Keywords:  Attention Deficit Disorder, Attention Deficit Hyperactive Disorder, Prozac, Oppositional Defiant Disorder, ADD/ADHD, ODD, biofeedback, neurofeedback, Ritalin, antidepressants, Consciousness Restructuring Process (CRP), hyperactivity, integrative treatment, psychotherapy, neurotransmitters, consciousness, dreams, healing, Chaos Theory, dynamical systems, attentional disorders, hippocampus, manic-depression

WHAT IS ATTENTION DEFICIT DISORDER AND HYPERACTIVITY?

ADHD, also known as hyperkinetic disorder (HKD) outside of the U.S. is estmated to affect 3-9% of children, more boys than girls.  Though they may be present earlier, signs of ADHD become apparent as early as age two or three and develop through adolescence.  Not only children have ADD.  Many symptoms, particularly hyperactivity, diminish in early adulthood, but impulsivity and inattention problems remain with up to 50% of ADHD individuals throughout their adult life.

Children with ADHD have short attention spans, becoming easily bored and/or frustrated with tasks.  Although they may be quite intelligent, their lack of focus frequently results in poor grades and difficulties in school.  ADHD children act impulsively, taking action first and thinking later.  They are constantly moving, running, climbing, squirming, and fidgeting, but often have trouble with gross and fine motor skills and, as a result, may be physically clumsy and awkward.  Their clumsiness may extend to the social arena, where they are sometimes shunned due to the their impulsive and intrusive behavior.

The causes of ADHD are not known.  However, it appears heredity plays a major role, since children with an ADHD parent or sibling are more likely to develop the disorder themselves.  Before birth, ADHD children may have been exposed to poor maternal nutrition, viral infections, or maternal substance abuse.  In early childhood, exposure to lead or other toxins can cause ADHD-like symptoms.  Traumatic brain injury or neurological disorder may also trigger ADHD symptoms.  Current treatment philosophy theorizes that there are imbalances of certain neurotransmitters which can be corrected by stimulant drugs, such as Ritalin.

DSM-IV requires that some symptoms develop before age seven, and that they significantly impair functioning in two or more settings (e.g. home and school) for a period of at least six months.  Children who meet the criteria for inattention, but not for hyperactivity/impulsivity are diagnosed with ADD, predominantly inattentive type.

Symptoms of inattention include the following:

*  Fails to pay close attention to detail or makes careless mistakes in schoolwork or other activities.

*  Has difficulty sustaining attention in tasks or activities.

*  Does not appear to listen when spoken to.

*  Does not follow through on instructions and does not finish tasks.

*  Has difficulty organizing tasks and activities.

*  Avoids or dislikes tasks that require sustained mental effort (e.g. homework).

*  Is easily distracted.

*  Is forgetful in daily activities; hyperactivity.

*  Fidgets with hands or feet or squirms in seat.

*  Does not remain seated when expected to.

*  Runs or climbs excessively when inappropriate (in adolescence and adults, feelings of restlessness).

*  Has difficulty playing quietly.

*  Is constantly on the move.

*  Talks excessively; impulsivity.

*  Blurts out answers before the question has been completed.

*  Has difficulty waiting for his or her turn.

*  Interrupts and/or intrudes on others.

Diagnosis begins with a physical examination by a pediatrician to assess developmental maturity and rule out organic causes.

CONVENTIONAL TREATMENT OF ADD/ADHD

It is important to note that mental disorders such as depression and anxiety disorder can cause symptoms similar to ADD or ADHD.  A complete and comprehensive psychiatric assessment is critical to differentiate ADHD from other possible mood and behavioral disorders, for example, childhood-onset manic depression may be misdiagnosed as ADHD.

Among physicians, psychologists and concerned parents there is a certain set of beliefs offered up as basic truths about why some children won’t behave or pay attention.  There is no known cause, but current thinking sees it as involving biochemical imbalances in areas of the brain that are responsible for attention, planning, and motor activity.

Children who suffer from ADD can experience significant school problems, suffer from low self-esteem, have difficulty relating to peers, and encounter problems in complying with rules at home leading to conflict with parents.  Some children with ADD also have learning disabilities, conduct disorders (destructive and/or antisocial behaviors), Tourette’s syndrome and/or mood disorders including depression and anxiety.  It represents a lifelong disorder for up to half of all those initially diagnosed.

Psychosocial therapy, usually combined with medications, is the conventional approach to alleviate ADD/ADHD symptoms.  Psychostimulants, such as Dexedrine, Ritalin, and pemoline (Cylert) are commonly prescribed to control hyperactive and impulsive behavior and increase attention span.

Many ADD proponents want to exert control over interventions just as they maintain control over the behavior of children by invoking the medical model.  However, the reality is that the most successful approaches for kids labeled ADD are in fact strategies that have been effective for all kids.  These are clearly defined expectations that are realistic and appropriate to their developmental stages.

The “good pill” is actually more like “kiddie speed,” which theoretically works by stimulating the production of certain neurotransmitters in the brain.  Possible side effects of stimulants include nervous tics, irregular heartbeat, nervousness, stomachaches and nausea,  headaches, dizziness, dysphoria, drowsiness, loss of appetite, skin rash,  glaucoma, seizures, and insomnia.

Medicated children cry more easily, are more sad/depressed, and nervous or withdrawn and socially isolated.  Stimulants are not universally prescribed for the syndrome.  For example, in Great Britain they are rarely or never used in treating children with attention and behavioral problems.

Ritalin is an extremely controversial drug, especially when prescribed to marginally overactive children who tend to “act out.”  Giving them a pill, rather than psychosocial therapy is an easier solution for parents and teachers, but can have dire consequences, such as generalized drug dependency.  The message is, “if you have a problem, take a pill; solve it externally.”  This may be an “easier” solution, but it is not benign.

Ritalin may restrict an individual’s creativity, and this reflects on the ability to solve one’s own problems and self-healing, since creativity is biochemically related to these activities.  Numerous ADD-diagnosed writers, artists, and public speakers report about their experience as adults on Ritalin.  They say their lives are more organized and their workdays easier when taking the drug, but their creativity seems to dry up.  Substance abusers of stimulants report the same effect--the drug saps creative juices.

Cases of children developing drug-induced delusional disorders and mania have occured, just as acute psychosis sometimes appears in street-drug users due to acute toxicity.  An alternate explanation of psychotic features may be that they emerge from drug treatment which kindles latent manic depression, which often has psychotic overtones.

Ritalin is a short-lived drug that is usually given in the morning.  It wears off after about four hours, (during school hours).  This leads to a rebound effect in the late afternoon or evening for some kids that consists of changes in mood, irritability, and increases in the behavior and attention problems that were there before the drug was taken.

Furthermore, children on the whole prefer being without the pills.  There is a pervasive dislike among hyperactive children for taking stimulants.  Their reports include complaints such as, “It makes me sad and I like to eat.”  “It takes over of me [sic]; it takes control.”  “It numbed me.”  “It makes me feel like a baby.”  Even children who said they didn’t mind taking the meds showed, by their actions, a very different attitude.

Amphetamines create changes in brain chemistry, and damage which may be permanent.  Some doctors will admit this.  Amphetamines interact with dopamine and norepinephrine producing subsequent changes in the production and actions of these neurotransmitters.

When it is supplimented externally, the body loses its ability to produce “feel good” chemistry.  Ritalin, like other amphetamines, can produce drug dependence and should be given cautiously to emotionally unstable people, especially adults with a history of drug dependence or alcoholism.  Ritalin is abused as a street drug, where a tablet can go for as much as $20.

Statistically, medicated children go on to significantly higher rates of drug abuse (16% versus 4%).  Evidence of familial tendency toward alcoholism in families with hyperactive kids raises the possibility they may be prone to drug dependence, and this prescription may potentiate substance abuse.  When pills rather than skills are encouraged, medication instead of mediation, children get a mixed message.  It also changes the expectations of others toward their ability to behave and pay attention.

Tricyclic antidepressants, Wellbutrin, Prozac, and Tegretol are frequently prescribed as an adjunct.  These medications modulate neurotransmitters, but carry dangerous side effects also, such as cardiac arrythmia, (see Depressive Disorders and CRP).  They are not particularly healthy for adults, much less in the developing nervous systems and brains of children.  Some of them create chemical dependencies and tolerance in the brain, much like the stimulants do.

Clonidine or Catapres, an antihypertensive medication, has been used to control aggression and hyperactivity, but cannot be used with Ritalin.  A child’s response to medication changes with age and maturation, so ADHD symptoms should be monitored closely and prescriptions adjusted accordingly.

Behavior modification therapy uses a reward system to reinforce good behavior and task completion and can be implemented both in the classroom and at home.  Cognitive- behavioral therapy works to decrease impulsive behavior by getting the child to recognize the connection between thoughts and behavior, and to change behavior by changing negative thinking patterns.

Individual therapy helps the child build self-esteem, gives them a place to discuss their worries and anxieties, and helps them gain insight into their behavior and feelings.  Family therapy is beneficial in helping family members develop coping skills and in working through feelings of guilt or anger parents may be experiencing.

Untreated, ADHD negatively affects a child’s social and educational performance and can seriously damage his or her sense of self-esteem.  ADHD children have impaired relationships with their peers and may be looked upon as social outcasts.  They  may be perceived as slow learners or troublemakers in the classroom.  Siblings and even parents may develop resentful feelings towards the ADHD child.

Some ADHD children also develop a conduct disorder problem, such as ODD, Oppositional Defiant Disorder.  25% of these go on to develop antisocial personality disorder and the criminal behavior, substance abuse, and high rate of suicide attempts that are symptomatic of it.  Children diagnosed with ADHD are also more likely to have a learning disorder, a mood disorder such as depression or manic-depression, or an anxiety disorder.  Approximately half of ADHD children seem to “outgrow” the disorder, perhaps because some of them never had a full-blown disorder to begin with.

EEG biofeedback or neurofeedback teaches ADHD patients which type of brainwave is associated with attention.  EEG biofeedback attempts to train patients to generate the desired brainwave activity.  Dietary therapy, based on sound nutrition suggests a diet high in protein and complex carbohydrates and free of white sugar and salicylate-containing foods such as strawberries, tomatoes, and grapes.  Herbal therapy recommends Ginko biloba for memory and mental sharpness and chamomile for calming.  Homeopathic care has been tried with good results by homeopaths experienced with ADD and ADHD.

TRANSACTIONAL ANALYSIS AND ADD/ADHD

In the Transactional Analysis model, ADD/ADHD is considered as passive behavior which indicates a chronically unresolved problem related to the whole family system.  Aspects of the syndrome may include physiological, neurological and/or social/emotional factors.  The child adopts passive behavior in the form of agitation.  Such behavior becomes an integral part of the child’s problem-solving structure through-out his development and is supported by the social system in which he lives.  T.A. is used within an inter-disciplinary approach to deal with the passivity and solve the problem(s), (Edwards, 1979).

Hyperactive children are often described as restless, bothersome, irritable, destructive, clumsy, and aggressive --in modern slang-- “agro,” out of control or simply uncontrollable and non-compliant.  This complex spectrum of behavior has both medical and behavioral origins.

T.A. describes a sort of “grammar” of the personality, and is therefore able to decipher the cryptic messages contained in behavior patterns and “acting out.”  In their article “Passivity,” Schiff and Schiff (1971) identified that an individual whose problem is consistently discounted will eventually stop being active about solving the problem and engage in passive behavior in an effort to transfer the problem to the environment in hopes that the discomfort experienced there will result in someone else doing something about the problem.

These behaviors include the following:

(1).  Doing Nothing:  The child stares into space and exerts no energy for the task at hand.

(2).  Overadaptation:  The child tries to do what he has been told without comprehending the meaning of what he is to do.

(3).  Agitation:  The child exhibits continual motion and restless fidgets.

(4).  Incapacitation/Violence:  Temper tantrums and destructive, aggressive behavior.

Agitation and incapacitation/violence are the passive behaviors most likely to be defined by family and school as problems because they annoy others.  Doing nothing and overadaptation are more likely to go unnoticed.  “Hyper” behavior indicates unsolved problems that the child now completely discounts.

The nature of the problem, regardless of source, is not revealed by the passive behavior.  It is a family problem because the passivity is taken for granted by all.  The longer the problem has been discounted the more severe the deficit in social/emotional development.  Therefore, the hyper behavior is not the problem, but a symptom of hidden problems.  Each subtle, discounted problem must be identified and treated with an inter-disciplinary approach.

A developmental history and family assessment show how and when the problem was set up, how the discounting and passivity began and what developmental stages have been severely affected.  Insight must be gained about how the current family system supports the passive behavior.  Assessment includes issues of time structure, stroking, transactional and scripting patterns.  Learning difficulties begin with discounting at an early age of development.

Any medical problems must be treated; learning problems addressed; environment and social systems changed through family therapy; home and school social and emotional issues addressed.  This involves working with the family system to change the time structure, stroking, transactional and script patterns that have supported the discounting and non-problem-solving behavior.

The most common issues include:  Preference for negative rather than positive strokes; time and space structure; limits; permissions to feel; expectation and demand to think and solve problems; forcing the issue of asking; Adult reasons and “how to’s” for behavior; cause and effect; incorporation of Parent-self.

Discounting gives the child a message which is internalized as “Don’t Be”, “Don’t Exist,” “Don’t Make It.” This internalization blocks the benefits of positive strokes by discounting them in favor of the negative self-image: “I exist, therefore I am bad.”

This leads to thoughts of inadequacy and self-loathing from a self-depricating, internalization of the negative authoritarian judgements.  “I’m not good enough.”  “This person wants something in return.”  “If you knew me better you wouldn’t say that.”  “This person is just trying to flatter me.”  “What does she really mean.”  “I don’t need strokes.”  “If they knew all the bad things about me they wouldn’t say it.”  “They know more they’re not saying.”

These self-discounting reactions to compliments or positive reinforcement include statements such as the following:  “Yes, but.”  “You must be feeling sorry for me.”  “It’s not as good as someone else’s.”  “Big deal, so what!”  “Most people are better at this than me.”  “The devil made me do it.”  “You’re wrong.”  “That doesn’t mean anything.”  “I don’t understand.”  “Well, I tried.”  “I can’t.”

In response to these internal and external injunctions and drivers of behavior, the hyperactive or ADD child will respond with a variety of avoidant techniques:  change the subject, be sarcastic, respond with a question, refuse to hear it, give credit to someone else, be quiet, hear a stroke but not believe it, laugh, intellectualize it, get angry, pretend not to understand, forget the stroke, talk crazy, not take the person seriously, pass it off, destroy what he/she has done, put off strokes to another time, or pretend to agree with the compliment but discount it internally.

This negative internal signal creates constant agitation or an inability to focus on external stimuli (blocking), and a passive plea to the environment to solve the irresolvable problem which is beyond the child’s resources to resolve.

Since this is a family systems problem, we can presume the possibility of fetal imprinting beginning in the womb.  The drama of life begins at conception.  Imprinting of cellular memory begins as early as the first trimester of pregnancy influenced by attitudes of the Parent, facts from the Adult, and feelings and sensations aroused in the Child of the mother which convey nonverbal messages to the fetus.  Ignoring the variable of of prenatal imprinting can keep a person script-bound.

At birth, another level of imprinting begins, influenced by the medical team, family and friends, by way of body language.  When the child learns vocabulary, imprinting is reactivated by words that fit the cellular memories.  He/she learns how to internalize injunctions, counterinjunctions, attributions, and script drivers.

Fetal imprinting may control or distort the script, and produce a tenacious impasse or stalemate.  Cellular memory imprints all sensory input during gestation, birth, and the succeeding five to seven months.  It stores the impression, picture, or vision, and is reactivated by words that fit the memory.

Primary scripting occurs in a prenatal symbiosis.  It remains beneath the surface after birth.  Babies are biologically programmed for a special survival purpose: to bind symbiotically with the parent for the learning process.  Therefore, when this bonding goes awry, it can affect the learning ability in general.  The first nonverbal greeting of the mother to fetus is crucial, both pre- and post-natal, (Johnson, 1978).

Physiological regression to fetal imprinting occurs while sleeping and dreaming, and becomes pathological when normal defenses are overwhelmed.  The distinctive quality of prenatal, symbiotic imprinting emerges as a shadowy feeling, which resists identification.  The fetus is affected by the mother’s Parent.  Fathers may contribute symptoms of hostility or rivalry from their own dependency needs.

Failure of the mother to adjust to changes in her encyclical rhythm from eight-hour cycles to the four-hour pregnancy rhythm may imprint faulty rhythms into the child.  Ambivalance, exception, or rejection of pregancy are communicated.  They lead to the imprinted injunction, “Don’t Exist.”  The birth greeting of a wriggling, squalling infant may be negative, reinforcing imprinting further.  The brain accepts impressions of visual images and body language.  The “don’t exist” message can ambush the person for life, unless therapy goes deep enough to dissolve this primal existential self-image.

The development of the Adult self and Little Professor may be stunted.  The Adult is the seat of fantasy and intuition, but the Little Professor contributes to its creativeness and inventiveness; but it can also contribute to a belief in magic or magical thinking. The Little Professor is intuitive, creative and insightful.   It is magical thinking to think parents have the supernatural power to make the child disappear, or to watch with eyes in the back of the head.  It creates confusion between wishful thinking and reality, and leads to superstition in adults.

As adults, we think we “should know better,” but we are locked in the immature pattern -- processing different information, and processing information differently.  The Little Professor still operates in an imaginative way on the basis of implicit and non-verbal information, hunches, fantasy, and invention.  For productive thinkers, this is a plus, for the learning disabled, a handicap.  High self-esteem is not acquired by being “reasonable” about negative messages.  They must be holistically reprogrammed through nonverbal processes that encode them, such as Gestalt.  Herein, lies an opportunity to merge TA and biofeedback.

Redecisions are essential to the deconfusion of the Child.  Magic thinking occurs whenever a Child redecision is viewed as an end point.  What is needed is a change in the frame of reference when Parent, Adult, and Child are in harmonious agreement.  Magic thinking and symbiosis occur if treatment stops with a Child redecision.

Early decisons are kept operative by a variety of stereotypical responses (behavior, feelings, posture) to the same old stimuli (messages, cues).  These are generalized into adaptive or non-adaptive syndromes.  Adult information and Parent protection allow for adaptive redecisions to create a new psychological position, a new frame of reference, and decision-making.

A DYNAMICAL APPROACH TO ADD/ADHD

There are neural mechanisms underlying attention.  Attentional disorders represent coarseness in limbic control of attentional processes.  Field potentials within the brainstem-thalamic-cortical system organize the systems of vigilance, sensorimotor integration, and cognitive processing.  Prefrontal cortex and limbic centers in the system should be included in any outline of attentional processes.

Clinical experience shows that mood disorders, involving disturbances in limbic functioning, typically involve disturbances of attention and concentration (decreases capacity for each in depression, hyper-distractibility in mania). On the other hand, attentional disorders, involving disturbances in prefrontal cortex functioning, typically involve depressed mood.  Both involve difficulties with memory, a function mediated through limbic centers.

Hyperactivity, distractibility, and a tendency toward preoccupation with certain activities, pathological undistractibility-distractability (becoming mesmerized by television or video games) all emphasize the role of the hippocampus.  It is fundamental in widespread input for all sensory modalities. It has reciprocative connections with the entire association cortex. It plays a role as an integration center for sensory fields, for comparing input with stored data, and is a center to filter out irrelevant (that is distractin) stimuli that might lead to maladaptive arousal responses.

The hippocampus orchestrates several components of the attentional process by selectively inhibiting a number of functions at a number of centers, including orientation, alertness, awareness, and arousal.  This inhibitory process is mediated by an oscillation in the theta range, while a prefrontal signal induces a beta rhythm in the hippocampus which blocks the theta inhibiting signal.  Hippocampus and prefrontal cortex exert selective inhibitory actions on a number of centers, presumably corresponding with the withdrawl of combinations of cognitive processing and vigilance functions.

The stability of the attentional system adjusted by CRP is of central importance.  If the system is in a stable attractor state, small imbalances at a point in the system will tend to be damped out by the functioning of the system as a whole.  If it is in such a state, small imbalances at any juncture will be maintained or amplified.  CRP adjusts the attentional system into a stable attractor state through the action of multiple self-adjusting feedback loops.

The effects of CRP can be understood in terms of well-known neurophysiological mechanisms.  Neural networks mediating the attention process can be adjusted through neuromodulation and stabilized through long term potentiation into stable (attractor) states.  During CRP, the participant consolidates enhanced capacity to regulate state changes and gatings of signals between brain centers, enhancing attentional capacity.

This process yields long lasting results compared to stimulant medication treatment of ADD/ADHD because it employs the same sort of neuromodulator control.  It frees sensorimotor skills, by creating new neural circuits, from the quantum and cellular level.

CRP can be combined in an integrative treatment with neurofeedback.  Neurofeedback allows a variety of practice experiences for regulating states.  Neuromodulation during neurofeedback work can fine tune control, and long term potentiation over the course of the treatment can make the changes permanent.

CRP AND ATTENTION DEFICIT DISORDERS

There is a commonality among all the attentional disorders, including ADD, OCD, manic-depression, depression, and schizophrenia.  CRP’s integrative treatment has successful results with many of these attentional symptoms.  CRP results are more persistent than those from stimulant medication because CRP and stimulants may operate at different locations with different long-term potentiation by neuromodulation.  But, the at-risk child must be able to get to appropriate therapy before anything can be done.

Parents are often traumatized by pressure to conform to the medically established paradigm.  Many who seek broader and richer solutions for their kids’ problems are left feeling like they could do irreparable harm to their children if they seek treatments outside of the “official”ones.  The fact is, their intuition about their own child’s relative situation may be a better guide than so-called expert, one pill fits all, advice.

Conventional beliefs about ADD/ADHD represent a coherently organized system of beliefs that helps contextualize the concerns parents, teachers, and other professionals have about children who won’t behave or pay attention despite appearing normal in other ways.   The fact is, there are political and economic realities behind the quick choice to medicate problem children, that are not in their best interests.  The lobbying from drug reps to doctors is intensive, and HMOs encourage quick, cheap solutions.

Therefore, ADD appears to exist as a diagnosis of clinical proportions only because of a unique convergence of the interests of frustrated activist parents, a highly developed psychopharmacological technology, a new cognitive research paradigm, a growth industry in new educational products, and a group of teachers, doctors and psychologists eager to introduce them to each other.  But it doesn’t necessarily make ADD a discrete clinical entity, requiring powerful drug treatment.

Curiously, with all the focus being placed on children who score at the high end of the hyperactivity and distractibility continuum, virtually no one in the field talks about kids who must statistically exist at the low end of the behavioral curve: children who are too focused, too compliant, too still; children who are hypoactive.  Why don’t we have special classes, medications, and treatments for these kids as well?

No one knows for sure what causes ADD/ADHD, but many factors influence our neurological growth and development, beginning with the fetus and even the overall psychophysical health of the mother.  The latest research (Helmuth, 2000) shows that infants respond physiologically and hormonally to pain.  Pain experienced by the youngest infants can have the longest lasting effects.  One wonders about circumcisions without analgesics and unmedicated premature infants and pain, just for starters.

Painful stimuli delivered shortly after birth can permanently rewire the spinal cord circuits that respond to pain.  Not only do the circuits have more axons, those axons extend to more areas of the spinal cord than they normally would.

Researchers note, “injury to the neonate or fetus can produce changes  that are somewhat different than [those] in adults...these wiring changes make [them] more sensitive to pain later in life.  Pain pathways start with sensory neurons in the skin, link to the dorsal horn of the spinal cord, and from there climb to the thalamus and cortex in the brain...Pain changed neuroanatomy only when induced during a distinct developmental window... more neurons became devoted to processing pain... This suggests that at a very early age, particularly in premature infants, ‘what’s happening could impact the ultimate wiring of the brain.’  [Those] who endured traumatic early days are somewhat more sensitive to pain as adults.” (Helmuth).

According to Barinaga (2000), developmental windows are “critical periods,” or time windows when the brain is not only receptive to acquiring a certain kind of information, but also needs that information for its continued normal development.  Critical periods are documented for the development of sensory systems in the brain, especially vision.  They underlie development of at least some of the brain functions that underlie complex learning and thinking skills, especially language.

No critical period ends suddenly like a window slamming shut, but they taper off gradually.  Critical periods are not unique to the first 3 years. Learning, even though more difficult, can continue into adulthood.  Some researchers, therefore, prefer the term “sensitive periods” to critical periods.  It is suggested that there are sensitive periods for different types of learning, as shown by brain imaging.

Emotional attachments are learned in the first year of life, being crucial to the infant’s survival.  Huttenlocher reports that synapses proliferate in most brain areas during the first year of life, after which, “you have a period when the synaptic density is high, for 6 to 12 months up to 5 to 15 years, depending on the area.”  Then the synapse levels decline, with visual areas tending to lose their synapses first and the higher cognitive areas dropping to adult levels later.

The basic functions of a brain area emerge during the period of initial proliferation of synapses.  For example, when the synapses begin to increase in the visual cortex, the child develops binocular vision.  During their fourth year, children learn that other individuals have thoughts and views that differ from their own, having gained enough experience to draw conclusions about the existence of other minds.  Age 12 to 14 is roughly the age when ease of language learning declines, about the time during which the density and number of synapses in the language area of the brain decreases.

The question remains open as to whether learning drives changes in the maturing brain, or whether the maturation process controls the ease with which learning occurs.  With a panoply of brain systems, the answer will be different for each individual system.  Younger brains change more readily, but older brains have not lost the capacity to change.

ADD and ADHD have to do with the primary wiring for basic arousal functions: waking and sleep, arousal and repose, calmness and restlessness, impulsivity and cautiousness, all sensory wiring, and gross and fine motor movement, attention vs. inattention, memory and forgetting, etc.  Even though the syndrome is one of inattention, there is a constant struggle to receive attention, to be noticed, to intrude oneself on others impulsively.

 The whole “stop-go” mechanism seems fundamentally off, whether it is for activity, sleep or rest cycles, or other systems.  Among neurotransmitters, two stand out as stars, communicating most of the brain’s urgent messages.  These fast-acting, ubiquitous chemicals -- GABA and Glutamate -- send the basic “stop” and “go” signals that most other neurotransmitters merely modulate (Helmuth, 2000).  Glutamate is called into action wherever rapid-fire excitatory signals are needed.

Perhaps this is the mechanism in overdrive in ADHD.  This is a possible intervention-point in psychobiological crosstalk where CRP may do some of its restructuring work.  Of course, the primary work takes place at the more fundamental level of the primal sensory image, but this self-organization, facilitated by REM journeys, precipitates into the molecules of emotion.

Current theory holds that ADD/ADHD is a neurotransmitter imbalance, whose exact nature is unknown.  The long-sought glutamate transporter may be a missing link in this equation.  True transporters actively escort neurotransmitters into a vesicle, pulling them uphill against the gradient between tightly packed neurotransmitters inside and the low concentration outside the vesicle.

It’s a slow process, but transporters can pack in more chemicals than the alternative, a channel.  Channels essentially open up part of the vessel wall, enabling chemicals to surge in, attracted by a charge or pH gradient.  Strangely, the glutamate transporter seems to have properties of both.

American Psychological Assn., DSM IV

Armstrong, Thomas; THE MYTH OF THE A.D.D. CHILD, Dutton/Penguin Books, New York, 1995.

Barinaga, Marcia, “A critical issue for the brain,” SCIENCE, Vol. 288 June 23, 2000, pp. 2116-2119.

Edwards, Sally Ann, “Hyperactivity as a passive behavior,” Transactional Analysis Journal, Vol. 9, No. 1, Jan. 1979.

Gales Encyclopedia of Medicine

Helmuth, Laura, “Early insult rewires pain circuits,” SCIENCE, Vol. 289, July 2000, pp. 221-2.

Helmuth, Laura, “Long-sought protein packages glutamate,” SCIENCE, Vol. 289, August 11, 2000, pp. 847-849.

Johnson, Lois M., “Imprinting: a variable in script analysis,” TA Journal, Vol. 8, No. 2, April 1978.

Schiff, A. and Schiff, J.  “Passivity,” Transactional Journal, 1971, 1(1).

ABSTRACT:  The Consciousness Restructuring Process can be used in an integrative treatment of ADD in both children and adults.  ADD is a developmental disorder characterized by distractability, impulsive behavior, and the inability to remain focused on tasks or activities, without or with (ADHD) hyperactivity.  Although the exact cause of ADHD is not known, an imbalance of certain neurotransmiters, the chemicals in the brain that transmit messages between nerve cells, is believed to be the mechanism behind symptoms.  CRP goes deeper than behavioral, or cognitive behavioral therapy, and includes family therapy, neurofeedback, and proper nutrition in its integrative approach.

Adults who had ADD as children still carry some of the patterns of the disease, as well as residuals from years of treatment with stimulants, tricyclics, or other antidepressants, and psychological fallout.  They benefit from CRP therapy as much as children in whom symptoms are amplified.  Many children with ADHD receive neither behavioral training nor careful dose calibrations for the stimulants physicians prescribe, especially though community sources.  About two-thirds of children do well enough to stay off medication with behavioral treatment alone.  Psychosocial interventions like CRP, especially combined with neurofeedback, can profoundly affect ADHD even if a genetic predisposition is involved.

Keywords:  Attention Deficit Disorder, Attention Deficit Hyperactive Disorder, Prozac, Oppositional Defiant Disorder, ADD/ADHD, ODD, biofeedback, neurofeedback, Ritalin, antidepressants, Consciousness Restructuring Process (CRP), hyperactivity, integrative treatment, psychotherapy, neurotransmitters, consciousness, dreams, healing, Chaos Theory, dynamical systems, attentional disorders, hippocampus, manic-depression

WHAT IS ATTENTION DEFICIT DISORDER AND HYPERACTIVITY?

ADHD, also known as hyperkinetic disorder (HKD) outside of the U.S. is estmated to affect 3-9% of children, more boys than girls.  Though they may be present earlier, signs of ADHD become apparent as early as age two or three and develop through adolescence.  Not only children have ADD.  Many symptoms, particularly hyperactivity, diminish in early adulthood, but impulsivity and inattention problems remain with up to 50% of ADHD individuals throughout their adult life.

Children with ADHD have short attention spans, becoming easily bored and/or frustrated with tasks.  Although they may be quite intelligent, their lack of focus frequently results in poor grades and difficulties in school.  ADHD children act impulsively, taking action first and thinking later.  They are constantly moving, running, climbing, squirming, and fidgeting, but often have trouble with gross and fine motor skills and, as a result, may be physically clumsy and awkward.  Their clumsiness may extend to the social arena, where they are sometimes shunned due to the their impulsive and intrusive behavior.

The causes of ADHD are not known.  However, it appears heredity plays a major role, since children with an ADHD parent or sibling are more likely to develop the disorder themselves.  Before birth, ADHD children may have been exposed to poor maternal nutrition, viral infections, or maternal substance abuse.  In early childhood, exposure to lead or other toxins can cause ADHD-like symptoms.  Traumatic brain injury or neurological disorder may also trigger ADHD symptoms.  Current treatment philosophy theorizes that there are imbalances of certain neurotransmitters which can be corrected by stimulant drugs, such as Ritalin.

DSM-IV requires that some symptoms develop before age seven, and that they significantly impair functioning in two or more settings (e.g. home and school) for a period of at least six months.  Children who meet the criteria for inattention, but not for hyperactivity/impulsivity are diagnosed with ADD, predominantly inattentive type.

Symptoms of inattention include the following:

*  Fails to pay close attention to detail or makes careless mistakes in schoolwork or other activities.

*  Has difficulty sustaining attention in tasks or activities.

*  Does not appear to listen when spoken to.

*  Does not follow through on instructions and does not finish tasks.

*  Has difficulty organizing tasks and activities.

*  Avoids or dislikes tasks that require sustained mental effort (e.g. homework).

*  Is easily distracted.

*  Is forgetful in daily activities; hyperactivity.

*  Fidgets with hands or feet or squirms in seat.

*  Does not remain seated when expected to.

*  Runs or climbs excessively when inappropriate (in adolescence and adults, feelings of restlessness).

*  Has difficulty playing quietly.

*  Is constantly on the move.

*  Talks excessively; impulsivity.

*  Blurts out answers before the question has been completed.

*  Has difficulty waiting for his or her turn.

*  Interrupts and/or intrudes on others.

Diagnosis begins with a physical examination by a pediatrician to assess developmental maturity and rule out organic causes.

CONVENTIONAL TREATMENT OF ADD/ADHD

It is important to note that mental disorders such as depression and anxiety disorder can cause symptoms similar to ADD or ADHD.  A complete and comprehensive psychiatric assessment is critical to differentiate ADHD from other possible mood and behavioral disorders, for example, childhood-onset manic depression may be misdiagnosed as ADHD.

Among physicians, psychologists and concerned parents there is a certain set of beliefs offered up as basic truths about why some children won’t behave or pay attention.  There is no known cause, but current thinking sees it as involving biochemical imbalances in areas of the brain that are responsible for attention, planning, and motor activity.

Children who suffer from ADD can experience significant school problems, suffer from low self-esteem, have difficulty relating to peers, and encounter problems in complying with rules at home leading to conflict with parents.  Some children with ADD also have learning disabilities, conduct disorders (destructive and/or antisocial behaviors), Tourette’s syndrome and/or mood disorders including depression and anxiety.  It represents a lifelong disorder for up to half of all those initially diagnosed.

Psychosocial therapy, usually combined with medications, is the conventional approach to alleviate ADD/ADHD symptoms.  Psychostimulants, such as Dexedrine, Ritalin, and pemoline (Cylert) are commonly prescribed to control hyperactive and impulsive behavior and increase attention span.

Many ADD proponents want to exert control over interventions just as they maintain control over the behavior of children by invoking the medical model.  However, the reality is that the most successful approaches for kids labeled ADD are in fact strategies that have been effective for all kids.  These are clearly defined expectations that are realistic and appropriate to their developmental stages.

The “good pill” is actually more like “kiddie speed,” which theoretically works by stimulating the production of certain neurotransmitters in the brain.  Possible side effects of stimulants include nervous tics, irregular heartbeat, nervousness, stomachaches and nausea,  headaches, dizziness, dysphoria, drowsiness, loss of appetite, skin rash,  glaucoma, seizures, and insomnia.

Medicated children cry more easily, are more sad/depressed, and nervous or withdrawn and socially isolated.  Stimulants are not universally prescribed for the syndrome.  For example, in Great Britain they are rarely or never used in treating children with attention and behavioral problems.

Ritalin is an extremely controversial drug, especially when prescribed to marginally overactive children who tend to “act out.”  Giving them a pill, rather than psychosocial therapy is an easier solution for parents and teachers, but can have dire consequences, such as generalized drug dependency.  The message is, “if you have a problem, take a pill; solve it externally.”  This may be an “easier” solution, but it is not benign.

Ritalin may restrict an individual’s creativity, and this reflects on the ability to solve one’s own problems and self-healing, since creativity is biochemically related to these activities.  Numerous ADD-diagnosed writers, artists, and public speakers report about their experience as adults on Ritalin.  They say their lives are more organized and their workdays easier when taking the drug, but their creativity seems to dry up.  Substance abusers of stimulants report the same effect--the drug saps creative juices.

Cases of children developing drug-induced delusional disorders and mania have occured, just as acute psychosis sometimes appears in street-drug users due to acute toxicity.  An alternate explanation of psychotic features may be that they emerge from drug treatment which kindles latent manic depression, which often has psychotic overtones.

Ritalin is a short-lived drug that is usually given in the morning.  It wears off after about four hours, (during school hours).  This leads to a rebound effect in the late afternoon or evening for some kids that consists of changes in mood, irritability, and increases in the behavior and attention problems that were there before the drug was taken.

Furthermore, children on the whole prefer being without the pills.  There is a pervasive dislike among hyperactive children for taking stimulants.  Their reports include complaints such as, “It makes me sad and I like to eat.”  “It takes over of me [sic]; it takes control.”  “It numbed me.”  “It makes me feel like a baby.”  Even children who said they didn’t mind taking the meds showed, by their actions, a very different attitude.

Amphetamines create changes in brain chemistry, and damage which may be permanent.  Some doctors will admit this.  Amphetamines interact with dopamine and norepinephrine producing subsequent changes in the production and actions of these neurotransmitters.

When it is supplimented externally, the body loses its ability to produce “feel good” chemistry.  Ritalin, like other amphetamines, can produce drug dependence and should be given cautiously to emotionally unstable people, especially adults with a history of drug dependence or alcoholism.  Ritalin is abused as a street drug, where a tablet can go for as much as $20.

Statistically, medicated children go on to significantly higher rates of drug abuse (16% versus 4%).  Evidence of familial tendency toward alcoholism in families with hyperactive kids raises the possibility they may be prone to drug dependence, and this prescription may potentiate substance abuse.  When pills rather than skills are encouraged, medication instead of mediation, children get a mixed message.  It also changes the expectations of others toward their ability to behave and pay attention.

Tricyclic antidepressants, Wellbutrin, Prozac, and Tegretol are frequently prescribed as an adjunct.  These medications modulate neurotransmitters, but carry dangerous side effects also, such as cardiac arrythmia, (see Depressive Disorders and CRP).  They are not particularly healthy for adults, much less in the developing nervous systems and brains of children.  Some of them create chemical dependencies and tolerance in the brain, much like the stimulants do.

Clonidine or Catapres, an antihypertensive medication, has been used to control aggression and hyperactivity, but cannot be used with Ritalin.  A child’s response to medication changes with age and maturation, so ADHD symptoms should be monitored closely and prescriptions adjusted accordingly.

Behavior modification therapy uses a reward system to reinforce good behavior and task completion and can be implemented both in the classroom and at home.  Cognitive- behavioral therapy works to decrease impulsive behavior by getting the child to recognize the connection between thoughts and behavior, and to change behavior by changing negative thinking patterns.

Individual therapy helps the child build self-esteem, gives them a place to discuss their worries and anxieties, and helps them gain insight into their behavior and feelings.  Family therapy is beneficial in helping family members develop coping skills and in working through feelings of guilt or anger parents may be experiencing.

Untreated, ADHD negatively affects a child’s social and educational performance and can seriously damage his or her sense of self-esteem.  ADHD children have impaired relationships with their peers and may be looked upon as social outcasts.  They  may be perceived as slow learners or troublemakers in the classroom.  Siblings and even parents may develop resentful feelings towards the ADHD child.

Some ADHD children also develop a conduct disorder problem, such as ODD, Oppositional Defiant Disorder.  25% of these go on to develop antisocial personality disorder and the criminal behavior, substance abuse, and high rate of suicide attempts that are symptomatic of it.  Children diagnosed with ADHD are also more likely to have a learning disorder, a mood disorder such as depression or manic-depression, or an anxiety disorder.  Approximately half of ADHD children seem to “outgrow” the disorder, perhaps because some of them never had a full-blown disorder to begin with.

EEG biofeedback or neurofeedback teaches ADHD patients which type of brainwave is associated with attention.  EEG biofeedback attempts to train patients to generate the desired brainwave activity.  Dietary therapy, based on sound nutrition suggests a diet high in protein and complex carbohydrates and free of white sugar and salicylate-containing foods such as strawberries, tomatoes, and grapes.  Herbal therapy recommends Ginko biloba for memory and mental sharpness and chamomile for calming.  Homeopathic care has been tried with good results by homeopaths experienced with ADD and ADHD.

TRANSACTIONAL ANALYSIS AND ADD/ADHD

In the Transactional Analysis model, ADD/ADHD is considered as passive behavior which indicates a chronically unresolved problem related to the whole family system.  Aspects of the syndrome may include physiological, neurological and/or social/emotional factors.  The child adopts passive behavior in the form of agitation.  Such behavior becomes an integral part of the child’s problem-solving structure through-out his development and is supported by the social system in which he lives.  T.A. is used within an inter-disciplinary approach to deal with the passivity and solve the problem(s), (Edwards, 1979).

Hyperactive children are often described as restless, bothersome, irritable, destructive, clumsy, and aggressive --in modern slang-- “agro,” out of control or simply uncontrollable and non-compliant.  This complex spectrum of behavior has both medical and behavioral origins.

T.A. describes a sort of “grammar” of the personality, and is therefore able to decipher the cryptic messages contained in behavior patterns and “acting out.”  In their article “Passivity,” Schiff and Schiff (1971) identified that an individual whose problem is consistently discounted will eventually stop being active about solving the problem and engage in passive behavior in an effort to transfer the problem to the environment in hopes that the discomfort experienced there will result in someone else doing something about the problem.

These behaviors include the following:

(1).  Doing Nothing:  The child stares into space and exerts no energy for the task at hand.

(2).  Overadaptation:  The child tries to do what he has been told without comprehending the meaning of what he is to do.

(3).  Agitation:  The child exhibits continual motion and restless fidgets.

(4).  Incapacitation/Violence:  Temper tantrums and destructive, aggressive behavior.

Agitation and incapacitation/violence are the passive behaviors most likely to be defined by family and school as problems because they annoy others.  Doing nothing and overadaptation are more likely to go unnoticed.  “Hyper” behavior indicates unsolved problems that the child now completely discounts.

The nature of the problem, regardless of source, is not revealed by the passive behavior.  It is a family problem because the passivity is taken for granted by all.  The longer the problem has been discounted the more severe the deficit in social/emotional development.  Therefore, the hyper behavior is not the problem, but a symptom of hidden problems.  Each subtle, discounted problem must be identified and treated with an inter-disciplinary approach.

A developmental history and family assessment show how and when the problem was set up, how the discounting and passivity began and what developmental stages have been severely affected.  Insight must be gained about how the current family system supports the passive behavior.  Assessment includes issues of time structure, stroking, transactional and scripting patterns.  Learning difficulties begin with discounting at an early age of development.

Any medical problems must be treated; learning problems addressed; environment and social systems changed through family therapy; home and school social and emotional issues addressed.  This involves working with the family system to change the time structure, stroking, transactional and script patterns that have supported the discounting and non-problem-solving behavior.

The most common issues include:  Preference for negative rather than positive strokes; time and space structure; limits; permissions to feel; expectation and demand to think and solve problems; forcing the issue of asking; Adult reasons and “how to’s” for behavior; cause and effect; incorporation of Parent-self.

Discounting gives the child a message which is internalized as “Don’t Be”, “Don’t Exist,” “Don’t Make It.” This internalization blocks the benefits of positive strokes by discounting them in favor of the negative self-image: “I exist, therefore I am bad.”

This leads to thoughts of inadequacy and self-loathing from a self-depricating, internalization of the negative authoritarian judgements.  “I’m not good enough.”  “This person wants something in return.”  “If you knew me better you wouldn’t say that.”  “This person is just trying to flatter me.”  “What does she really mean.”  “I don’t need strokes.”  “If they knew all the bad things about me they wouldn’t say it.”  “They know more they’re not saying.”

These self-discounting reactions to compliments or positive reinforcement include statements such as the following:  “Yes, but.”  “You must be feeling sorry for me.”  “It’s not as good as someone else’s.”  “Big deal, so what!”  “Most people are better at this than me.”  “The devil made me do it.”  “You’re wrong.”  “That doesn’t mean anything.”  “I don’t understand.”  “Well, I tried.”  “I can’t.”

In response to these internal and external injunctions and drivers of behavior, the hyperactive or ADD child will respond with a variety of avoidant techniques:  change the subject, be sarcastic, respond with a question, refuse to hear it, give credit to someone else, be quiet, hear a stroke but not believe it, laugh, intellectualize it, get angry, pretend not to understand, forget the stroke, talk crazy, not take the person seriously, pass it off, destroy what he/she has done, put off strokes to another time, or pretend to agree with the compliment but discount it internally.

This negative internal signal creates constant agitation or an inability to focus on external stimuli (blocking), and a passive plea to the environment to solve the irresolvable problem which is beyond the child’s resources to resolve.

Since this is a family systems problem, we can presume the possibility of fetal imprinting beginning in the womb.  The drama of life begins at conception.  Imprinting of cellular memory begins as early as the first trimester of pregnancy influenced by attitudes of the Parent, facts from the Adult, and feelings and sensations aroused in the Child of the mother which convey nonverbal messages to the fetus.  Ignoring the variable of of prenatal imprinting can keep a person script-bound.

At birth, another level of imprinting begins, influenced by the medical team, family and friends, by way of body language.  When the child learns vocabulary, imprinting is reactivated by words that fit the cellular memories.  He/she learns how to internalize injunctions, counterinjunctions, attributions, and script drivers.

Fetal imprinting may control or distort the script, and produce a tenacious impasse or stalemate.  Cellular memory imprints all sensory input during gestation, birth, and the succeeding five to seven months.  It stores the impression, picture, or vision, and is reactivated by words that fit the memory.

Primary scripting occurs in a prenatal symbiosis.  It remains beneath the surface after birth.  Babies are biologically programmed for a special survival purpose: to bind symbiotically with the parent for the learning process.  Therefore, when this bonding goes awry, it can affect the learning ability in general.  The first nonverbal greeting of the mother to fetus is crucial, both pre- and post-natal, (Johnson, 1978).

Physiological regression to fetal imprinting occurs while sleeping and dreaming, and becomes pathological when normal defenses are overwhelmed.  The distinctive quality of prenatal, symbiotic imprinting emerges as a shadowy feeling, which resists identification.  The fetus is affected by the mother’s Parent.  Fathers may contribute symptoms of hostility or rivalry from their own dependency needs.

Failure of the mother to adjust to changes in her encyclical rhythm from eight-hour cycles to the four-hour pregnancy rhythm may imprint faulty rhythms into the child.  Ambivalance, exception, or rejection of pregancy are communicated.  They lead to the imprinted injunction, “Don’t Exist.”  The birth greeting of a wriggling, squalling infant may be negative, reinforcing imprinting further.  The brain accepts impressions of visual images and body language.  The “don’t exist” message can ambush the person for life, unless therapy goes deep enough to dissolve this primal existential self-image.

The development of the Adult self and Little Professor may be stunted.  The Adult is the seat of fantasy and intuition, but the Little Professor contributes to its creativeness and inventiveness; but it can also contribute to a belief in magic or magical thinking. The Little Professor is intuitive, creative and insightful.   It is magical thinking to think parents have the supernatural power to make the child disappear, or to watch with eyes in the back of the head.  It creates confusion between wishful thinking and reality, and leads to superstition in adults.

As adults, we think we “should know better,” but we are locked in the immature pattern -- processing different information, and processing information differently.  The Little Professor still operates in an imaginative way on the basis of implicit and non-verbal information, hunches, fantasy, and invention.  For productive thinkers, this is a plus, for the learning disabled, a handicap.  High self-esteem is not acquired by being “reasonable” about negative messages.  They must be holistically reprogrammed through nonverbal processes that encode them, such as Gestalt.  Herein, lies an opportunity to merge TA and biofeedback.

Redecisions are essential to the deconfusion of the Child.  Magic thinking occurs whenever a Child redecision is viewed as an end point.  What is needed is a change in the frame of reference when Parent, Adult, and Child are in harmonious agreement.  Magic thinking and symbiosis occur if treatment stops with a Child redecision.

Early decisons are kept operative by a variety of stereotypical responses (behavior, feelings, posture) to the same old stimuli (messages, cues).  These are generalized into adaptive or non-adaptive syndromes.  Adult information and Parent protection allow for adaptive redecisions to create a new psychological position, a new frame of reference, and decision-making.

A DYNAMICAL APPROACH TO ADD/ADHD

There are neural mechanisms underlying attention.  Attentional disorders represent coarseness in limbic control of attentional processes.  Field potentials within the brainstem-thalamic-cortical system organize the systems of vigilance, sensorimotor integration, and cognitive processing.  Prefrontal cortex and limbic centers in the system should be included in any outline of attentional processes.

Clinical experience shows that mood disorders, involving disturbances in limbic functioning, typically involve disturbances of attention and concentration (decreases capacity for each in depression, hyper-distractibility in mania). On the other hand, attentional disorders, involving disturbances in prefrontal cortex functioning, typically involve depressed mood.  Both involve difficulties with memory, a function mediated through limbic centers.

Hyperactivity, distractibility, and a tendency toward preoccupation with certain activities, pathological undistractibility-distractability (becoming mesmerized by television or video games) all emphasize the role of the hippocampus.  It is fundamental in widespread input for all sensory modalities. It has reciprocative connections with the entire association cortex. It plays a role as an integration center for sensory fields, for comparing input with stored data, and is a center to filter out irrelevant (that is distractin) stimuli that might lead to maladaptive arousal responses.

The hippocampus orchestrates several components of the attentional process by selectively inhibiting a number of functions at a number of centers, including orientation, alertness, awareness, and arousal.  This inhibitory process is mediated by an oscillation in the theta range, while a prefrontal signal induces a beta rhythm in the hippocampus which blocks the theta inhibiting signal.  Hippocampus and prefrontal cortex exert selective inhibitory actions on a number of centers, presumably corresponding with the withdrawl of combinations of cognitive processing and vigilance functions.

The stability of the attentional system adjusted by CRP is of central importance.  If the system is in a stable attractor state, small imbalances at a point in the system will tend to be damped out by the functioning of the system as a whole.  If it is in such a state, small imbalances at any juncture will be maintained or amplified.  CRP adjusts the attentional system into a stable attractor state through the action of multiple self-adjusting feedback loops.

The effects of CRP can be understood in terms of well-known neurophysiological mechanisms.  Neural networks mediating the attention process can be adjusted through neuromodulation and stabilized through long term potentiation into stable (attractor) states.  During CRP, the participant consolidates enhanced capacity to regulate state changes and gatings of signals between brain centers, enhancing attentional capacity.

This process yields long lasting results compared to stimulant medication treatment of ADD/ADHD because it employs the same sort of neuromodulator control.  It frees sensorimotor skills, by creating new neural circuits, from the quantum and cellular level.

CRP can be combined in an integrative treatment with neurofeedback.  Neurofeedback allows a variety of practice experiences for regulating states.  Neuromodulation during neurofeedback work can fine tune control, and long term potentiation over the course of the treatment can make the changes permanent.

CRP AND ATTENTION DEFICIT DISORDERS

There is a commonality among all the attentional disorders, including ADD, OCD, manic-depression, depression, and schizophrenia.  CRP’s integrative treatment has successful results with many of these attentional symptoms.  CRP results are more persistent than those from stimulant medication because CRP and stimulants may operate at different locations with different long-term potentiation by neuromodulation.  But, the at-risk child must be able to get to appropriate therapy before anything can be done.

Parents are often traumatized by pressure to conform to the medically established paradigm.  Many who seek broader and richer solutions for their kids’ problems are left feeling like they could do irreparable harm to their children if they seek treatments outside of the “official”ones.  The fact is, their intuition about their own child’s relative situation may be a better guide than so-called expert, one pill fits all, advice.

Conventional beliefs about ADD/ADHD represent a coherently organized system of beliefs that helps contextualize the concerns parents, teachers, and other professionals have about children who won’t behave or pay attention despite appearing normal in other ways.   The fact is, there are political and economic realities behind the quick choice to medicate problem children, that are not in their best interests.  The lobbying from drug reps to doctors is intensive, and HMOs encourage quick, cheap solutions.

Therefore, ADD appears to exist as a diagnosis of clinical proportions only because of a unique convergence of the interests of frustrated activist parents, a highly developed psychopharmacological technology, a new cognitive research paradigm, a growth industry in new educational products, and a group of teachers, doctors and psychologists eager to introduce them to each other.  But it doesn’t necessarily make ADD a discrete clinical entity, requiring powerful drug treatment.

Curiously, with all the focus being placed on children who score at the high end of the hyperactivity and distractibility continuum, virtually no one in the field talks about kids who must statistically exist at the low end of the behavioral curve: children who are too focused, too compliant, too still; children who are hypoactive.  Why don’t we have special classes, medications, and treatments for these kids as well?

No one knows for sure what causes ADD/ADHD, but many factors influence our neurological growth and development, beginning with the fetus and even the overall psychophysical health of the mother.  The latest research (Helmuth, 2000) shows that infants respond physiologically and hormonally to pain.  Pain experienced by the youngest infants can have the longest lasting effects.  One wonders about circumcisions without analgesics and unmedicated premature infants and pain, just for starters.

Painful stimuli delivered shortly after birth can permanently rewire the spinal cord circuits that respond to pain.  Not only do the circuits have more axons, those axons extend to more areas of the spinal cord than they normally would.

Researchers note, “injury to the neonate or fetus can produce changes  that are somewhat different than [those] in adults...these wiring changes make [them] more sensitive to pain later in life.  Pain pathways start with sensory neurons in the skin, link to the dorsal horn of the spinal cord, and from there climb to the thalamus and cortex in the brain...Pain changed neuroanatomy only when induced during a distinct developmental window... more neurons became devoted to processing pain... This suggests that at a very early age, particularly in premature infants, ‘what’s happening could impact the ultimate wiring of the brain.’  [Those] who endured traumatic early days are somewhat more sensitive to pain as adults.” (Helmuth).

According to Barinaga (2000), developmental windows are “critical periods,” or time windows when the brain is not only receptive to acquiring a certain kind of information, but also needs that information for its continued normal development.  Critical periods are documented for the development of sensory systems in the brain, especially vision.  They underlie development of at least some of the brain functions that underlie complex learning and thinking skills, especially language.

No critical period ends suddenly like a window slamming shut, but they taper off gradually.  Critical periods are not unique to the first 3 years. Learning, even though more difficult, can continue into adulthood.  Some researchers, therefore, prefer the term “sensitive periods” to critical periods.  It is suggested that there are sensitive periods for different types of learning, as shown by brain imaging.

Emotional attachments are learned in the first year of life, being crucial to the infant’s survival.  Huttenlocher reports that synapses proliferate in most brain areas during the first year of life, after which, “you have a period when the synaptic density is high, for 6 to 12 months up to 5 to 15 years, depending on the area.”  Then the synapse levels decline, with visual areas tending to lose their synapses first and the higher cognitive areas dropping to adult levels later.

The basic functions of a brain area emerge during the period of initial proliferation of synapses.  For example, when the synapses begin to increase in the visual cortex, the child develops binocular vision.  During their fourth year, children learn that other individuals have thoughts and views that differ from their own, having gained enough experience to draw conclusions about the existence of other minds.  Age 12 to 14 is roughly the age when ease of language learning declines, about the time during which the density and number of synapses in the language area of the brain decreases.

The question remains open as to whether learning drives changes in the maturing brain, or whether the maturation process controls the ease with which learning occurs.  With a panoply of brain systems, the answer will be different for each individual system.  Younger brains change more readily, but older brains have not lost the capacity to change.

ADD and ADHD have to do with the primary wiring for basic arousal functions: waking and sleep, arousal and repose, calmness and restlessness, impulsivity and cautiousness, all sensory wiring, and gross and fine motor movement, attention vs. inattention, memory and forgetting, etc.  Even though the syndrome is one of inattention, there is a constant struggle to receive attention, to be noticed, to intrude oneself on others impulsively.

 The whole “stop-go” mechanism seems fundamentally off, whether it is for activity, sleep or rest cycles, or other systems.  Among neurotransmitters, two stand out as stars, communicating most of the brain’s urgent messages.  These fast-acting, ubiquitous chemicals -- GABA and Glutamate -- send the basic “stop” and “go” signals that most other neurotransmitters merely modulate (Helmuth, 2000).  Glutamate is called into action wherever rapid-fire excitatory signals are needed.

Perhaps this is the mechanism in overdrive in ADHD.  This is a possible intervention-point in psychobiological crosstalk where CRP may do some of its restructuring work.  Of course, the primary work takes place at the more fundamental level of the primal sensory image, but this self-organization, facilitated by REM journeys, precipitates into the molecules of emotion.

Current theory holds that ADD/ADHD is a neurotransmitter imbalance, whose exact nature is unknown.  The long-sought glutamate transporter may be a missing link in this equation.  True transporters actively escort neurotransmitters into a vesicle, pulling them uphill against the gradient between tightly packed neurotransmitters inside and the low concentration outside the vesicle.

It’s a slow process, but transporters can pack in more chemicals than the alternative, a channel.  Channels essentially open up part of the vessel wall, enabling chemicals to surge in, attracted by a charge or pH gradient.  Strangely, the glutamate transporter seems to have properties of both.

American Psychological Assn., DSM IV

Armstrong, Thomas; THE MYTH OF THE A.D.D. CHILD, Dutton/Penguin Books, New York, 1995.

Barinaga, Marcia, “A critical issue for the brain,” SCIENCE, Vol. 288 June 23, 2000, pp. 2116-2119.

Edwards, Sally Ann, “Hyperactivity as a passive behavior,” Transactional Analysis Journal, Vol. 9, No. 1, Jan. 1979.

Gales Encyclopedia of Medicine

Helmuth, Laura, “Early insult rewires pain circuits,” SCIENCE, Vol. 289, July 2000, pp. 221-2.

Helmuth, Laura, “Long-sought protein packages glutamate,” SCIENCE, Vol. 289, August 11, 2000, pp. 847-849.

Johnson, Lois M., “Imprinting: a variable in script analysis,” TA Journal, Vol. 8, No. 2, April 1978.

Schiff, A. and Schiff, J.  “Passivity,” Transactional Journal, 1971, 1(1).