(Hyperactivity)
Not an excuse, but a biological difference that makes a difference.
Charles K. Kenyon 1, Assistant State Public Defender, Marinette
NOTE: This paper will be updated at the 1998 Wisconsin State Public Defender Forum. When it is, you will be able to review the updated version at this address and this page will be moved to a new URL.
If you want, you can be notified by e-mail when this page is changed.
Why should the public care about attention deficit disorder (ADD / ADHD)? Isn’t that a rare problem that some people use to excuse their misbehavior?
This is a serious problem.
A. 40% of boys with (untreated) ADHD will be arrested for
a felony by the time they’re 16. B. 52% of people with (untreated) ADD will have drug or
alcohol problems. C. 30% of people with ADD (untreated) will never finish
high school. D. 75% of adults with ADD have relationship problems as
an adult. E. ADD is the most common learning problem among
children, teens, and adults. It affects more than 17
million Americans. F. Upon a little questioning it seems that 40-50% of my
clients have diagnoses of ADD or hyperactivity in their
past or at least meet the history requirements for such a
diagnosis. G. The population of our prisons is primarily people with
ADD or a learning disorder.
- If ADD people are effectively treated for the ADD, these figures move very close to the population norms. The sooner the treatment starts, the better and easier the client’s life will be.
- If the behavior is a symptom of ADD, punishment will not stop the behavior. The person will not be able to stop because they won’t know why they are doing what they are doing. This does not mean that the ADD is an excuse for antisocial behavior. It does mean that unless the ADD is treated the punishment might satisfy our sense of "justice" i.e. - we got even, but it will not change future behavior for this person or for others with ADD.
- Well-meaning, competent, teachers, parents, social workers,
judges, doctors and attorneys often tell people with ADD that
if they would try harder they’d do better.
- "Try to stay out of fights."
- "Think before you act."
- Unfortunately, the harder people with ADD try, the
worse it gets. Instead of harder, they have to try
doing something different, i.e. different friends, anger
management to rehearse and plan reactions to common triggers,
multiple reminders and artificial deadlines. Unless they know
about and understand the ADD, they will keep trying harder, and
often failing because their brain is shutting down on them.
The ADD person will not be able to stop because they won’t know why they are doing what they are doing. This does not mean that the ADD is an excuse for antisocial behavior.
They won’t be able to stop because their brains have been conditioned since early childhood to seek out or create stimulation as a survival mechanism. This is something which is not at the conscious level but rather a conditioned response.
What is attention deficit disorder (ADD / ADHD)?
ADD is a neurological difference 2 in how the brain operates. An ADD person will display one of six related patterns (Daniel G. Amen, M.D. 3 )
1. Classic (DSM-IV) combined type - meet requirements 1 and 2:
a. Inattention (six or more of following - to the point that they have been a problem for more than six months)1) Often fails to give close attention to details or makes careless mistakes in work, schoolwork, or other activities2) Often has difficulty sustaining attention in tasks
3) Often does not seem to listen when spoken to directly
4) Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand)
5) Often has difficulty organizing tasks and activities
6) Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
7) often loses needed items (keys, pens, books, tools)
8) Is often easily distracted by extraneous stimuli
9) Is often forgetful in daily activity
b. Hyperactivity and impulsivity: (six or more of following)
1) Often interrupts or intrudes on others (e.g. butts into conversations or activities uninvited)2) Often has difficulty awaiting turn
3) Often blurts out answers before questions have been completed
4) Often fidgets with hands or feet or squirms in seat (adults may express by tapping finger, etc.)
5) Often moves about in situations where the norm is to remain seated (classroom, meeting, workplace)
6) Subjective feelings of restlessness (usually acted upon by younger children running around or climbing excessively in situations where inappropriate)
7) Difficulty playing or engaging in leisure activities quietly
8) Often talks excessively
9) Is often on the go or often acts as if driven by a motor
2. Classic (DSM-IV) predominantly hyperactive type - meet requirements 1 and 2:
a. Inattention (LESS THAN SIX examples)1) Often fails to give close attention to details or makes careless mistakes in work, schoolwork, or other activities2) Often has difficulty sustaining attention in tasks
3) Often does not seem to listen when spoken to directly
4) Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand)
5) Often has difficulty organizing tasks and activities
6) Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
7) Often loses needed items (keys, pens, books, tools)
8) Is often easily distracted by extraneous stimuli
9) Is often forgetful in daily activity
b. Hyperactivity and impulsivity: (SIX OR MORE examples)
1) Often interrupts or intrudes on others (e.g. butts into conversations or activities uninvited)2) Often has difficulty awaiting turn
3) Often blurts out answers before questions have been completed
4) Often fidgets with hands or feet or squirms in seat (adults may express by tapping finger, etc.)
5) Often moves about in situations where the norm is to remain seated (classroom, meeting, workplace)
6) Subjective feelings of restlessness (usually acted upon by younger children running around or climbing excessively in situations where inappropriate)
7) Difficulty playing or engaging in leisure activities quietly
8) Often talks excessively
9) Is often on the go or often acts as if driven by a motor
3. Classic (DSM-IV) primarily inattentive type - meet requirements 1 & 2:
a. Inattention (SIX OR MORE examples)1) Often fails to give close attention to details or makes careless mistakes in work, schoolwork, or other activities.2) Often has difficulty sustaining attention in tasks
3) Often does not seem to listen when spoken to directly
4) Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand)
5) Often has difficulty organizing tasks and activities
6) Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
7) Often loses needed items (keys, pens, books, tools)
8) Is often easily distracted by extraneous stimuli
9) Is often forgetful in daily activity
b. Not as much Impulsivity and Hyperactivity (LESS THAN six examples)
1) Often interrupts or intrudes on others (e.g. butts into conversations or activities uninvited)2) Often has difficulty awaiting turn
3) Often blurts out answers before questions have been completed
4) Often fidgets with hands or feet
5) Often moves about in situations where the norm is to remain seated
6) Subjective feelings of restlessness
7) Difficulty playing or engaging in leisure activities quietly
8) Often talks excessively
9) Is often on the go or often acts as if driven by a motor
4. Overfocused type - meet requirements 1 & 2 :
a. Severe difficulty in paying attention:1) Difficulty with sustained attention or erratic attention span2) Easily distracted by extraneous stimuli
b. Fixation (FOUR signs of being very inflexible)
1) Excessive or senseless worrying2) Disorganized or super-organized
3) Oppositional, argumentative
4) Strong tendency to get locked into negative thoughts, having the same thought over and over
5) Tendency toward compulsive behavior
6) Intense dislike for change
7) Tendency to hold grudges
8) Trouble shifting attention from subject to subject
9) Difficulties seeing options in situations
10) Tendency to hold on to own opinion and not listen to others
11) Tendency to get locked into a course of action, whether or not it is good for the person
12) Needing to have things done a certain way or becomes very upset
13) Others see as worrying too much
5. Depressive subtype - meet requirements 1 & 2
a. Severe difficulty in paying attention:1) Difficulty with sustained attention or erratic attention span2) Easily distracted by extraneous stimuli
b. Moodiness (FOUR signs of moodiness or depression)
1) Moodiness2) Negativity
3) Low energy
4) Irritability
5) Social isolation, hopelessness, helplessness, excessive guilt
6) Disorganization
7) Lowered sexual interest
8) Sleep changes (too much or too little)
9) Forgetfulness
10) Low self-esteem
6. Explosive subtype (10-15% of ADD people) (violent acts up to and including homicide - doesn’t know why or no good reason)
a. Severe difficulty in paying attention:1) Difficulty with sustained attention or erratic attention span2) Easily distracted by extraneous stimuli
b. Explosivity:FOUR signs of explosive temper
1) Impulse control problems2) Short fuse or periods of extreme irritability
3) Periods of rages with little provocation
4) Often misinterprets comments as negative when they are not
5) Irritability builds, then explodes, then recedes; often tired after a rage
6) Periods of spaciness or confusion
7) Periods of panic or fear for no specific reason
8) Visual changes, such as seeing shadows or objects changing shape
9) Frequent periods of deja vu
10) Sensitivity or mild paranoia
11) History of a head injury or family history of violence or explosiveness
12) Dark thought: may involve suicidal or homicidal thoughts
13) Periods of forgetfulness or memory problems
What’s going on in the brain?
- Classic - combined, primarily hyperactive, and primarily inattentive types - prefrontal lobes low activity, especially when trying to concentrate
- Overfocused type - top-center of frontal lobes overly active
- Depressive type - limbic system overactive plus frontal lobe low activity
- Explosive type - temporal lobe overactivity
Medications for these types are different
- Classic - all three types - stimulants - ritalin, dexadrine, adderall, cylert; if those don’t work then Wellbutrin or tricyclic antidepressants or Chlonodine (anti hypertension med)
- Overfocused type - anti-obsessive antidepressants - prozac, paxil, zoloft, etc.
- Depressive type - stimulants with anti-depressants
- Explosive type - anti-seizure medication (stimulants can make worse) or anti-seizure medication with stimulants
What experts in the field are saying:
A. Daniel G. Amen, M.D.
—— Brain studies of patients with classic AD/HD reveal a decrease in brain activity in the frontal lobes of the brain in response to an intellectual challenge. The harder these people try to concentrate, the worse it gets. (Windows into the A.D.D. Mind, p 32)—— Sometimes I cry when I think of all the children and teenagers who are in group homes, residential treatment facilities, juvenile halls, or who have run away from home because their families could not deal with them any longer. I know that many, many of them have brain problems who have never been properly evaluated. Perhaps they have seen a local counselor or physician who looked at the abnormal behavior and told the parents that the child could behave if only he or she really wanted to. In today’s "enlightened" society that attitude is as prevalent now as ever. (Slide Presentation: Windows Into the Mind, Text)
—— I was raised in a strong Catholic family. I was taught to believe that if you live a clean life and work hard you will be successful. I believed that there was something the matter with the character of those people who were drug addicts, murderers, child abusers, and even those who took their own lives. After being involved with about 1,500 brain SPECT studies my mind has completely changed. I now believe that it is essential to evaluate the brain when behavior is out of the bounds of normal. The brain is an organ that dramatically influences behavior. thoughts and feeling. Andy’s case was yet another dramatic example to me to press on studying the brains of people with abnormal behavior. What we need is more knowledge, more understanding and less judgment. (Slide Presentation: Windows Into the Mind, Text)
—— Coming to understand ADD has been like stepping through a porthole into a wider world, expanding my view of my patients, friends, and family. I now know that many personality traits and psychological problems have a genuine basis in biology — not just ADD, but also depression, learning disorders, anxiety, panic attacks, and even shyness. (Psychology Today, May/June 1997, p.41)—— I have seen more than a few teetering marriages right themselves when the couple understood it was ADD, not bad character, causing their troubles. I have also seen many careers that had been languishing in the bin labeled "under-achiever" suddenly take off after diagnosis and treatment of ADD. Scores of students have been able to rescue their academic careers after diagnosis and treatment. It is a powerful diagnosis: powerfully destructive when missed and powerfully constructive when correctly picked up. (Psychology Today, May/June 1997, p.41)
—— When people ask me where ADD has been all these years, I respond that it has been in classrooms and offices and homes all over the world, right under our noses all along, only it has been called by different names: laziness, stupidity, rottenness, and worthlessness. For decades children with ADD have been shamed, beaten, punished, and humiliated. They have been told they suffered from a deficit not of attention but of motivation and effort. That approach fails as miserably as trying to beat nearsightedness out of a child — and the damage carries over into adulthood. (Psychology Today, May/June 1997, p.41)
—— Nothing matters more in ADD than proper diagnosis. Even today this condition is so misunderstood that it is both missed and overdiagnosed. . . . [D]epression can cause someone to be distracted and inattentive (and in many cases depression and ADD even occur together). However, a constant pattern of ADD symptoms usually extends back to early childhood, while depression is usually episodic. Thyroid disease can also look very much like ADD, and only testing by a physician can rule this out. High IQ can also mask or delay the diagnosis of ADD. (Psychology Today, May/June 1997, p.41)
—— This understanding [that I had ADD] freed me emotionally. In fact, I would much rather have ADD than not have it, since I love the positive qualities that go along with it — creativity, energy, and unpredictability. . . . The only time talking about this diagnosis will get you in trouble is when you offer it as an excuse. (Psychology Today, May/June 1997, p.41)
—— The diagnosis and treatment of ADD represent a triumph of science over human suffering — just one example of the many syndromes of the brain we are at last learning to address without scorn or hidden moral judgment. As we begin to bring mental suffering out of the stigmatized darkness it has inhabited for centuries and into the light of scientific understanding and effective treatment, we all have reason to rejoice. (Psychology Today, May/June 1997, p.41)
—— [In answer to the question: What is the difference between a learning disability and ADD?] ADD affects learning globally; it can compromise all cognitive functions. ADD turns down all the lights in the room; it can make it difficult to see anything. A learning disability, on the other hand, compromises one specific cognitive function, for example, doing math. It turns down the lighting in one part of the room, but the rest of the room remains well lit.
Another way to think of the difference between ADD and a learning disability is to think of an athlete. When the athlete is extremely tired, it is difficult for him to perform any athletic feat, from running to jumping to throwing a ball. This is like ADD. On the other hand, if he has a pulled muscle in his arm, he may not be able to throw a ball with that arm, but he may be fully able to run or jump or even throw a ball with the other hand. This is like a learning disability. (Answers to Distraction with John Ratey, M.D. p. 33)
—— Studies have looked at the wide range of treatment modalities and the only factor that has helped forestall antisocial behavior is the consistent use of medication. Adequate dosing and persistence in monitoring the medication are crucial. . . . Make sure that everyone in the house who has ADD is being treated to the fullest capacity. . . . Keep the awareness of ADD alive and keep the education process constant. . . . Use and encourage humor as a way to deal with conflict. (Answers to Distraction with John Ratey, M.D. p. 278)
C. Circuit Court Judge Jean Lewis
—— Some years ago I noticed that I had never sent a child to a training institution who could read at grade level.
D. Judge Jeffrey H. Gallet
—— If you cannot read there are only two ways to make a living — the welfare system or crime — and crime has more status.—— Everyone at school said that I was lazy or stupid or both. After a while I began to believe them. Sometimes, I just gave up.
—— I was a lucky one. . . .They [supporters] knew that I was neither stupid nor lazy, even though there were times I was not so sure myself. By the time I was, by chance, diagnosed as learning-disabled at the age of thirty-five, I had already learned to deal with my disabilities. By the age of thirty-seven, I was a judge. . . .
—— Almost every week I see a learning disabled child who, undiagnosed or untreated, is venting his or her frustrations in anti-social ways. I could have stood in the same spot. If not for loving, caring, involved parents, my frustrations at not being able to keep up in class, and to some extent in the play yard, could have burst forth in the same self-destructive way.
—— The schools and the courts have not met their responsibilities to LD children. When I was young, they simply did not recognize the problem. Now, they can diagnose and deal with LD but have not allocated the resources to do what must be done.
Resources
1. CH.A.D.D. - CHildren and Adults with attention Deficit Disorders.
Membership application in materials. Local chapters can assist in finding experts who know about ADD. Publishes member magazine / newsletter. Annual conference includes legal topics. The conference moves and is usually held in fall.CH.A.D.D.
499 Northwest 70th Avenue, Suite 101
Plantation, Florida 33317954-587-3700
htpp://www.chadd.org
2. NADDA - National Attention Deficit Disorder Association.
More oriented toward adults. Annual conference includes legal topics and is usually held in spring.National ADDA
9930 Johnnycake Ridge Road, Suite 3E
Mentor, OH 44060440-350-9595
E-Mail: NatlADDA@aol.com
http://www.add.org/content/menu1.html
3. Learning Disabilities Association of America (LDA)
4156 Library Road, Pittsburg, PA 15234
Phone: 412-341-1515
4. National Center for Learning Disabilities (NCLD)
381 Park Avenue South, Suite 1401
New York, NY 10016
Phone: 212-545-7510
5. Orton Dyslexia Society (ODS)
Chester Building
8600 LaSalle Rd., Suite 382
Baltimore, MD 21286-2044Phone: 410-296-0232
6. ERIC Clearinghouse
Disabilities & Gifted Education
1920 Association Drive
Reston, VA 20191-1589Phone: 800-328-0272 or 703-620-3660
7. Council for Learning Disabilities (CLD)
P.O. Box 40303
Overland Park, KS 66204Phone: 913-492-8755
8. HEATH Resource Center (Higher Education and Adult Training for People with Handicaps
One Dupont Circle, Ste. 800
Washington, DC 20036Phone: 800-544-3284
9. National Information Center for Children and Youth with Disabilities
1875 Connecticut Avenue, 8th Floor
Washington, DC 20009Phone: 800-695-0285
10. National Council of Juvenile and Family Court Judges
Book published by NCJFCJ: Juvenile & Family Court Journal:Learning Disabilities and the Juvenile Justice System $10.00P.O. Box 8970
Reno, NV 89507Phone: 702-784-6012
Internet - Computers
1. Computer Networks
a. Compuserve - GO ADD - includes advocacy sectionb. America On Line - Keyword: "PEN"
c. Prodigy:
2. ADD CHATJUMP: CHATClick on PRODIGY CHAT
Choose Medical/Health area
Bulletin Board
Keyword: "PEN"Medical Support Bulletin Board
JUMP: Medical Support
Choose Attention Deficit
Backdate some
2. Internet Websites (also look under organizations supra)
a. COPAA: Council of Parent Attorneys and Advocateshttp://www.edlaw.net/edcenter/copaab. The Special Ed Advocate
http://www.wrightslaw.com/c. Dr. Daniel Amen, M.D.
http://www.amenclinic.comd. LD OnLine Learning Disabilities Resources
http://LDOnline.org/e. Attention Deficit Disorder Archives
http://www.enteract.com/~peregrin/add/index.htmlf. ADD on AOL
http://users.aol.com/jimjams/index.htmlg. Bouncing Brains
http://www.bouncingbrains.comi. ADD/LD Online Resource Center (This is a Chicago clinic’s website — it seems to have solid information that is well-presented.)
http://www4.interaccess.com/add/index.htmlj. One ADD Place
http://www.greatconnect.com/oneaddplace/k. The grandfather of all ADD sites
http://add.miningco.com/l. http://www.pcnet.com/~dodge/addlist.html.
3. Newsgroup: alt.support.attn-deficit
Government
NIMH National Institute of Mental Health
- Published a 42-page booklet on Attention Deficit Hyperactivy Disorder (1994). Anyone can receive a free copy of this booklet by calling 301-443-4513 or by writing: Information Resources Inquiries Branch, Room 7C-02, Office of Scientific Information, NIMH, 5600 Fishers Lane, Rockville, Maryland 20857. This booklet is great for giving to clients, judges, prosecutors, and could be introduced into evidence as a government document. The booklet is on the InterNet at http://ww.nimh.nih.gov/publicat/adhd.htm (also available on this site at ) http://www.addbalance.com/add/adhd.htm.
Books
- A Teenager’s Guide to A.D.D., Antony Amen; Sharon Johnson; & Daniel G. Amen, M.D., Mindworks Press, paper, 1996
- Adult ADD - the Complete Handbook, David B. Sudderth, M.D., and Joseph Kandel, M.D., Prima Publishing, paper, 1997
- Driven to Distraction, Hallowell & Ratey
- Answers to Distraction, Hallowell & Ratey
- You Mean I’m Not Lazy, Stupid or Crazy?! Kate Kelly & Peggy Ramundo, 1993
- Windows into the A.D.D. Mind, Daniel G. Amen, M.D., Mindworks Press, hard
- Attention Deficit Disorder: A Different Perception: a hunter in a farmer’s world, Thom Hartmann, (2nd ed.) 1997
- Women With Attention Deficit Disorder: Embracing Disorganization at Home and in the Workplace Sari Solden
- Images Into the Mind, Daniel G. Amen, M.D., Mindworks Press, paper, 1996 (color plates of brain scans & deals more with violent behavior and brain problems)
- Overload: Attention Deficit Disorder and the Addictive Brain, David Miller and Kenneth Blum, 1996
- Shadow Syndromes, John Ratey, M.D., hard, 1997
- DSM-IV - Diagnostic and Statistical Manual - 4th ed. - 1994 (out of date as to Adult ADD, field studies not based on adults, but still considered the Bible by many courts and expert witnesses)
Footnotes
- About the Author Charles K. Kenyon was been an Assistant State Public Defender in the Marinette, Wisconsin office 1992-2000. He graduated from the UW-Madison Law School in Dec. 1978, was in private practice from 1979-1987, and served as the Kewaunee County District Attorney 1987-1991. He has argued (and won) before the Wisconsin Supreme Court and tried his first jury trial in 1979. His undergraduate degree (also UW-Madison) was in psychology. Kenyon is past president of both the Menominee River Defenders Association and the Marinette County Bar Association. He is past-president of the Door-Kewaunee Bar Association. He has a personal website: http://www.addbalance.com/ -- Go Back
- Zametkin, Alan J. (National Institute of Mental Health) "Cerebral Glucose Metabolism in Adults with Hyperactivity of Childhood Onset." New England Journal of Medicine, 323: 1360-61 (20, 1413-1415). -- Go Back Also cited in the NIMH publication on ADHD.
- Daniel G. Amen, M.D. is a board certified neurological pediatric psychiatrist practicing in Fairfield, CA. He has treated thousands of people with ADD and has published information from his SPECT images of brain activity. The slides that we are seeing today are his work. In addition to presentations and papers before professional groups he is the author of numerous books on the brain and behavior. The classification criteria for six types of ADD are paraphrased from his book: A Teenager’s Guide to A.D.D. His website can be found at : http://www.amenclinic.com -- Go Back
Last updated 10/1/98.
This is a living hypertext document. If you find any errors, of fact or in links, please contact me so that they may be corrected. You can reach me at Balance Check at ADD Balance.
ADD - ADHD - AD/HD Books List
ADD - ADHD - AD/HD Home Page
ADD - ADHD - AD/HD Links Pages