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Attention Deficit Hyperactivity Disorder

Causes of ADD

01/28/2001

Question:

How des a person get A.D.D? Is there an actual cure or just treatments?

Answer:

A LONG ANSWER TO A SHORT QUESTION ADD involves genetically transmitted (i.e., present at birth and inherited through one or both parents) variations in the way the neurotransmitters (chemicals that activate and deactivate brain and other nervous system activity) function. However, since we have no way to accurately measure exactly what the neurotransmitters are doing, we define whether or not someone has ADD by how they function, both currently and in the past. If you have many of the specific traits and actions we associate with certain neurotransmitter variation, you “have ADD.” We all have unique brains but, just as with skin characteristics or body-type, we can all be grouped into a wide variety of sub groups. From a health perspective, some of us fall into the category of “fair skinned” and are more likely to get skin cancer with sun exposure. Some of us are more than 20% above what has been determined to be healthy body weight and so we are “obese” and are more likely to have heart problems as we age. And some of us have less dopamine (the main neurotransmitter that appears to most significantly affect attention, impulsivity and hyperactivity in ADD) available in our frontal lobes and reticular activating systems (the areas of the brain where we have found very low dopamine activity in persons with ADD) and are more likely to have problems with those characteristics that would define us as “having ADD.” How we respond to our neurotransmitter differences is a function of things such as the degree of chemical and anatomic variation; our general intelligence, abilities and gifts; our developmental stage (what we are capable of and trying out at different ages) and the environment around us. One bright person with ADD, Ann, might have a lot of problems learning things she hears but may be so good at learning by reading that she still does well in an interesting lecture course because she makes sure to read all related materials. Her brother with ADD, Dan, might do well in the same course without lifting a book because he has no auditory (related to hearing) learning difficulties and is even more fascinated with the course than she is. But their cousin, Stan, in spite of an IQ 20 points higher than either of the others, might have such a difficult time with focus that he is unable to recall many of the lectures and can’t concentrate long enough to get through a full page of text without having his mind wander. All three of these people could likely benefit from ADD medication but her cousin Stan is more likely to be “diagnosed” because either his parents, the school, a teacher, or he himself are more likely to notice he needs help. There is no known “cure” for the neurotransmission variations that are associated with ADD. What we do have are medications, behavioral modification techniques, and time. Current medications temporarily increase them and/or keep them around longer, but only for hours at a time. Behavioral changes can help as well. Someone with auditory learning problems can benefit from taping lectures and replaying them. Someone with reading problems may still become “well read” by listening to books-on-tape. Developmental change can help because, in general, all of us become less impulsive and more able to make ourselves do things we prefer not doing. But aging does not do away with the neurotransmitter variation, it just modifies it. None if these, medication, behavioral modification nor developmental changes with aging, have been shown to permanently and significantly effect the neurotransmitter variations of ADD.

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Response by:

Susan Louisa Montauk, MD
Formerly Professor of Family Medicine
University of Cincinnati