When learning isn't easy: Dr. Ed Hamlin provides a crash course in brain functioning and outlines holistic treatments for ADD/ADHD

New Life Journal, August, 2008 by Ed Hamlin

[ILLUSTRATION OMITTED]

The human brain is arguably the most complex entity in the universe. This relatively small, three-pound mass is what permits humans to be the most creative and adaptive species living on the planet. Our brain is largely molded through its interactions with the environment. It continues to develop throughout life and functions as the primary organ of learning. In fact, one of the brain's main functions is to help us learn and solve problems to facilitate our survival and development. It accomplishes this critically important task by growing and strengthening connections between the 100 billion brain cells (neurons) that comprise its mass. Each neuron may have between 1,000 and 10,000 connections with other brain cells. Throughout its lifetime, the brain reorganizes itself by creating new connections. So, the old adage "use it or lose it" applies as much to the brain as it does to muscle mass (1).

The brain contains specialized areas for gathering information through its sensory channels, developing meaning through the association areas, creating new ideas by means of the executive centers, and acting on these new meanings through the motor cortex. The flow of activity from the input, association, processing, and output channels of the brain depends on good connections between the different areas involved and the precise timing of their operations. Most learning problems and disabilities are due to insufficient connectivity between brain regions or disparities in the timing of their operations (2).

A common problem encountered in this learning process is attention deficit disorder (ADD) or attention deficit/hyperactivity disorder (ADHD). Government estimates from community samples suggest that five to 15 percent of children from ages four to 17 years have ADD or ADHD. Recent studies have shown that a high percentage of these children will continue to have symptoms of these disorders into their adulthood (3). Though there are different types of attention disorders, neuroimaging studies of both children and adults with ADD/ADHD show that the frontal lobes of their brains are underactive relative to other areas of the brain. The frontal lobes are the seat of executive functioning where priority of focus is assigned, distractions and impulses are inhibited, tasks are planned and organized, persistence until completion is maintained, and internal rewards are dispensed for a job well done. In individuals with ADD/ADHD, underactive frontal lobes don't adequately communicate with other important regions of the brain and coordinate their relevant functions (4).

The DSM-IV (the current diagnostic manual for psychiatry and psychology) describes the essential features of ADD/ADHD as "a persistent pattern of inattention and/or hyperactivity/impulsivity." The core features of ADD/ADHD interfere with an individual's ability to give close attention to details, which leads to careless errors, makes sustaining attention and following through on tasks more difficult, increases forgetfulness, contributes to disorganization, and results in a person not always hearing what they're told. The more impulsive and hyperactive forms result in increased fidgetiness and squirming, difficulty engaging in quiet activities, excessive talking, interrupting others and impatience.

Beyond these obvious impairments to academic and vocational performance caused by ADD/ ADHD, other common problems may include an increased risk for substance abuse, increased incidence of automobile accidents in adolescence and adulthood, higher tendency to engage in high risk behaviors, relationship problems due to unreliability and inconsistencies, poor self-esteem, depression and anxiety (5).

Treatment of ADD/ADHD has tended to focus on medication primarily involving psychostimulants (e.g., Ritalin, Adderall, Concerta, Focalin and others). Many individuals have good response in some areas of cognitive functioning to medications, but their role in the overall treatment of attention deficits appears somewhat limited. As with many prescription medications, adverse side effects are sometimes encountered. These may include loss of appetite, increased headaches, disrupted sleep, reduced stature, anxiety and tics. There are also limitations of the medications. It appears that attention can be improved by low doses of the medication while the reduction of impulsivity requires higher doses. These higher doses of psychostimulants frequently do not improve attention. Also, long-term outcomes for individuals treated with psychostimulants don't show reduced risk of automobile accidents or substance abuse. Finally, there are cognitive aspects of ADD/ADHD that are not improved by medication. One major cognitive deficit encountered in attention deficits is working memory. Working memory is the ability to hold information in awareness long enough to perform necessary operations to complete a task.

This capacity is essential for many complex cognitive tasks, including reading comprehension, problem solving, and the control of attention. Unfortunately, important aspects of working memory generally show little or no benefit from psychostimulant medication. For all of these reasons, implementing a more holistic approach in treating ADD and ADHD is advantageous or necessary.