Attention Deficit Disorder: The Unfocused Mind in Children and Adults

by Thomas E Brown, Ph.D.
Yale University Press © 2005
$27.50 384 pp

For years Thomas E. Brown, Ph.D. has been paying attention to the stories of patients with AD/HD. As associate director of the Yale Clinic for Attention and Related Disorders and assistant clinical professor of psychiatry at Yale University School of Medicine, he also knows the science behind the diagnosis. The result is a new book, Attention Deficit Disorder: The Unfocused Mind in Children and Adults. Like Dr. Brown’s very popular talks at annual ADDA conferences, it presents the stories he’s collected during his clinical experience and pairs them with recent research to draw a clear picture of ADHD.

Dr. Brown’s model of ADD groups significant chronic difficulties which tend to show up together and improve together into six clusters of symptoms which he calls the ADD Syndrome: “a complex disorder that involves impairment in focus, organization, motivation, emotional modulation, memory and other functions of the brain’s management system.”

These executive function impairments are often described as being like a slightly off maestro lacking control of an orchestra. He has trouble managing the starting and stopping of thoughts and actions; his memory and focus are disorganized and undependable.

Executive functions impaired in the ADD syndrome are not simply skills to be learned. ADD Syndrome is not about a lack of will power. Trying harder will not fix it. And medication is not magic — Pills can’t teach skills.

As for any disorder, the most important thing in successful treatment of ADD is education about what it is, what it does, and how it affects the person and his family. The education in this book is clear and comprehensive in its offering. Brown’s references to the problem of emotional modulation for people with ADD is not reflected in the DSM-IV* but it makes sense in my limited experience. I also found some interesting explanations for other problems that I didn’t know were related to ADHD. For example, I learned that while I may understand all the words my children use to describe their day, my ability to repeat them – word for word — it is out of scale with my understanding of the story. An obscure fact? Perhaps. But I believe knowing that’s common for people with ADD will help me appreciate why a verbal grocery list is less effective than a written one.

The book is heavily cited for clinicians but never in a way that made me feel inferior. In addition, the book includes the clearest explanation I have ever seen of how the brain uses its special proteins to move thoughts around and how different medications affect that process. I particularly appreciate Dr. Brown’s gentle humor and compassion in the construction of metaphors to explain complicated concepts and then his further explanation about why they are not quite the full story. He’d regularly speaks at ADDA conferences. If you have the opportunity, do not miss him!@

ADD is, if anything, a collection of symptoms – widely varied in those diagnosed with it. For clinicians, this book has the studies to back the premise that ADD Syndrome includes a more complex collection of markers. For parents or adults with ADD, this book lays out the intricacies of the bits and pieces of behaviors that have just not made sense before.

* For a refresher on what the DSM-IV says about ADHD, check out the very useful website of David Rabiner, Ph.D. Associate Research Professor, Duke University

Fidget to Focus – Outwit Your Boredom: Sensory Strategies for Living with ADD
Roland Rotz, Ph.D. and Sarah D. Wright, M.S., A.C.T.
IUniverse © 2005
$14.95
126 pp

Do your kids swear that listening to music while they do homework actually helps them concentrate? Can you sit still OR focus, but not both – simultaneously?

If your answer is “yes,” you might already understand the art of effective fidgeting – using simultaneous sensory-motor activities to increase your ability to pay attention.

Based on the collected stories of hundreds of people, authors Roland Rotz, Ph.D. — a licensed child and adult psychologist — and Sarah D. Wright, M.S., A.C.T. – a professional AD/HD coach – propose sifting the paradigm: Give yourself permission to fidget. “Restlessness is not just an expression of trying to ‘get out of the fidgets’ in order to become calm. It is rather an attempt to self-arouse to become focused.”

The beauty of fidgeting in order to focus is that it works for everyone, not just people with ADD. Moving your body is particularly effective. Running, walking or even plain old recess activities help many people attend even after those activities have stopped. Personally, I find knitting to be a great way to keep myself focused while attending mlong meetings. It actuates the sense of touch, and it’s much better than picking at my nails. Color coded file folders are more plesant to look at so they help make the drudgery of filing a bit more interesting.

Key is to identify socially acceptable forms of fidgeting. Whether it’s doodling in a notebook while listening to a lecture, chewing gum while taking a test, or racing against the clock to finish a tedious task like cleaning the kitchen, what makes it work is using different senses for the fidget and for the focus.

This short book is structured with review points at the end of each chapter. It aims to help you identify your own socially acceptable devices to keep one part of your brain busy while allowing greater focus by another part. The strategies suggested in the text and in the “Fidget Strategies Workbook” included with the appendices will likely lead you to think of other techniques that will work for you. You’ll find suggestions for using your senses: sight, sound, touch, taste and smell as well as movement, time awareness, or a companion.

A couple of big points from the book:

“Effective fidgeting uses a second sensory-motor activity, one other than that needed for our primary activity, to help us stay alert and focus the primary activity.” These secondary activities might include listening to loud music while doing housework, racing against the clock to finish a tedious task like cleaning the kitchen, doodling in a notebook while listening to a lecture, or chewing gum while taking a test.

“Some of the strategies we use to simulate ourselves into interest and thus action, e.g. procrastination or emotional conflict, can have undesirable side effects.” The authors warn that if you don’t actually choose your method of fidgeting, you could wind up doing something harmful: perhaps something as simple as picking your cuticles or more problematic smoking or engaging in some other addictive behavior.

ADDitude Magazine asked me to write a review of
When Too Much Isn’t Enough:
Ending the Destructive Cycle of AD/HD and Addictive Behavior
by Wendy Richardson, MA
Piñon Press; $15.99

They chose a different version of the review, so this one isn’t bothered with their copyright issues. Thank you very much.

Let me just say, “I know some people…” who are not technically addicted to food or alcohol or video games. But I do know people who over indulge more often than they should in harmful activities — including just plain ole harmless solitaire.

So Wendy Richardson’s new book, When Too Much Isn’t Enough: Ending the Destructive Cycle of AD/HD and Addictive Behavior, put a great deal of abusive behavior in to a very clear picture for me.

It’s hard to know when you’ve eaten enough, if you don’t notice a full feeling in your stomach. People with AD/HD could find it hard just to remember how much they’ve had to drink — and I’m not talking here because of a drunken stupor. Undiagnosed or untreated AD/HD makes it easier to slide into problems and then more difficult to recover from them.

Richardson’s easily-readable book looks at the many faces of self-medication and why people with AD/HD overindulge or become addicted to drugs, food, alcohol and compulsive behaviors. She makes a strong case for getting a proper and complete diagnosis and treatment. She advocates for finding professionals who understand both AD/HD and addictive behaviors. She also presents many possible avenues for recovery including not only the well known 12-step programs, but also therapy, counseling, coaching and medication. The book’s appendices and end notes include extensive resources available on the Internet, in libraries, and through educational and support organizations.

Obviously, noticing a behavior is key to changing it, but people with AD/HD are notoriously bad at self monitoring. So the chapter “The Less Talked About Traits” is helpful in recognizing how sensory sensitivity, sleep problems and organization issues might affect a person’s abilities to manage his own life effectively.

The chapter “It’s Not Your Fault, But It Is Your Problem” has an excellent explanation of the genetic and biological aspects of AD/HD and addiction. It is written for the general public but comprehensively cited for anyone who wants more in-depth information.

“The Truth about Medication” addresses many concerns that recovering drug addicts and alcoholics have about medication interfering with that recovery.

If you — or someone with whom you live or work — struggles to control problematic behaviors, this book will surely be useful to you. But if you are watching someone who has AD/HD and you are just beginning to notice behaviors that might be crossing some imaginary line — if you’re just not sure what’s going on – this book will be more useful than you can imagine.