Women With Attention Deficit Disorder: Embrace Your Differences and Transform Your Life. Sari Boone's Solden

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 involved in the creation of AD/HD symptoms. With the promise of these new brain-imaging techniques, we will better understand the great variations in human brains in the future.

      The Many Faces of AD/HD

      For many years, when people thought of AD/HD, the picture that came to mind was of a hyperactive, troublemaking little boy, running around causing a lot of problems and was identified with these overt behaviors: not being able to pay attention, having an overactive activity level, and impulsively acting out. These disruptive behaviors were impossible to miss. In reality, AD/HD has many more dimensions than this common stereotyped picture.

      We used to believe that children with these behaviors outgrew their AD/HD when they became adults. However, we eventually learned that a large percentage of them continued to struggle as adults even though their hyperactivity diminished. Even though their difficulties were often less visible as adults, their poorly regulated attentional system caused them just as many perplexing and frustrating problems. Since the first edition of this book, we have become more aware of another group of adults with AD/HD who never were hyperactive. These people, largely consisting of women, continue to be under identified in childhood and often remain undiagnosed as adults.

      AD/HD by Any Other Name . . .

      The Names Change, but the Facts Remain the Same

      It seems that the official labels used by the professional community to diagnose Attention Deficit Disorder change every few years, thereby confusing many people in the process of attempting to more accurately describe this syndrome and capture its variations, as well as its core characteristics. Individuals in the professional community may differ on the wisdom of some of the nomenclature, but the general characteristics they are trying to describe stay the same.

      To confuse matters further, it is common for many people, especially the general population, to use the terms ADD or AD/HD without differentiating types since it is awkward to specify types in normal conversation.

      Different Types of AD/HD (as of this writing)

      AD/HD Hyperactive/Impulsive Type

      These people used to be called AD/HD with hyperactivity and are the speedy, hyper, bounce-off-the-wall children and multi-tasking adults.

      AD/HD Inattentive Type

      These people used to be called AD/HD without hyperactivity. They can be dreamy and under active and work and move slowly. Much of the focus of this book is women with inattentive AD/HD. Again, there is much variation. Many women who were hyperactive as children have lost the hyperactivity yet still experience the effects of attention problems. Many who are under active on the outside are hyperactive in their thoughts and experience an internal feeling of being driven even if it is not translated to hyperactive physical activity.

      There are also combined types of AD/HD who share characteristics of both.

      Detailed Breakdown of What AD/HD is and What It’s Not

      AD/HD Does NOT = A Deficit of Attention

      Instead it means attention irregularity and inconsistency. This includes difficulties with the following:

      •Distractibility or excessive shifting of attention.

      •Activating,