If ADHD describes the symptoms, are we all suffering from the same thing?

[Bibliophile]

There was a quote from the “ADD and Loving It” movie that struck me as interesting. One of the doctors said that if you have seen one person with ADHD, than you have seen one person with ADHD. Having participated in the forums for some time, it has occurred to me that maybe we are not all suffering from the same cause of the symptoms. Sure many of the symptoms are similar, but the degree to which they differ and the variation in the level of impairment is so extreme that maybe there are multiple causes that are demonstrating their effects in a similar fashion. It is telling that there is so much division in the advice for coping with the symptoms. Maybe the symptoms are actually radically different from one another. Also, why do some people have one comorbidity while someone else develops another? Surely there is some biological cause of it all.

What I think the ADHD sufferers need is a neurological tool to determine the cause of the impairment, both for diagnosing and devising coping strategies. Who knows, maybe one day there will be a way of changing the function of the brain.

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[Anonymous]

Just as there’s a difference between a case of the “blues” and acute depression, there are varying degrees of ADHD. To make matters more complicated, there are six areas of executive functions that are impaired and so it is likely that each individual will have their own varying levels of each of those areas.

Add to that the impact on the person’s psyche as they grow up and accumulate 30-odd years’ worth of complications due to not being able to do things as easily as everyone tells them they should be able to do so and never understanding why.

So yeah, everyone’s different, even more so as we finally realize why we never could keep up in the “one-size fits all” world we were growing up in.

But at the root is the failure of the executive functions of the brain. How it manifests itself and how we eventually find a means to adapt to it unfortunately depends on who we are. What works for one doesn’t necessarily work for another.

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[Wgreen]

Hey there:

It’s certainly true that saying somebody has ADHD is like saying somebody is wearing a shirt. A shirt is a shirt, but it can be cotton or polyester, red, blue, pink, white, long sleeve, short sleeve, you name it.

At the risk of reposting something (which I know is “Verboten”), here again is (I think) a useful definition offered by Thomas Trilling:

“Attention deficit disorder is a congeries [jumble] of symptoms, to all appearances unrelated and sometimes contradictory. If there is a linking theme, it is the inability to maintain a productive level of concentration (“focus”) through the normal range of daily activities. Lack of focus can show itself as a failure to do the right things or to keep from doing the wrong things. The symptoms are almost as diverse as the demands of life itself: hyperactivity, but also lethargy and daydreaming; procrastination, but also rushing into situations without thinking about rules and consequences; unwanted shifts of attention, as when a conversation overheard across the room suddenly drowns out everything else; unprovoked or disproportionate outbursts of temper; inability to plan ahead, stick to a task, or keep track of time; insensitivity to other people’s unspoken needs; high-risk and thrill-seeking behavior; and obsessive cravings that are no sooner satisfied than they give way to others just as intense. The list goes on…”

…and on, and on.

To make matters worse, medications that work for one person don’t work for another. Coping strategies that work for some don’t work so well for others. Everything about this disorder is slippery, and that can lead to enormous frustration for people looking for definitive answers. I’m afraid we may be a long way off from being able to provide real relief to all those who suffer from it—assuming all want relief, which, of course, is not the case.

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[Bibliophile]

My issue is not whether ADHD exists or with the varying degrees of impairment, but with the inability to point at a root cause. I certainly agree that it involves an impairment of executive functions, but what causes that impairment? Why is ADHD used to identify people with different executive function impairments or only partial executive function impairment? How come some sufferers have comorbid conditions (ones that are not associated with emotional state, e.g. cognitive impairment) while others are just distractable?

My problem in a nutshell is that we are labeling the disorder based on the symptoms alone and not the cause of the disorder itself. And possibly there are multiple causes of these similar symptoms that have to be determined so that disorders can be placed into a taxonomy.

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[Anonymous]

Perhaps it is because we still do not know what the cause is? As for labeling goes, they’ve been on a bundling kick as of late – not sure why. For instance, all patients with Aspergers are now placed under the Autistic umbrella.

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[Bibliophile]

I came across this lecture by Dr. Oren Mason on Youtube that is very interesting as it speaks about the executive functions and some of the neurobiological differences in ADHD discovered by George Bush. It is a little old (May 25, 2007), but gives a good rundown of the disorder, its possible causes, how the medication works, etc. He does insert “uh” pauses a bit too much.

http://www.youtube.com/watch?v=8cRrjJCgRcQ

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[Anonymous]

Pretty interesting lecture and I took a few important things away from it. and I got through the whole thing!! while organizing papers, but I still feel like I got the main points.

most interesting to me:

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how those with ADHD use emotional parts of our brains to compensate for the lack of executive function.

(I see myself in this as I have a lot of trouble doing things in which I am unmotivated ie. cleaning, organizing, cooking, other daily activities. I had a lot of trouble with being unable to tolerate menial repetitive work. I survive my current work because it fires me up on a daily basis. I have never understood how people could tolerate working 10+ years doing retail jobs. Maybe now I get it. I survived school because I have always been very passionate about doing well in school. When I was a child, it was my source of self-esteem. As an adult, it was my life direction when everything else in my life was a chaotic mess. Passion is the common thread.

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how many of those with ADHD have trouble with arousal. I cannot drive longer than one hour without needing to stop and take a nap and I am not a sleepy type of person. I get what I call “narco-driver”. I head bob and pull over because it freaks me out. I try so hard to focus on the road and understand its importance, but my brain fails me. I need to caffeinate myself to twitches to make a two hour highway drive. With the meds, I could do it pretty seamlessly. I also had trouble staying awake while shadowing other professionals to learn from them. If I were not directly involved, keeping myself awake was hell. I don’t remember falling asleep like this in school, but it may have been due to pretty intense anxiety problems and the constant school interruptions. Also taking notes saves me from mental coma. I fall asleep reading textbooks. I didn’t do this as a kid, but perhaps because we never needed to read 100 pages of textbook at a time like in college.

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I have always hated the “just do it” slogan. well.. I don’t need a slogan if it is something I care about or want to do..i just did it. however…… i want to throw a brick at people who tell me to just clean my house.

hmm trying to sum up other things. I find it really helpful when I contemplate after watching something educational “what did I learn today?”

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trouble with rigid boundaries and rule-following. I am usually a people pleaser, but have little tolerance for bureaucracy or stupid rules. I know no one likes that stuff, but I get myself in trouble..ie written up for that type of lack of tolerance. I find that my brain explodes and it is too painful just to roll with. However, I get extremely overwhelmed and just feel free floating and lost if there are no clear expectations of what I am supposed to do. In addition, I will procrastinate to the point of not doing something without a set deadline.

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on the other topic, I agree with you about the great variation of executive dysfunction. We all definitely do not have the same illness. We have the same experience dealing with deficits, but different ones. Some people on here talk about superior ability to multitask and finish work rapidly. or to work in fast-paced adrenaline fueled situations. Not me at all. I am the opposite. I am slow like a slug, I get lost in thought, I linger on tasks, I lose track of time, I have a lot of cognitive noise in which I have trouble making decisions, I get seriously overwhelmed in crisis situations. My mind just goes a million places at once and I feel paralyzed to do anything at all. I somehow found myself in a fast paced, decision now, chaotic environment of occasional crisis because the type of work is my passion. huge conflict between passion and attention deficits sent me to seek help.. so here I am! I’m sure that there is some interesting variations of brain chemistry and mechanism between me and the others I mentioned.

good topic! thank you!

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[Anonymous]

I really don’t know whether to consider ADHD as a set of different disorders, or different presentaions of the same disorder. If you have worked with dementia patients, you will realise that even the same type of dementia in the same part of the brain will affect each person differently. And a lot depends on personality. Each person, in addition to having an individual genetic make up, also develops different neural pathways to another person as they develop and grow, which could account for the different presentation of disorders of the brain – because even other psychiatric disorders have multiple presentations. But so do other injuries and illnesses. One person may be screaming in pain from a fracture identical to that in a person who is sitting calmly without flinching. Our individual genetic make up results in all sorts of differences in disease/disorder symptoms. It could be enough to explain why ADHD presents in so many different ways. There still seems to be a common thread, or else why would we feel such a sense of “coming home” when we read the threads here.

Conversely I could argue that ADHD could be similar to dementia in that there are possibly multiple causes, as well as areas of the brain affected. If you have worked with patients with dementia, you soon learn to pick what sort of dementia a person has (vascular, Alzheimer’s, Korsakoff’s, multi infarct) and where in the brain it affects (frontal lobe, temporal lobe, whole brain). I could suggest that ADHD may be similar in that there are several causes (probably different genes for the most part, as well as maybe developmental hiccups, and environmental factors), as well as several parts of the “ADHD part” of the brain (so those responsible for different executive function deficits), and this accounts for the differences – hyperactivity vs lethargy, hyperfocus vs procrastination.

Admittedly, if you look at Dr Barkley’s videos on Youtube, he does a good job of explaining some of these symptoms and looking at them as having the same roots, despite outward differences. Such as hyperfocus and procrastination both being forms of perseveration (repetitive thought/movement) – so a person with either is “stuck in a loop”, either of activity or inactivity, and unable to break free. The brain’s choice of activity vs inactivity could be an individual difference due to a person’s personality (introverted vs extroverted, or similar) but the perseveration of hyperfocus and procrastination is an ADHD symptom.

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[Anonymous]

KrazyKat, you make a lot good points. What is so interesting about mental illnesses is that there are genetic components, but not so much one gene (ie. the bipolar gene). (exception to diseases like huntington’s disease which is more a neurological disorder). Thus different people who satisfy the bipolar diagnosis have a different combination of genes involved, not even thinking about the environmental factors.

Many developmentally disabled individuals demonstrate many symptoms of ADHD. These individuals also have executive deficits, probably mostly by different mechanisms. Many are treated with stimulant medications. I’ve seen stimulants used in Traumatic brain injuries, autism, mental retardation, fetal alcohol, etc. One cannot really make the argument that the fact that one uses the same class of medication to treat ADHD makes it a single disorder. Anticonvulsants treat epilepsy, bipolar disorder, chronic pain, migraine headaches, and aggression.

Versus describing different disorders, perhaps, ADHD is more like a spectrum disorder? Life is certainly not as black/white as the DSM-IV! I think the DSM V is going to change bipolar disorder and autism into spectrum disorders. The mental health professionals continue to argue with each other on these distinctions. very interesting.

yay for stirring up those brain juices you are awesome

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[Anonymous]

I loved that video (and agree on the umms). The part about us being driven by emotion really hit home for me. I had mentioned before that I was really good in school, mostly an A student, studied physics and went to grad school before graduating second in my class from law school.

I never thought I was particularly smart, I always said it was just hard work. Now I realize why it was so hard–I have ADHD. The emotional motivation really hit home because, when I was very young my teacher sent me home with a note. I wasn’t supposed to read it, but I did, and it said I should be tested for a learning disability.

My father was my hero, and he was a very proud man. He fought his whole life through undiagnosed dyslexia. He worked 16 hour days as a truck driver for 40 years. He would wake up at 3 am, drive to the South Bronx, pick up his grocery truck and drive all over the northeast, unloading the groceries by hand. He would come home at 5 or 6, eat dinner with us and be in bed by 9. All he ever wanted for my brother and I was to not have to work so hard, to use our brains instead of our muscles.

I was 8 when I brought that note to him, and he was crushed. He tried not to show it, but I could tell he saw my life unfolding the way his had and it hurt him. For the next 25 years, I worked my ass off trying to never see that look in his eyes again. I worked hard. I took in knowledge like a sponge, I studied every subject, threw myself into extra credit, mathletes, chess club and did nothing that didn’t get me higher grades.

You could say I over-compensated. My brother and I were the first in our families ever to go to college (he went on a basketball scholarship), and I kept going, getting that demon out. I was top ten in my class in a prestigious university for physics. I went to graduate school and won a fellowship from NASA. I worked so hard, that when I was in graduate school, I reminded my dad of that letter from Mrs. Tanchuck. He had no idea what I was talking about. I guess I showed them.

He died 4 years ago, after seeing me work for the most prestigious law firm in the world. Ironically, I never got to spend time with him because I was working so hard to make him proud. Cats in the cradle, I guess. When he died suddenly, that’s when my problems started to resurface. I lost focus on my career. I gained more and more weight (I always self-medicated with sugar and carbs, but I gained over 50 lbs in a year). I started screwing up more and more at home and at work. I’ve been like a speedboat with no rudder.

I’m finally getting help, but it’s good to know that it was my love and respect for my father that drove me this far.

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[Bibliophile]

I still find it very difficult to believe you did so well in school AND struggled with severe ADHD, Pete-Puma. A lot of ADHD sufferers report erratic marks, only doing well when motivated, continual lateness, which impede school performance. I was an A student in science classes in high school until I got to University and had to deal with huge labs that lasted 4+ hours, hour long lectures in halls filled with 1,200 people for a class, Calculus classes with no interaction between the student and teacher in a large lecture hall, etc. I am not saying you are not ADHD, I just have never seen someone succeed as you describe who was ADHD.

A friend of mine in university also likely had ADHD. It took him over 6 years to finish his undergrad. He kept switching majors. He was incredibly bright and is working on his law degree and forensics degrees simultaneously now, but he just never stayed focused and performance was only there if personally motivated. Papers were chronically late, etc. An acquaintance of mine with ADHD never finished her Masters and went off to do other things. My mother defaulted on her Masters twice due to the paper requirements. These are the experiences I have seen of those suffering ADHD.

Personally, I never had an issue with lateness, but had to switch to a subject that supported small class sizes, my personal interests, etc. When I hit a course that I was only partially interested in, marks dived. It was not that I wasn’t interested in Science at a University level, I just couldn’t cope in that environment at all. Didn’t matter who I was disappointing or that I had an interest in the field, just too much to overcome.

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[Bibliophile]

@KrazyKat part of the problem with ADHD at present is that its assessment only describes the observed behaviours and not the root causes. Someone who is aging will lose their working memory causing them to not function as they did before. However, an adult who has always had ADHD was always like that. Two different causes, same symptoms. This is just one overlap, I am sure there are many more. Similarly, head trauma can lead to dysfunction of the executive functions in the brain. The question arises: are we grouping people with different biological problems in the same group because the symptoms appear similar? and what are the outcomes of treatments based on the root biological deficiencies? Only now does it look like the medical community are looking into this and I believe it will revolutionize how ADHD is identified and successfully managed.

I like Barkley’s approach to ADHD. It strikes how with how difficult it has been to get things done and the lack of emotional regulation my whole life. Mind you, I was diagnosed as a child and never questioned the results of that assessment as it fit. Barkley’s twisting of the more popular view of hyperfocusing into one of perseveration makes complete sense to me.

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[Bill]

Pete-Puma,

I find your description of your experiences very believable in the context of ADHD. I’m interested in the idea of using emotion, e.g. wanting your Dad to be proud of you, in the place of executive function. That mirrors my own experience.

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[Anonymous]

I appreciate that my story is not typical, but that’s why I found the emotional explanation so interesting. I’m not saying I was an A student all the time, or that I never lost focus. My relationships were always a mess, and the one that lasted a while in college took my GPA from a 3.8 to 2.3 in one semester. I recovered, but only after we broke up.

I do agree that large classes were a problem for me. My physics major helped a lot. There were only 1 or 2 classes that had more than 20 people in them. There’s not much call for general relativity for English Lit or Psychology majors. It also helped that physics is such a broad and interesting area of science. I took a biology class once and it bored me to tears. Too much memorization of arbitrary names.

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[Bibliophile]

It was my interpretation that the emotional brain’s compensation was more of a short term approach. It did not fully make up for the failure of the executive functions, but could fill in under particular stressful situations, e.g. big game. Very short term and nothing that could be sustained. The problem is the control. Just like the perseveration/hyperfocusing, some times it clicks on the right thing and others not so much.

@Pete-Puma your 2nd description paints a very different picture than “I was really good in school, mostly an A student, studied physics and went to grad school before graduating second in my class from law school.” would imply. Maybe I should have switched to physics instead of dropping science altogether. Typical over emotional and impulsive response to a predicament. Probably still couldn’t handle the lab work. My university had large classes in almost every science field until the 3rd year courses though.

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[Author]

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