What is ADD?



Profiles: The Diverse Face of ADD




Doug is a twenty year old college student suffering from sleep apnea triggered by allergies.  Because he is always extremely tired, he has trouble concentrating and learning new things.  He’s also unorganized and depressed because he’s so tired.    Note that a brain scan would probably show abnormal glucose metabolism that researchers would cites as “proof” of brain damage, even though it really shows a lack of sleep and accompanying depression and anxiety.  When his sleep condition is treated his “ADD” clears up.


Ed is a successful entrepreneur who discovered he was ADD after his son was diagnosed with it. His IQ is 134. Although Ed was an underachieving “wise-ass” in school and barely made it through college, his imagination and risk-taking tendency was a key component of his later success. Ed hyperfocuses on problems until he solves them and is a workaholic.  His strong tendency towards disorganization was solved by hiring competent bookkeepers and secretaries, and marrying an organized wife.

Ryan is a seven-year old boy who is naturally active and has an IQ of 120. His mother is very passive and neither one of his parents have ever disciplined him appropriately. They nag, yell and threaten, but NEVER follow up with a consequence.  As a result, Ryan is a major behavior problem in school.  He constantly talks when he’s not supposed to, gets into fights, and refuses to do schoolwork.  When he doesn’t get his way he throws a tantrum. He lies about other kids, tattling on them to the teacher. He’s not very fidgety, he just likes to run and chase balls.  He doesn’t have motor problems, and is actually pretty coordinated. Ryan is essentially a spoiled brat.  He, like most kids, also has a fatty acid deficiency which exacerbates his negative behavior. 

See also Readers’ Stories

There are two major types of ADD at this time (this aspect of ADD keeps evolving): ADD with hyperactivity (the traditional type of ADD) and ADD without hyperactivity (“inattentive” type). Here are the DSM IV diagnostic criteria in a condensed form:

Inattention (must meet six of the following to a degree that is “maladaptive”):

  • Often fails to give close attention to details or makes mistakes in schoolwork;
  • difficulty sustaining attention in tasks;
  • seems not to listen;
  • fails to follow instructions or finish work;
  • unorganized;
  • difficulties with schoolwork or homework;
  • loses things like school assignments, books, tools, etc.;
  • easily distracted;
  • forgetful about daily activities.


  • fidgety in a squirmy sense;
  • doesn’t stay seated;
  • runs or climbs excessively (or feelings of restlessness in older children);
  • difficulty playing quietly;
  • often “on the go” or acts if “driven by a motor”;
  • often talks excessively;
  • blurts out answers to questions;
  • difficulty waiting in lines or waiting turns;
  • often interrupts or intrudes on others.


Technically, ADD is not something you can suddenly come down with.  “Symptoms” such as excessive daydreaming or hyperactivity must be present by the age of seven in two or more settings and cannot be explained by some other psychological condition such as depression or anxiety.  However, there are cases of people acquiring the symptoms of ADD after experiencing brain trauma.



Background and History:  ADD was first identified and studied in the early 1900’s, although it wasn’t called ADD back then.   After World War I, researchers noted that children who had contracted encephalitis displayed a high incidence of hyperactivity, impulsivity, and conduct disorders.  And in the 1940’s, some soldiers who had experienced brain injuries were found to have behavioral disorders.1   It seemed clear that brain damage could cause hyperactivity.  Other forms of brain insult have since been identified as causes of hyperactivity, including exposure to lead and other environmental toxins, as well as fetal exposure to drugs and alcohol.



In the 1990’s a growing number of ADD experts began to view ADD not so much as a disorder, but instead a natural condition which leaves ADDers at a disadvantage in some common modern settings, and many positive attributes became associated with ADD, such as creativity, enthusiasm and entrepreneurial tendencies.  This is probably due in part to the ever expanding world of ADDers.  A few decades ago only the most dysfunctional hyperactive kids were identified as “disordered” and these kids were more likely to suffer from actual brain injury. Today, the diagnostic criteria are so broad that millions of children in the U.S. are getting the label.  Any underachiever who doesn’t seem to pay attention in school or who has trouble handing in finished homework is fair game for a diagnosis.  I spoke to one teenager who was diagnosed ADD even though her grade point average had never been below a 3.85 (taking Ritalin allowed her to achieve a 4.0).    I also spoke to a psychiatrist who routinely prescribed Ritalin to “C” students in an effort to improve their grade point average.

How common is ADD?

The figure for ADD is typically given as 3-5 percent of the population.  The real figure is unknown and estimates vary between 1 and 20 percent or even more.  This is largely because the diagnostic criteria are so subjective: What is considered “clinically significant impairment” to one person might seem more like normal childhood behavior to someone else.  For example, in one English survey, only 0.09 percent of the children were found to be ADD.   But in an Israeli study, 28 percent of children were rated hyperactive by their teachers.  And in one U.S. study, teachers rated 50 percent of boys as restless, 43 percent of boys as having “short attention spans” and 43 percent of boys as “inattentive to what others say.” 2

Diagnoses and medication rates can vary greatly within the U.S.  Gretchen Lefever, a pediatric psychologist who became concerned when she was suddenly inundated with ADD referrals, studied 30,000 grade-school students in two Virginia school districts.  Her findings, which were published in “The American Journal of Public Health”, showed that 17% of white boys in the region were given medication for ADD while at school.  Other rates were 9% for African-American boys, 7% for white girls, and 3% for African-American girls.3

Is ADD Real? 

Some people have argued that there is no such thing as ADD.  Upon reading their arguments I have found that what most of them are actually saying is that ADD is not a singular “disease”, but rather a collection of behaviors or “symptoms” caused by a wide range of problems. So, to some extent, it’s really a matter of semantics. They compare a diagnosis of ADD to that of a diagnosis of “fever.”  Imagine going to the doctor with a temperature and being told you have been diagnosed with a disease called “Fever,” and that all you can do is take aspirin to lower it.  You might question the wisdom of such a simplistic approach and wonder why the doctor doesn’t look for the CAUSE of the fever. Doctors rarely look for the cause of ADD behaviors. Instead, they assume such behaviors are due to some mysterious brain defect that for some odd reason a huge number of people seem to have. 

Opponents of this simplistic approach argue that the concept of ADD as a singular and discreet disease is a complete fabrication.  They do NOT argue that ADD behaviors are simply caused by lack of discipline or are figments of people’s imagination. They believe people should be seen as individuals, and their specific problems treated as symptoms.  The actual “condition” causing the behavior could range from brain damage to giftedness to allergies, and “treatment” would similarly range from stimulant medication to alternative education to allergy shots, depending on the root of problem.

How is ADD Diagnosed?



Ask the practitioner what his or her ADD assessment entails.  A good assessment typically runs several hours and will include tests for IQ and creativity.  Avoid anyone who simply asks a few question and then prescribes medication to “see what happens.”  Most people do better and feel better on stimulants, even those without ADD, so this is a very bad approach for a professional to follow.  For additional information and a  checklist for children see my page called Children: Diagnosis, “Treatment” and Alternatives.

Common Misconceptions About ADD

1.  Many people assume ADDers cannot pay attention.  This is completely false.  In fact, ADDers are known to “hyperfocus” on anything which captures their attention, to the point where it is difficult to get their attention.   It is true, however, that a higher degree of interest is necessary before the ADDer can pay attention.  ADDers do not tune-out or daydream on purpose or to be rude.   Some people have likened it to having an on-off switch in the brain.  Interest is needed to activate or “turn on” the brain, after which the ADDer can pay attention.  If there is no interest, then the brain is “off” and the ADDer is likely to do something to try and get it back on.  This can include sensation seeking, daydreaming, or becoming immersed in something the ADDer finds very interesting. It can also include disruptive behavior. This might be nature’s way of making sure that some people are always on the lookout for something new and interesting – these are our explorers and discoverers.  Ritalin and other stimulants appear to work by artificially stimulating the brain, allowing the ADDer to tolerate a duller setting than they could otherwise function well in (e.g. schools). 



4. You cannot tell if someone is ADD by their response to stimulants.  Most people perform better and feel better when given stimulants, including those who are not ADD.  That’s why so many people drink coffee.

How Do ADD Brains Differ from Average Brains?










Dopamine: The neurotransmitter dopamine has been implicated in ADD.  Dopamine is the “feel good” chemical in the brain which is responsible for our ability to concentrate as well as our feelings of happiness.  Just about all mood-altering drugs work on dopamine, including alcohol, cigarettes, caffeine, heroin, and cocaine, as do stimulant medications for ADD.  Dopamine activity increases naturally in response to mental or physical stimulation (this is nature’s way of getting us off our butts), which is why ADDers can focus much better after exercise or during an emergency. In fact, it is said that many of the people involved in emergency response are ADD, such as firemen and ER physicians.





1.  A Parent’s Guide to Attention Deficit Disorders by Lisa J. Bain, 1991, Children’s Hospital of Philadelphia.

2. The Myth of the A.D.D. Child, by Thomas Armstrong, Ph.D., 1997

3. “Study Suggests Doctors Overprescribing Ritalin”, CNN Report, Aired August 31, 1999.

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