by Edward M. Hallowell, MD and John J. Ratey, MD
Attention Deficit Hyperactivity Disorder (ADHD), formerly ADD, is a disorder of the brain that has garnered much controversy over the past few decades. In children, it is the source of much handwringing. Kids are pretty hyper by nature and the notion of medicating their unique personalities, their verve for exploration and learning, is actually quite frightening. But there are questions of degree, of an identifiable syndrome of behaviors and ways of relating to the world that can make childhood, particularly school, a real challenge for kids. And it often results in a life-long problem with self-esteem, after years of being told they are stupid, incapable of achievement, disruptive or unaccomplished. That doesn't seem terribly fair to the kids, but the differences between basic childish exuberence, and a true psychological defect can be subtle. The treatments for this defect include therapy, guidance, and very controversial medications. Among the several available medicines, Ritalin gets a bad rap, as a rule, but has proven effectiveness in treating ADD. As recently as this year, it was blamed for the grim violence in mass school shootings. That's a ludicrous argument, but it shows how it has become shorthand for the perceived faults in our ability to raise psychologically healthy children, or our notion of medicating away our problems.
Meanwhile, in adults, ADD is also powerfully disruptive. Adults with the disorder can be impulsive, craving of danger, unreliable and equally weighted with the disappointments of unachieved goals and dreams. Adult ADD is less widely known, but the treatments are similar. Still, much other psychological challenge comes along with it, including the same kind of low self-esteem we see in children, along with depression and anxiety. Separating out the various causes and effects of these issues can be a long arduous process and, once again, cannot be simply medicated away, much as we would like. On the other hand, sensitive application of stimulants and anti-depressants, along with proper diagnosis and guidance, can have rapid restorative affects. None of this is easy, though.
This book is one of the landmark volumes in the literature of ADD and ADHD. It is a broad overview of the defect, with many personal stories of suffering and treatment. One of its authors also suffers the disorder, and so carries a deep sensitivity to his patients' exeperiences. We read of children with ADD and their long-suffering parents who may have long blamed themselves for their children's lack of success. This is perhaps the most common story of ADD, and it has many of its greatest challenges, requiring the help of parents, doctors and our overworked, underpaid and dedicated teachers. We read, also, of adult ADD, men and women chronically late, bad with organizing, impulsive to an extreme, and craving ever more exciting input from life. These people can be equally brilliant and focused under the right conditions, but they are often seen as unreliable and flighty. We read of the way ADD can affect relationships, marriages, and families.
At the same time, the authors offer ways of identifying and treating ADD. There is a chapter on the psychobiology of the disorder. They give guidance in approaching the problem in children, long questionnaires for adults, many of their points surprisingly wide in scope. The authors seek to offer the help of their experience, and include a list of resources available to those with the disorder. The book is a sensitive, engagingly written, and valuable resource for those beginning to understand some of the challenges they have faced all their lives.
To some extent, we all experience elements of ADD. In a world of constant stimulation from a 24/7 firehose of social media, a world given over to ever greater moments of stimulation (why else would office towers be installing ever more frightening glass observation decks?), can't we say that environmental input is a significant factor in our ever greater deficits in attention, focus, reliability and achievement? Sure, to some extent, but there is a greater and deeper element at work in the human mind. Our chemistry is amazing in its complexity and astonishing in its sensitivity to defect and disorder. In an ADHD world, it will be hard to pull out the adults and children who need genuine medical or psychological intervention in order to achieve their greatest potential. But just because we're all a bit distracted is no reason to dismiss those among us who are suffering a genuine inability to overcome and manage our social morass and find some moments, at least, of peace.
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