I am always amazed how narrowly many people view the world—it’s their view or no view. If they haven’t seen it, it doesn’t exist. Illness treatment is often associated with prejudice (pre’ judge’) however ADD or Attention Deficit Disorder takes the cake. I have many patients who were never treated because “my parents said that was hooey and I was just lazy.” Or, “you could sit still if you wanted to but you are just spoiled rotten by your mother.” Most prejudice is aimed at the involuntary behaviors like excessive pacing, nervous twitching, disengaged conversation, or anxiety that arises from repeated failure—things people can literally see.
Many believe ADD can be “cured” by behavior modification or good parenting. “If just enough behavioral tools were applied there would be no need for medication” is a common belief. No doubt, we all could benefit from modifying our behavior with some coaching.
I recently had a mother who brought her ADD 5-year-old to the exam. In that 10 minute exam, I counted over 100 “stop”, “don’t”, “quit it”, “you are going to get a spanking” one liners. One hundred! In just ten minutes! Imagine what a lifetime of these negatives will do? She scoffed when I told her an excellent pediatrician who specialized in ADD with a team approach was just up the road. Her answer was, “He just needs a whooping.” I’ll bet he either whoops her one day or he’ll just whoop up on himself. This is after she was treated the same way by her parents for her ADD and even after she has basically resolved it with medication. She just can’t “see” it.
My wife had a kid in her first-grade class who was taped to the chair every day by the nuns since he literally could not stay seated. They also beat him with rulers. He didn’t show up for second grade. I recently read of a principle who taped a child’s mouth shut and spanked him while being held up by his feet because he could not sit still. Can you imagine? Hard to but it is true.
Another perspective is severity. I had a grandparent inquiring about ADD treatment who has two grandchildren that are very hyperactive. One is an 8th grader who literally cannot sleep without melatonin. Imagine a 13-year-old who can’t sleep! He talks very fast and he cannot sit still. However he has a learning curve of 1—one time and done! He can finish a Rubik’s Cube in less than 20 seconds. He plays 8 instruments very well because he gets bored so easily. He was recently invited to play the piano in Europe at a prestigious school. He has mastered the Intelligent Investor, the book that taught Warren Buffett. He makes his own stock trades and has a 20% return rate. Does this kid need treatment of his hyperactivity? Her other grandson also cannot stop pacing or ever sit for more than 30 seconds. He loses or breaks almost anything he touches. He finished high school in special needs class and he now makes a living in lawn care. He literally writes upside down and backwards. Just try that with your name! This kid needs the whole behavioral team and medication. Two cases of hyperactivity—two entirely different outcomes. Two different perspectives.
Most of us have ten fingers and ten toes but most of us cannot perform like Drew Brees. The human brain is fascinating. Each one looks exactly like the next on an MRI or CT scan. But put them under a function scan like SPECT, and the brain universe literally lights up differently. Pioneered by Dr. Daniel Amen, SPECT scans literally changed ADD from a behavioral disorder to a biochemical disorder over Dr. Amen’s career. He has demonstrated unequivocally nerve cells do not all function equally from person to person. He has also demonstrated that many nerve cells and nerve circuits can improve with nutrition and medication. Yet, as primitive as SPECT scans are compared to what we will see in future brain function scans, just matching the scan with the behaviors has been a game changer in brain medicine. We now can see brain function disorders. One would think that would change perspective. Well, for the person with ADD—believe me, it has.
