                   ATTENTION DEFICIT DISORDER (ADD)
        
                     FREQUENTLY ASKED QUESTIONS 
        
        Index:
        
        |1) What is an Attention Deficit Disorder?
        2) What are some common symptoms of ADD?
        3) How is ADHD diagnosed?
        4) Is this a new disease?
        5) What other names has this disease been known by?
        6) What causes ADHD (Etiology)?
        7) What is the long term prognosis?
        8) Are there other complications of this disease?
        9) What treatment is there for ADHD?
        10) Controversial treatments for ADHD
        11) What medications can be used in treatment?
        12) Monitoring tools/scales
        13) Myth-conceptions
        14) Are there any support groups?
        15) Is there a good commercial source for information?
        16) Are there any internet resources?
        17) Books on ADD
        18) ADD in Adults?
        
        
        1) What is an Attention Deficit Disorder?
          
          Attention Deficit Disorder (ADD) is a syndrome which is usually
        characterized by serious and persistent difficulties resulting
        in:
          a) poor attention span
          b) weak impulse control
          c) hyperactivity
        
          ADD also has a subtype which includes hyperactivity (ADHD). It
        is a treatable (note not cureable) complex disorder which affects
        approximately 3 to 6 percent of the population (70% in relatives
        of ADD children).  Inattentiveness, impulsivity, and oftentimes,
        hyperactivity, are common characteristics of the disorder. Boys
        with ADD tend to outnumber girls by 3 to 1, although ADD in  
        girls is underidentified.
        
          The term ADD is usually referring to ADHD.  ADD without 
        hyperactivity is also known as ADD/WO (With Out) or
        Undifferentiated ADD.
        
        2) What are some common symptoms of ADD?
        
          1. Excessively fidgets or squirms
          2. Difficulty remaining seated
          3. Easily distracted
          4. Difficulty awaiting turn in games
          5. Blurts out answers to questions
          6. Difficulty following instructions
          7. Difficulty sustaining attention
          8. Shifts from one activity to another
          9. Difficulty playing quietly
         10. Often talks excessively
         11. Often interrupts
         12. Often doesn't listen to what is said
         13. Often loses things
         14. Often engages in dangerous activities
        
          Recent literature proposes 2 subtypes of ADHD Behavioral and
          Cognitive (being split 80/20).
        
        3) How is ADHD diagnosed?
        
          The list above is  taken directly from the American Psychiatric
        Association's (APA) latest "Diagnostics and Statistical Manual of
        Mental Disorders (DSM-III-R). To qualify for a diagnosis of ADHD
        a child must exhibit 8 of these for a period longer than 6 months
        and have appeared before the age of 7 years.
        
          EEG abnormalities can appear in up to 50% of ADD children (not 
        used in diagnoses).  However, you don`t have to be hyperactive to
        have an attention deficit disorder. In fact, up to 30% of
        children with ADD are not hyperactive at all, but still have a
        lot of trouble focusing.
        
        4) Is this a new disease?
        
          No. It has been identified in medical literature more than 100
        years ago.  A popular German tale (Hoffmann's "Struwel Peter") 
        written in rhyme for children portrays a child with ADHD.
        
        5) What other names has this disease been known by:
        
          Minimal brain dysfunction (MBD) and hyperactivity
        (hyper-kinetic) or (in Britain) conduct disorder (not the same
        implications as the North American reference in the DSM-III-R).
        
        6) What causes ADHD (Etiology)?
        
          A single cause has not been conclusively proven. Some
        possibilities are:
        
          1. Genetic/ Hereditary
          2. Brain damage (head trauma) before, after and during birth    
             (twice as likely to have had labour> 13hrs)
          3. Brain damage by toxins (internal bacterial and viral,        
             external fetal alcohol syndrome, metal intoxication eg lead)
          4. Strongly held belief by some people (including at least one
             book Feingold's "Cookbook for Hyperactive children") that    
             food allergies cause ADD. This has *not* been proven         
             scientifically.
        
        7) What is the long term prognosis?
        
          One book states 20% outgrow it by puberty but other problems
        can interfere.. ADD that lasts into Adulthood is referred to as
        ADD-RT (Residual Type).
        
        8) Are there other complications of this disease?
        
          Yes. Not really complications in the classical sense but rather
        clusters of other problems of the Central Nervous System (CNS)
        such as:
        
           - Learning Disabilities (LDs)
           - TIC disorders (such as Tourette`s) 20 % of ADD children      
             whereas 40 to 60% of TIC children have ADD
           - Gross and Fine Motor control delays (coordination) 50% of    
             ADD children
           - developmental delays (such as speech)
           - Obsessive-compulsive disorders (OCD)
        
        9) What treatment is there for ADHD?
        
          No simple treatment. Must be a multi-modal approach including 
        (but not limited to):
        
           a. Medication
           b. Training of parents
           c. Counselling/training of child:
              such as modeling, self-verbalization and                    
              self-reinforcement.
           d. Special education environment
        
        10) Controversial ADD Treatments
        
          This section was condensed from an article "Controversial 
        Treatments for Children with ADHD" By S. Goldstein Ph.D. & B.
        Ingersoll Ph.D.
        
          a) Dietary Intervention. The changing of a child's diet to
        prevent ADHD.
        
             Conclusion: No scientific evidence of effectiveness.
         
          b) Megavitamin and Mineral Supplements. The use of very high 
        does of vitamins and/or minerals to treat ADHD.
        
             Conclusion: No scientific evidence of effectiveness.
        
          c) Anti-Motion Sickness Medication. The advocates of this
        believe that a relationship exists between ADHD and the
        inner-ear.
        
             Conclusion: No scientific evidence of effectiveness.
        
          d) Candida Yeast. Those who support this model believe that
        toxins created by the yeast overgrow and weaken the immune system
        making the individual susceptible to many illnesses including
        ADHD. 
        
             Conclusion: No scientific evidence of effectiveness.
        
          e) EEG Biofeedback. Proponents of this approach believe that
        ADHD children can be trained to increase the type of brain-wave
        activity associated with sustained attention.
        
             Conclusion: No scientific evidence of effectiveness.
        
          f) Applied Kinesiology (Chiropratic approach). This theory
        believes that Learning Disabilities are caused by 2 specific
        bones in the skull. 
        
             Conclusion: No scientific evidence of effectiveness.
        
          g) Optometric Vision Training. This proposes that reading
        related Learning Disabilities are caused by visual problems.
        
             Conclusion: No scientific evidence of effectiveness.
        
        11) What medications can be used in treatment?
        
          This is a constantly evolving area. At the time of the writing
        (Jan 93) of this FAQ and known to this author are:
        
          Phychostimulants (Trade name and chemical name):
        
           1. Ritalin (methylphenidate) also SR Ritalin (Slow Release)
           2. Dexedrine (dextroamphetamine)
           3. Cylert (pemoline)
        
          Antidepressants (Tricyclic or TCAs) used to treat bed wetting
        and depression:
        
           1. Tofranil or Janimine (impramine)
           2. Norpramin or Pertofane (desipramine)
           3. Pamelor (nortriptyline) principle metabolite of ELavil 
              (amitripyline)
        
          Neuroleptics (usually used with stimulant):
        
           1. thioridazine
           2. Propericiazine
           3. chlorpromazine (unsure of category)
        
          Tranquilizers:
        
           1. Mellaril
           2. Atarax
        
          Antihypertensive:
        
           1. Catapres (clonidine)
        
          Others:
        
           1. antidepressants ( called monoamin oxidase inhibitors MAO)
              fluoxetine or burproprion
           2. lithium
           3. Tegretol (anticonvulsant caramazepine) mood stabilizer
        
             Note none of these (listed in other) have been extensively
        studied for use with children.
        
        12) Monitoring tools/scales:
        
           1. Conners Teacher/Parents Rating scales (CTRS,CPRS) *
           2. ADD-H Comprehensive teacher rating scale (ACTeRS) *
           3. Child Attention Problems (CAP) Rating scale
           4. Yale Children's Inventory (YCI)
           5. Attention Battery (includes Continuous Performance Task,
              Progressive Maze Test and Sequential Organization Test      
              (SOT).
           6. DSM-III-R
           7. Wechsler Intelligence Scales for Children (WISC-R)
           8. Child Behavior Checklist (CBCL)
           9. T.O.V.A - Test of Variables of Attention*
          10. Learning Efficiency Test II (LETT-II)*
          11. DEVELOPMENTAL TEST OF VISUAL MOTOR INTEGRATION (VIM) 
          12. Wide Range Achievement Test (WRAT-R) *
        
         * (Can be purchased from ADD Warehouse)
        
        13) Myth-conceptions
            
          a. Medication should be stopped when a child reaches teen
        years.
           
           Research clearly shows that there is continued benefit to 
        medication for those teens who meet criteria for diagnosis of
        ADD.
        
          b. Children build up a tolerance to medication.
        
           Although the dose of medication may need adjusting from time
        to time there is no evidence that children build up a tolerance
        to medication.
           
          c. Taking medication for ADD leads to greater likelihood of
        later drug addiction.
        
           There is no evidence to indicate that ADD medication leads to
        an increased likelihood of later drug addiction.
        
          d. Positive response to medication is confirmation of a
        diagnosis of ADD.
        
           The fact that a child shows improvement of attention span or a 
        reduction of activity while taking ADD medication does not 
        substantiate the diagnosis of ADD.  Even some normal children
        will show a marked improvement in attentiveness when they take
        ADD medications.
        
          e. Medication stunts growth.
        
           ADD medications may cause an initial and mild slowing of
        growth, but over time the growth suppression effect is minimal if
        non-existent in most cases.
        
          f. Taking ADD medications as a child makes you more reliant on 
        drugs as an adult.
        
           There is no evidence of increased medication taking when 
        medicated ADD children become adults, nor is there evidence that
        ADD children become addicted to their medications.
        
          g. ADD children who take medication attribute their success
        only to medication.
        
           When self-esteem is encouraged, a child taking medication 
        attributes his success not only to the medication but to himself
        as well.
        
             NOTE: this section was lifted from an article published in
        the Fall 1991 Chadder titled "Medical Management of Children with
        ADD Commonly Asked Questions" by Parker et al.
        
        |14) Are there any support groups?
        
          Yes. Largest is CHADD.
        
          CHildren & Adults with Attention Deficit Disorder
          National Office
          499 N.W. 70th Ave.
          Suite 308
          Plantation, Florida 33317
        
          Phone 305-587-3700
          Fax 305-587-4599
        
          LDA
          Learning Disabilities Association
          4156 Library Road
          Pittsburg, Pennsylvania 15234
        
        
        15) Is there a good commercial source for information?
        
          Yes. ADD Warehouse.
          1-800-233-9273 (US only)
          Phone 305-792-8944
          Fax 305-792-8545
        
        16) Are there any internet resources?
        
             Yes. There is an ADD parents mail list.
        
             Requests to listserv@n7kbt.rain.com.
        
        To subscribe send email to above address with body of message as 
        follows:
             subscribe add-parents YOUR-NAME
        
             Welcome to the ADD parent's mailing list. This forum is a
        way for parents of children with Attention Deficit/Hyperactivity
        Disorder to connect with each other and share information and
        support.
        
          To send mail to the others on the list, mail to
        
          add-parents@n7kbt.rain.com
        
          To contact the list administrator (Deborah J. Ruppert), send
        mail to phoenix@n7kbt.rain.com
        
        16) Books on ADD.
        
          This is the author's personal list (maybe we can have a net
        vote if there is enough interest). Ranked in order of preference.
        
        a. "Why Johnnie Can't Concentrate - Coping with Attention Deficit 
           Problems" Robert A. Moss, Bantam, 1990, ISBN 0-553-34968-6 ,   
           PB, (p. 203)
        
        b. The Children`s Hosp. of Philadelphia - "A Parents Guide to     
           ADD" Lisa J. Bain, Delta ,1991, ISBN 0-385-300031-X, PB, (p.   
           216)
        
        c. "COPING ADD" Mary Ellen Beugin, Detselig Enterprises, Calgary, 
           Alberta, 1990, ISBN 1-55059-013-8, PB, (p. 173)
        
        d. "If your child is hyperactive, inattentive, impulsive,         
           distractible...helping the ADD hyperactive child" S & M        
           Garber, 1990, villard ny, ISBN 0-394-57205-x, HB, (p. 235)
        
        e. ADDH Revisited "A concise source of info for parents &         
           teachers" H. Moghadam, Detselig, ISBN 0-920490-78-6, 1988, PB, 
           (p. 101)
        
        f. (PAMPHLET) "A Parents guide to ADHD".
        
        g. (Paper) "Controversial Treatments For Children With ADHD"
           S. Goldstein Ph.D & B. Ingersoll Ph.D.
        
        18. ADD in Adults?
            Adult ADD (ADD-RT) appears to be getting much more visibility
            in the media.
        
        
        SUGGESTED DIAGNOSTIC CRITERIA FOR ATTENTION DEFICIT DISORDER IN
        ADULTS
        
        by Edward M. Hallowell, MD and John J. Ratey, MD
        
        Note: These criteria are based on extensive clinical experience 
        but have not yet been statistically validated by field trials.
        
        Note: Consider a criterion met only if the behavior is 
        considerably more frequent than that of most people of the same
        mental age.
        
        A. A chronic disturbance in which at least twelve of the 
        following are present:
        
        1. a sense of underachievement, of not meeting one's goals 
        (regardless of how much one has accomplished). 
        
        We put this symptom first because it is the most common reason 
        an adult seeks help. "I just can't get my act together," is the
        frequent refrain.  The person may be highly accomplished by 
        objective standards, or may be floundering, stuck with a  sense
        of being lost in a maze, unable to capitalize on innate
        potential.
        
        2. difficulty getting organized.
        
        A major problem for most adults with ADD. Without the structure
        of school, without parents around to get things organized for him
        or her, the adult may stagger under the organizational demands of
        everyday life. The supposed "little things" may mount up tp
        create huge obstacles.  For the want of a proverbial nail--a
        missed appointment, a lost check, a forgotten deadline --their
        kingdom may be lost.
        
        3. chronic procrastination or trouble getting started.
        
        Adults with ADD associate so much anxiety with beginning a task, 
        due to their fears that they won't do it right, that they put it
        off, and off, which, of course, only adds to the anxiety around
        the task.
        
        4. many projects going simultaneously; trouble with
        follow-through.
        
        A corollary of #3. As one task is put off, another is taken up.
        By the end of the day, or week, or year, countless projects have
        been undertaken, while few have found completion.
        
        5. tendency to say what comes to mind without necessarily 
        considering the timing or appropriateness of the remark.
        
        Like the child with ADD in the classroom, the adult with  ADD
        gets carries away in enthusiasm. An idea comes and it  must be
        spoken, tact or guile yielding to child-like exuberance.
        
        6. an ongoing search for high stimulation.
        
        The adult with ADD is always on the lookout for something novel, 
        something in the outside world that can catch up with  the
        whirlwind that's rushing inside.
        
        7. a tendency to be easily bored.
        
        A corollary of #6. Boredom surrounds the adult with ADD like a 
        sinkhole, ever ready to drain off energy and leave the individual
        hungry for more stimulation. This can easily be misinterpreted 
        as a lack of interest; actually it is a relative inability to
        sustain interest over time.  As much as the person cares, his
        battery pack runs low quickly.
        
        8. easy distractibility, trouble focusing attention, tendency to
        tune out or drift away in the middle of a page or a conversation,
        often coupled with an ability to hyperfocus at times.
        
        The hallmark symptom of ADD. The "tuning out" is quite
        involuntary.  It happens when the person isn't looking, so to
        speak, and the next thing you know, he or she isn't there. The
        often extraordinary ability to hyperfocus is also usually
        present, emphasizing the fact that this is a syndrome not of
        attention deficit but of attention inconsistency.
        
        9. often creative, intuitive, highly intelligent.
        
        Not a symptom, but a trait deserving of mention. Adults with ADD 
        often have unusually creative minds. In the midst of  their 
        disorganization and distractibility, they show flashes of
        brilliance.  Capturing this "special something" is one of the
        goals of treatment.
        
        10. trouble going through established channels, following proper 
        procedure.
        
        Contrary to what one might think, this is not due to some 
        unresolved problem with authority figures. Rather it is a
        manifestation of boredom and frustration: boredom with routine
        ways of doing things and excitement around novel approaches, and
        frustration with being unable to do things the way they're
        supposed to be done.
        
        11. impatient; low tolerance for frustration.
        
        Frustration of any sort reminds the adult with ADD of all the
        failures in the past. "Oh no," he thinks, "here we go again." So
        he gets angry or withdraws. The impatience has to do with the
        need for stimulation and can lead others to think of the
        individual as immature or insatiable.
        
        12. impulsive, either verbally or in action, as in impulsive
        spending of money, changing plans, enacting new schemes or career
        plans, and the like.
        
        This is one of the more dangerous of the adult symptoms, or, 
        depending on the impulse, one of the more advantageous.
        
        13. tendency to worry needlessly, endlessly; tendency to scan 
        the horizon looking for something to worry about alternating 
        with inattention to or disregard for actual dangers.
        
        Worry becomes what attention turns into when it isn't focused on 
        some task.
        
        14. sense of impending doom, insecurity, alternating with high-
        risk-taking.
        
        This symptom is related to both the tendency to worry needlessly 
        and the tendency to be impulsive.
        
        15. mood swings, depression, especially when disengaged from a 
        person or a project.
        
        Adults with ADD, more than children, are given to unstable moods.
        Much of this is due to their experience of frustration and/or
        failure, while some of it is due to the biology of the disorder.
        
        16. restlessness
        
        One usually does not see, in an adult, the full-blown
        hyperactivity one may see in a child. Instead one sees what looks
        like "nervous energy": pacing, drumming of fingers, shifting
        position while  sitting, leaving a table or room frequently,
        feeling edgy while at rest.
        
        17. tendency toward addicitive behavior.
        
        The addiction may be to a substance such as alcohol or cocaine, 
        or to an activity, such as gambling, or shopping, or eating, or
        overwork.
        
        18. chronic problems with self-esteem.
        
        These are the direct and unhappy result of years of conditioning:
        years of being told one is a klutz, a spaceshot, an
        underachiever, lazy, weird, different, out of it, and the like.
        Years of frustration, failure, or of just not getting it right to
        do lead to problems with self-esteem. What is impressive is how
        resilient most adults are, despite all the setbacks.
        
        19. inaccurate self-observation.
        
        People with ADD are poor self-observers. They do not accurately 
        gauge the impact they have on other people. This can often lead
        to big misunderstandings and deeply hurt feelings.
        
        20. Family history of ADD or manic-depressive illness or
        depression or substance abuse or other disorders of impulse
        control or mood.
        
        Since ADD is genetically transmitted and related to the other 
        considerations mentioned, it is not uncommon (but not necessary)
        to find such a family history.
        
        B. Childhood history of ADD (It may have been formally 
        diagnosed, but in reviewing the history the signs and  symptoms
        were there.
        
        C. Situation not explained by other medical or psychiatric
        condition.
        
        It cannot be stressed too firmly how important it is not to
        diagnose oneself. From the information and examples  presented
        here it is hoped that your suspicion may be  raised, but an
        evaluation by a physician to rule out other conditions is
        essential. 
        
