Persons with Attention Deficit Disorder Have Complex Cognitive Problems

Attention deficit disorder (ADD) is a complicated impairment of the brain’s management systems often accompanied by other psychiatric problems, according to a new book edited by a Yale professor.

“Attention deficit disorder is not a simple problem of being hyperactive or unable to pay attention when someone is talking,” says Thomas Brown, assistant clinical professor of psychiatry at Yale School of Medicine and associate director of the Yale Clinic for Attention and Related Disorders.

Brown edited “Attention Deficit Disorders and Comorbidities in Children: Adolescents and Adults.” In the book he explains new understandings of ADD emerging from recent research. Other experts joined to pull together all of the important findings to date on ADD as it often occurs with order disorders of anxiety, sleep, mood, behavior, substance abuse and learning. These complex forms of ADD are found in both sexes and across all ages and levels of intelligence.

He said recent research indicates that persons with ADD have chronic impairments in the “executive functions” of the brain.

“ADD symptoms involve impairments in short term memory and holding one thing in the mind while doing something else,” Brown said. “The executive functions help you plan and get cranked up to get going with a project and to hold your focus to pursue the task and finish it, although it might not interest you. Executive functions also help you put your feelings on the back burner, holding back impulsive reactions so you can think carefully and complete what you are doing.”

Brown said that everyone has symptoms of ADD sometimes, but those diagnosed with ADD are impaired much more consistently and severely.

“Persons with ADD,” he said, “do not have any difficulty maintaining their focus if the task interests them. Yet they often are unable to mobilize themselves effectively for many other tasks they need to do in school, work or family life. This may appear to be a simple problem of willpower and lack of motivation, but it is not.”

Research shows that persons with ADD suffer from a chemical problem that affects the brain’s ability to effectively transmit messages crucial to managing many cognitive functions.

“This disorder is inherited,” Brown said. “Out of every four people with ADD, one has a mom or dad with it and the other three usually have a sibling, grandparent, uncle, aunt or cousin with ADD.”

More than 50 percent of persons with ADD also suffer from a mood disorder, learning disorder, anxiety disorder, sleep disorder, substance abuse or other related problems. These disorders occur in persons with ADD at rates two to five times higher than those in the general population. Also, seven out of 10 children with ADD continue to have ADD problems as adults.

More than 70 percent of children, adolescents and adults with ADD are helped significantly by stimulant medications, such as Ritalin, Dexedrine or Adderall because they facilitate controlled release and re-uptake of dopamine, which is one of 50 neurotransmitters manufactured in the brain. Dopamine is apparently the key chemical facilitating message transmission for the executive functions. ADD symptoms are related to chronic impairments in function of dopamine networks of the brain.

The book emphasizes the importance of comprehensive evaluation to accurately diagnose ADD and its possible complications. It also describes treatment options and the need to tailor treatment to each affected individual and family.

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