ADD - Practical Coping Methods - B. Fisher, R. Beckley (CRC, 1999) WW

365 Pages·1999·2.87 MB·English

Attention Deficit Disorder:
Practical Coping Methods

Barbara C. Fisher, Ph.D. and Ross A. Beckley, Ph.D.

© 1999 by CRC Press LLC

Acquiring Editor:
N. Frabotta
Project Editor:
Sylvia Wood
Marketing Manager:
Becky McEldowney
Cover design:
Dawn Boyd

Library of Congress Cataloging-in-Publication Data

Fisher, Barbara C.
Attention deficit disorder: practical coping methods / Barbara C. Fisher and Ross A. Beckley.
p. cm.
Includes bibliographical references and index.
ISBN 0-8493-1899-0
1.Attention-deficit hyperactivity disorder. 2. Adjustment
(Psychology) 3. Biological psychiatry. Neuropsychology.
Beckley, Ross A. II. Title.
[DNLM: 1. Attention Deficit Disroder with Hyperactivity.
2. Biological Psychiatry. Neuropsychology. WS 350.8.A8 F533ab
1998]
RC394.A85F57 1998
616. 85’ 89—dc21
DNLM/DLC
98-7960
for Library of Congress
CIP

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© 1999 by CRC Press LLC

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Library of Congress Card Number 98-7960
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© 1999 by CRC Press LLC

Preface

This book has been rewritten no fewer than five times in an effort to keep
abreast of current information. It is a compilation of personal/professional
experiences, notes, anecdotes, research and hopes that have been stored and
shared over the past decade. New research is occurring constantly and this
disorder, which has been historically looked upon as a disorder of child-
hood, is now being widely accepted as one that spans the lifetime. It is a dis-
order that one is born with, and it does not end with childhood, instead,
symptoms develop and change commensurate with the developmental
cycles of adolescence, adulthood, middle age and advanced age. This book
is meant for parents, children, teachers and ADD adults who are tired of
searching and are ready for answers to their many questions about this very
diverse and complicated disorder.
Our goal is to demystify the vast amount of information that has been gener-
ated and to present this rather confusing disorder in a manner that is both
understandable and applicable by providing what we have learned that is
helpful in addressing this disorder in the individual’s everyday life. This
books addresses the questions of why Ritalin does and doesn’t work, why
ADD is not just a childhood disorder, why ADHD is being over-diagnosed
and why so often the person diagnosed and treated with medication is not
cured and the story is far from over.
The presence of ADD has broken up marriages, prevented many from
attending college, fulfilling their potential, or following the career path that
they truly desire. It has made people feel stupid and incompetent. With new
perspectives, changes can occur, and people can create the life they want
and deserve; they can fulfill their dreams. ADD is a disorder with far-reach-
ing consequences, however, it is also a disorder that can be treated and spe-
cific symptoms can be managed. We prefer to think of ADD as a challenge
that can be met with good physical health, nutrition, specific coping mecha-
nisms, medication, and, most of all, education and understanding. A good
diagnosis identifying all of the various disorders that can complicate the sit-
uation is absolutely imperative.
What we provide to the reader in this book in the way of knowledge about
ADD has been field-tested in a variety of settings—households, schools,
clinics, businesses, colleges, hospitals, and classrooms.

© 1999 by CRC Press LLC

Authors

Barbara C. Fisher, Ph.D, is a fully licensed psychologist who has specialized
in neuropsychology for the past 19 years. She approaches Attention Deficit
Disorder from a brain-behavior viewpoint and utilizes her knowledge of the
brain and neuroanatomy to understand, diagnose, and explain specific
symptoms of this disorder.
Dr. Fisher is the author of Reasons for Misdiagnosis, Approaching ADD from a
Brain-Behavior Neuropsychological Perspective for Assessment and Treatment, and
co-author of We Are Not Getting Older, We Are Just Coming of Age.. She also spe-
cializes in the diagnosis of head trauma, as well as Alzheimer’s Disorder and
Dementia.
A well-known speaker, Dr. Fisher has presented at various workshops with
her husband, Ross Beckley, including radio and television, on such varied
topics as ADD, Depression and Anxiety, and Comorbid Disorders. She con-
ducts custody evaluations; neuropsychological evaluations; alcohol assess-
ments; and psychological, education, and achievement evaluations. Trained
in hypnosis, she is a member of the American Society of Clinical Hypnosis.

Ross Beckley, Ph.D, is a former school teacher, special-education teacher,
and teacher consultant for the learning disabled, the emotionally impaired,
and educable mentally impaired. Dr. Beckley holds a Ph.D. in Clinical Psy-
chology, a degree in Elementary Education, Master’s degrees in Reading and
Learning Disabilities, and Marriage and Family Therapy. He also has a spe-
cialist degree in Administrative and Organizational Studies. More impor-
tantly, Ross is stepdad to an ADD child.
Both Fisher and Beckley are members of the National Physicians Consor-
tium for Attention Deficit Disorder, American Psychological Association,
Association of Family and Conciliation Courts, and various support groups
for Attention Deficit Disorder. They have been speaking for the past several
years on ADD and currently run a successful parent-training program.
Together, they operate United Psychological Services and the Attentional
Deficit Disorder Clinic in Clinton Township, with a satellite office in Lansing,
Michigan.

© 1999 by CRC Press LLC

Acknowledgments

In the completion of this project, we would like to recognize the following
individuals for their direct or indirect contribution to this project.

Special recognition is due to:
God, the source

Mr. Phillip Fisher: accountant/bean-counter extraordinaire, father, father-
in-law

Mr. Donald Beckley: organizer, critic, cheerleader

Blythe VanderBeek: partner, editor, and friend

Dr. Edna Copeland: expert in ADD and renowned author who first said,
“Why don’t you two write a book?”

Greer Huntley: typist, proofreader, who always believed in this project

Janine Thomas: M.S.W., colleague, idea person, truth teller

Don Santilli, Chuck O’Connor, Utica Community Schools

Nick Simkins, attorney specializing in head injury

Dr. Akemi Takekoshi: neurologist

Dr. David Villanueva: psychiatrist

The many pediatricians and neurologists for their insightful knowledge
of clinical aspects of this disorder

Dr. Douglas Davidson: The Union Institute, Western Michigan University

And, last but never least, Laura and Jeff, relentless partners in questions,
answers, worries/fears, love, honor, and stars

© 1999 by CRC Press LLC

Contents

1.
What Is Attention Deficit Disorder?

2.
The Two Subtypes Of ADD: ADD without
Hyperactivity and ADHD

3.
Looking At ADD without Hyperactivity

4.
Over-Focused Subtype of ADD without Hyperactivity

5.
ADHD Revisited

6.
Comorbid, Associated Physical Disorders

7.
Comorbid, Associated Emotional Disorders

8.
Assessment and Why it is So Important in
Diagnosing ADD

9.
After the Evaluation: How Tests or Clinical Findings are
used to Develop Coping Mechanisms to Address the
Symptoms of ADD

10.
How to Tell your Child about ADD: What It Is and
Isn’t and Why Take Medication

11.
Adolescence and ADD: A Class by Itself

12.
The Impact of Attention Disorders within the
Family System

13.
Living with an ADD Adult: How Does ADD
Affect a Marriage?

14.
ADD in the Workplace

15.
Legal Information: IDEA, Section 504 and ADA

16.
How to Work with the Schools to Get What You Need

© 1999 by CRC Press LLC

17.
Medications

18.
Treatment Does Not Mean Just Medication

19.
ADD and Brain Damage: Does it Make a Difference?

20.
Summary of Issues Critical to Understanding ADD

Bibliography

© 1999 by CRC Press LLC

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1

What is Attention Deficit Disorder?

1.1
What Attention Deficit Disorder (ADD) Was Once
Thought to Be

Historically, when Attention Deficit Disorder (ADD) was discussed, we were
referring to Attention Deficit Disorder with Hyperactivity (ADHD). At that
time there was no awareness of ADD without hyperactivity. It was thought
that ADD was a psychological or behavioral problem viewed as a disorder of
childhood. The symptoms were hyperactivity, overactiveness, and attention
deficiency, hence the term ADD.
The theory was that the disorder was the consequence of a system in the
brain not being mature — perhaps due to early birth or damage to the brain.
That underdeveloped system in the brain was thought to be the Reticular
Activating System (RAS), which is involved in general arousal and alertness.
In that underdeveloped or immature state, the result was overactive or
hyperactive behavior on the part of the child. As this system developed, the
symptoms of ADHD and its hyperactive or overactive component would dis-
appear. It was believed that because the system was immature it produced
the overactivate and inappropriate behavior characteristic of hyperactivity, a
motor-driven activity.
Therefore, ADD was not understood as a disorder involving the thought pro-
cesses but as a disorder linked to behavior with symptoms such as a child who
“ran but did not walk” and was continually distracted, not focused, or could
not attend to task. These children were seen as behavioral problems as they did
not respond to directions, but did as they pleased without obeying the rules
and regulations of the family household. The attention disorder was viewed as
ADHD; a rather disruptive behavioral problem that was expected to go away
once the child reached the later stages of adolescence and the RAS matured and
began to function as it should, and no longer produced overactive behavior.
The problem was that ADD and the systems seen did not make sense. Some-
times the behavior would be there and sometimes it would not. There seemed
to be no rhyme or reason. It was difficult to diagnose unless the disorder was

© 1999 by CRC Press LLC

severe and there were clear symptoms for the doctor or psychologist to
observe. Parents did not see symptoms of the disorder but teachers did. Chil-
dren who should have been able to function better and lead productive lives
after adolescence still had problems. ADD children, once they became adults,
still had problems and were not like their peers.

1.2
If the Disorder was Over, Why Wasn’t It Over?

What was not understood was that ADD was a thinking disorder involving the
higher-level portions of the brain, or higher-level functioning of the brain. Fur-
ther, on reaching adolescence and adulthood this disorder does not go away.
Rather, it persists throughout the life span and through the aging process. In
fact, we have tested individuals in the age range of 70 to 80 years and found
clear symptoms of an attentional disorder that had been impacting their lives.
Now we realize that, first, ADD does not go away and, also, there is another
disorder with the absence of hyperactivity (or motor overactivity) entitled Atten-
tion Deficit Disorder without Hyperactivity.

1.3
How is this New View or Theory of ADD Known?

Recent research was conducted in which researchers found evidence of hypo-
frontality — a lack of activity in the frontal area of the brain when it should
have been activated. Using a computerized technique called the PET scan,
researchers were able to measure the brain’s use of energy. The PET scan
allows the activity of the brain to be measured in response to some sort of task
performance. Testing diagnosed ADHD individuals who performed tasks
that necessarily require the frontal area of the brain. Hypofrontality was dis-
played because frontal regions of the brain were not aroused as they should
have been for the task performance. This can also be seen on SPECT scans,
which measure how the brain is utilizing its energy.
Hypofrontality was then linked to the deficiency of dopamine and norepi-
nephrine, two neurotransmitters or brain messengers.

1.4
Defining Neurotransmitters or Brain Messengers

The brain contains structures geared to performing specific jobs. All of these
structures must be able to communicate with one another to allow thinking

© 1999 by CRC Press LLC

and acting to be a smooth operation. It is like a giant communication system,
e.g., the Internet or the information highway. The brain transmits messages
to itself — it talks to itself; therefore, the brain structures can work only if its
communication system is in order.

EXAMPLE
For a car to run, you need fuel and spark. You can have a perfectly fine automobile,
but it will not go anywhere unless it has a full tank of gas and a charged battery. The
same is true of the brain. The brain can be fine and intact, however, it will not work
unless it has fuel and a spark.
The brain talks to itself using two systems, chemical and electrical. When
either of these communication systems breaks down, there is potential for a
whole host of problems ranging from emotional disorders to physical disor-
ders to damage to the brain. When people cannot think, or they can’t walk or
talk or act appropriately or make the right decisions, something has hap-
pened to one or both of these systems.

1.5
ADD Has to do with the Way the Brain Talks to Itself
Chemically

When the brain talks to itself chemically, it does so through what we call neu-
rotransmitters or brain messengers. These neurotransmitters allow the commu-
nication system or information highway to transmit messages between
different brain structures. Each brain structure has a specific job that allows
the body to walk, talk, think, learn. The brain structures are connected by
neurons. It is the neurotransmitters or brain messengers that allow informa-
tion to travel from one neuron to another. When defining neurons, see the
brain activity as a series of steps:

1. Neurons are composed of a cell body connected to an axon that
connects to another cell body that connects to an axon and so on
(Figure 1.1).

2. The neurons have projections called dendrites, or branches, whose
primary function is to receive information from other cells and pass
this information along to the cell body.

3. Electrical changes occur in the nerve membrane that result in infor-
mation being passed along the axon to the nerve terminal located
at the end of the axon.

4. It is the change in membrane permeability at the nerve terminal
that triggers the release of the neurotransmitter substance.

© 1999 by CRC Press LLC