Attention Deficit Disorder is a complex condition that is not well understood at the present time by many clinicians and the general public. New information is being discovered rapidly however. Dr. Amen is one of the pioneers in this field and this article is meant to summarize his work. Attention Deficit Disorder (ADD) and Attention Deficit Disorder with Hyperactivity (ADHD) occur as a result of neurological dysfunction in the prefrontal cortex of the brain. This is the newest part of our tri-brain system in evolutionary terms. It is the part of our brain that performs executive functions. The functions of this brain deal with 1) attention span, 2) perseverance, 3) judgment, 4) organization, 5) impulse control, 6) self-monitoring and supervision, 7) problem solving, 8) critical thinking, 9) forward thinking, 10) learning from experience, 11) ability to feel and express emotions, 12) interaction with the limbic system, and 13) empathy.

Whenever there is a problem with this part of the brain, a number of skills that many human beings take for granted would not be available in any optimal way. The following are problems that develop when the prefrontal cortex is affected. 1) Short attention span, 2) distractibility, 3) lack of perseverance, 4) impulse control problems, 5) hyperactivity, 6) chronic lateness and poor time management, 7) disorganization, 8) procrastination, 9) unavailability of emotions, 10) misperceptions, 11) poor judgment, 12) trouble learning from experience, 13) short-term memory loss, and 14) social and test anxiety.

The exact neurological problem with ADD is unknown at this time. However SPECT scans, single photon emission computed tomography, which measures cerebral blood flow and metabolic activity patterns, has noted that when someone with ADD concentrates, their prefrontal lobe activity decreases significantly. This essentially means that under stress and concentration someone with these disorders cannot bring to bear their full cognitive capacity.

It is theorized that our usual ability to screen out and attend to stimuli of our choice is impaired with these individuals. I like to think of it as going to the mall during the summer. It is too bright and there are too many people around, but it is not overwhelming. However, at Christmas time after a couple of hours at the mall people are so over-stimulated that it is hard to find the car. People with ADD feel this way almost all the time.

There are five recommended courses of treatment for someone with ADD or ADHD. Physicians often give an antidepressant such as Wellbutrin and Strattera, which tends to calm the limbic system and increase dopamine, a neurotransmitter. In my experience as a therapist, this can be helpful but stimulants, the second course, seem to do a better job. Stimulants given in small doses, so the mood alteration is minimal, act in a paradoxical manner. This means that instead of accelerating a person they help to focus and calm them while still allowing the prefrontal lobe to remain active. They also seem to increase dopamine. This neurotransmitter is negatively affected with people suffering from ADD. The third regimen, a combination of an anti-depressant and a stimulant, seems to work best for most people suffering from most forms of ADD. The fourth treatment consists of teaching relaxation, stress-management, organizational, and socializing skills. This should always be included as part of treatment whether or not medication is used.

Another form of treatment is the naturopathic approach. Due to my background I cannot adequately discuss this method, and as yet am not sufficiently familiar with the treatment to be able to measure its efficacy. At the present time, supplements, vitamins and chiropractic care seem to be effective as an adjunct to stimulants.

There are numerous misconceptions about Attention Deficit Disorder and a lot of emotional fervor about the diagnosis. It reminds me of the debate over Prozac several years ago or whether or not Alcoholism is a disease or a moral defect. It is understandable that people worry about giving young children a mood-altering drug. However, any time medication is considered as an approach, the physician needs to carefully assess both the costs the benefits and the severity of the problem. Most medication difficulties with ADD result from mismanagement. When the appropriate amount of medication is used with ADD the benefits are immense and the cost is minimal. A person