still be holding onto. Finally, I hope that another group of women will be helped to share their untold story.
Sari Solden
June, 2005
A Pocket Guide to AD/HD
This section can be used for important information about AD/HD before reading the rest of the book. It is useful for people who are not familiar with AD/HD and can also be consulted as a handy reference throughout the book.
Defining AD/HD
Most people start out by telling you what AD/HD is. I’d like to start out by telling you what AD/HD is not. Because so many people who don’t fit the common picture of AD/HD rule themselves out prematurely, it is important to clear up the misconceptions and stereotypes that surround AD/HD.
AD/HD is NOT:
•Just for kids
•Just for boys
•Just about hyperactivity
•About a “deficit of attention”
•About being irresponsible or having a character flaw
AD/HD IS:
•A neurochemical condition (not a psychological one) that affects behavior on various levels:
– attention
– activity
– impulsivity
•A diagnosis of AD/HD requires that these behaviors be:
– chronic (meaning you have had them a long time)
– severe (impacting your life negatively in serious ways, more so than other people)
Diagnosing AD/HD is Complex
However, even if you have had challenges all your life, they may have been masked by structure or support or because you were very smart or creative. You may have compensated all your life in ways that kept the symptoms under control, or you may have self-medicated without knowing that’s what you were doing.
What can be even more confusing is that even though you may have these difficulties over time, you may not have had them consistently. As Thomas Brown, Ph.D. puts it “they may be chronic but not constant.” (1999, pg. 3) They may vary from situation to situation. You may have done some things very well and have had significant gaps in other areas. To complicate the diagnostic picture even more, no two people with AD/HD will have the exact same problems.
AD/HD can be best understood by explaining the executive, or management, function of the brain. Thomas Brown, Ph.D. leading expert in adult AD/HD from the department of psychiatry at Yale University illustrates this condition as he lectures about executive function with the metaphor of wonderful musicians trying to play together in an orchestra without a conductor! Executive functioning is described in more detail in Chapter 5, but it has to do with shifting, starting, dividing, stopping, and starting your attention. It includes the following:
•Activating your brain to begin to work.
•Maintaining attention in the midst of distractions.
•Sustaining attention when energy and interest fade.
It is extremely important to understand that while AD/HD is a serious disorder, it is not characterological or psychological, but neurobiological. This means it’s not your fault, but it’s how your individual brain works. It does not mean you have brain damage.
While no one knows exactly what causes AD/HD, it is commonly understood to be genetically transmitted. You are born this way, and there are probably others in your family who either have or have had these difficulties.
The Information Highway in Your Head
The brain uses multiple chemical substances called neurotransmitters to act as messengers, sending information to and from the different parts of your brain. Three neurotransmitters that have been linked to behavioral and emotional conditions are Dopamine, Serotonin, and Norepinephrine. While low levels of Serotonin are linked with clinical depression, AD/HD appears related to the other two neurotransmitters, Dopamine and Norepinephrine. Most people agree that AD/HD symptoms are connected to the inefficiency and inconsistency of this chemical information transmission system in the brain. The brain itself is fine. There is no damage, and actually people with AD/HD are often quite bright or creative. It is just that for some reason these chemical messengers are not firing consistently or efficiently. It’s logical that if the regulators aren’t firing properly in the part of your brain that regulates attention, activity level, and impulsivity that these areas of behavior would also be inconsistent.
In his 2004 article on the basics of the neurobiology of AD/HD, Terry Dickson, M.D., an expert in the field, likens the difficulty of communicating inefficiently across nerve synapses in the brain to talking on a cell phone with bad reception. I liken this neurotransmitter inconsistency to problems you may experience with your computer. Even if you have the most expensive, well-built computer with the ability to process and store great amounts of information, your desktop can get too full, or something can go wrong with the operating system. Or your computer could have great long-term information storage capability but inadequate operating capability to match. Those of us who use computers have all experienced the frustration when an error message suddenly appears without warning—the screen freezes, and the system crashes. In a sense, this is what AD/HD is like; not being able to use the potential of the fine tool that is there.
The inefficient and irregular transmission of information in the brain causes a host of unique difficulties in each person affected. The huge number of variations and limitless possibilities of combinations that exist in these chemical connections makes what we now call AD/HD so confusing to understand. It’s hard for many to accept, especially because the symptoms manifest so differently in each person. AD/HD even looks different in the same person at various times.
Seeing is Believing
Promising technological advances have allowed us to actually see the brain in action thus bringing us closer to a true understanding of how it functions. In the same article by Dr. Dickson mentioned above, he tells us about three functional brain imaging techniques—MRI, Pet and Spect—used to take pictures of the metabolism of brain chemicals. Dr. Dickson says that these functional brain-imaging techniques have played a vital role in understanding the AD/HD brain.
One of the leading scientific discoveries was made by Dr. Alan Zametkin (1990) of the National Institute of Mental Health. Through the use of a special brain-imaging technique called Positron Emission Tomography (PET) scans, he has been able to measure and document the glucose metabolic process in individuals. These tests show fairly conclusively that during tasks that require concentration, the brains of individuals with AD/HD have a markedly lower level of brain activity in these areas as compared with those without AD/HD.
There is no clear agreement on the exact process by which AD/HD symptoms are produced in the brain. However, researchers surmise that because certain medications that affect the specific processes in the brain work so well in the reduction of AD/HD symptoms that these brain chemicals are also the ones
