walkitout (walkitout) wrote,

_Attention Deficit Disorder_, Dr. Thomas Brown, Ph.D. (kindle)

Subtitled: The Unfocused Mind in Children and Adults
Published by Yale University Press

I believe I picked this up around the same time I got the book about shopping problems. I realized (and this is going to sound a little silly) that This is a Thing and I could read a book about it and maybe understand it better. I have been accused of being ADD or ADHD, by my husband, and by one of the people I regularly walked with in Seattle, C. I have repeatedly looked at the DSM-IV description of ADHD and just felt that it didn't do a good job describing me. At all. Like, the opposite of having ADHD. Recent conversation with R. turned up the following explanation: (1) I twitch -- I really do have motor restlessness and (2) if I'm really focused on something, you may have to try several times to get my attention.

I've always had mixed feelings about ADD/ADHD. On the one hand, it did seem clear that there were people who were way better at coming up with plans than others and, given a plan, there are people who are way better at implementing. It's not about native intelligence and it's not about willpower. But I wasn't sure _what_ it was about. I also felt like some of what was missing with people who had trouble implementing was having Good Habits, in turn attributable to chaotic home environments or home environments which were so highly structured that once you left them the World Outside required things of you that you had no chance to practice before. Also, I believed that sleep deprivation as a result of undiagnosed sleep apnea was a good candidate to explain a lot of what got labeled attention deficit.

About a third of the way into this book, I had a bit of a crisis, and talked to R. about it. I _really_ thought this author was full of it, and R. really disagreed with me. So I continued. Halfway through the book, I finally Got It. (1) _I_ really don't have attention deficit. I really do have the opposite of attention deficit. (2) R. really does have some of aspects of attention deficit, and he has Fantastic Habits that help to counter those aspects. But what he has is Nothing Remotely Like what's going on with people who are diagnosable.

Motor restlessness/hyperactivity are red herrings. Sure, they do get associated with attention deficit, but not always. Sure, they are the Most Disruptive aspects in classroom settings (well, for suitable definitions of Most). But the real problems lie in that overlap between executive function and working memory that enable people who have lots of attentional capacity to seamlessly keep track of three other things coming up at specific times later in the day (a meeting, a doctor's appointment, the kids' arrival home) without losing track of what one is doing at the moment (playing Whack-a-mole, or the employment or parental equivalent thereof). Turns out that's a capacity some people lack, along with the ability to repeat back, using approximately the same set of words, a short, narrative story that one just heard. I cannot even _imagine_ having that particular issue, but remember, my own problems involve a language acquisition process that is colloquially known as "cut-and-paste".

Around the halfway point, I called my dear, dear friend R., and we had a (fortunately non-triggering) chat about a series of men she has had close relationships with, who either had diagnoses or probably should have had diagnoses, of ADD. We went over whether they had a diagnosis, whether they had ever been medicated, whether it worked, why they stopped, blah blah bleeping blah. Turns out in one case, medication never really did work (that's the unfortunate 1 in 5 that Brown talks about), but possibly the CPAP machine did; she ended the relationship before she found out. And the descriptions she gave me of what it was like to live with or around them confirmed the sense that I had developed over the years: they were attracted to her in part because she was willing to help keep their lives from falling completely apart (make sure bills got paid, type of thing). Alas, like many people who date/marry those with ADD, R.'s frustrations and unmet needs built up over time.

At around the three quarters point, as I was reading about co-morbidities (and I have to say, this author's take on autism spectrum/Asperger's is Not Great, but fortunately, he doesn't spend a lot of time on it), that I realized how little I really knew about oppositional defiant disorder and conduct disorder, and that it might be rewarding to read about those, too. Also, I started to realize _just how utterly amazing_ Ross Greene's _The Explosive Child_ really was. I read it back in 2003, give or take, and it was the book which convinced me I really _could_ be a decent parent, by showing me a way to deal with tantrums in a way that was compatible with my values (harsh punishment and positive parenting strategies both give me the wiggins, and I Am Not a Doormat).

This isn't much of a review of the book, except to tell you that I read the book with some skepticism of ADD, and some skepticism of medical management of ADD, and the author Convinced me Completely (in part because he was willing to draw a direct line between caffeine and other socially acceptable stimulants and stimulant treatment of ADD. You connect those dots and I'll go right along with you).

If there isn't a better book about ADD out there (I wouldn't know), I hope there will be. Dr. Brown left a lot of space, by focusing so relentlessly on it-must-be-chemical-because-it-responds-to-chemicals (<-- That is a _great_ argument.) . I hope some future book will reflect some (probably) future research that explains the genetic underpinnings as we discover them, better testing to identify how ADD manifests in various individuals (look, if it's different in day-to-day, we ought to be able to devise tests that display that, right?), and a more nuanced understanding of behaviorist approaches that are helpful vs. behaviorist approaches which do nothing vs. behaviorist approaches which are counter-productive.

Finally, the author recognized the genetic underpinnings and thus the likelihood that one or both parents had attributes of the disorder if not the disorder entire. The author told stories about parents who brought themselves in for treatment after their kid got better with treatment. The author showed data that kids from more chaotic households did worse -- this is one of those things where Parenting Matters. But there's a whole chunk that could be written about Family Policy -- on all levels -- that is outside of scope here, but would be useful to work through.

If you think you know someone with this, you should read it. It'll help you determine if you have properly understood the category, and help you articulate better why you think someone is in that category, as you explore options in getting them help. I would say, if you think you have this, you should read it, and if you can, great, but you really don't need any more shoulds in your life. There are too many already.

Good luck. We all need it.
Tags: book review, non-fiction
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