat him. This happened because one day while home sick I turned on the TV and I heard someone say there was a new treatment for ADHD. This was January, 1993. Again, I believe that divine intervention was involved. The new therapy was EEG Biofeedback, also known as neurotherapy. After we researched the procedure, my wife and I decided it was cheaper to purchase the equipment ourselves and train in the use of it than to spend six months in California having Nick treated. We were, however, having a difficult time stabilizing him. One protocol would reduce his impulsivity and eliminate his tics, but eventually he would become too relaxed and begin sleeping too much (all night, after school, and during school). Using the opposite protocol would decrease his sleeping, but eventually it would decrease too much and he would sleep only a few hours a day. As his sleep decreased, his impulsivity returned. The workshop instructor, who used only one protocol for his clients, told us that EEG Biofeedback could not help Nick and that we would have to put him on medication. My wife and I felt crushed. My father was one of the first people in the United States to go on lithium, almost 30 years ago. My father died last year. We were told that the toxicity of the lithium hastened his death. For the last 15 years before his death, he had Parkinson-like tremors in both of his hands. We were told that the lithium caused the tremors. The tremors and the health problems my father developed from medications were frightening. Eventually, my father also benefited greatly from EEG Biofeedback, but the damage had already been done. We were concerned about the long-term consequence of medication, but felt Nick wasn't going to make it to adulthood if we didn't do something right away. We believed this impulsivity and risk-taking were life-threatening.
I consulted with the company that sold us the EEG Biofeedback equipment, and they said they had recently developed a protocol for Bipolar Disorder. We started treating him with the bipolar protocol in March (2000), and hoped we could get him turned around by fall when he would be allowed to go back to school. Over the summer he seemed to improve. His impulsivity decreased. He became more cooperative. His affect and sleep improved. Nick went back to school in the fall, and he stayed out of trouble. He made new friends. His grades improved to A’s and B’s. Not only did the teachers like him, but he was voted the most improved student. My wife and I believe he could not have made it through school without EEG Biofeedback. If we had placed him on Ritalin, as the school was trying to force us to do, the stimulant would have aggravated his tics and precipitated even more serious emotional problems.