Monday, March 19, 2012

"Pay No Attention to the Man Behind the Curtain...

Says the Great and Powerful Oz..."

or, the Anatomy of the Executive Function(s):

Lately I have been doing a lot of study with what materials are available, both on ADHD and AgCC...alphabet soup, don't ya know?

As I'd mentioned in an earlier blog, since childhood, and then again in adolescence through adulthood prior to my definitive AgCC diagnoses, doctors and therapists remained "all over the map" with me, in trying to pin down both the symptoms and sources of my disability.  I'd always known I was ADHD, I was in childhood, there can be no doubt of that.  What we are learning about ADHD now, in just the past decade goes farther than the idea of "oh, he just can't/won't 'pay attention.' "  I'm currently reading a rather dense book about ADHD, titled "Attention Deficit Disorder - The Unfocused Mind in Children and Adults " by Thomas E. Brown, Ph.D. This researcher has over 30 years of intensive work with and study of both children and adults with this disorder.

I admit I get both impatient and angry at well wishers and pseudo-scientists that claim that ADHD doesn't exist, and that we are overmedicating our kids....they also like to throw around a (false) claim that it only exists in our country/culture...which simply has no truth to it, roughly the same percentage in other populations exhibit symptoms that are consistent with the presentation of ADHD.

 As I mentioned in another post, I'd recently, for the first time been put on Strattera, a non stimulant medication for ADHD mostly used in children.  I'd also mentioned that no other medication has effected all aspects of my life, thinking, cognition, impulse control, communications skills in the way it has, and in a relatively short period of time.  I've come to realize that for me, the traditional stimulant medications helped only a small bit, and for me had devastating side effects.  Perhaps the only thing the stims helped was with some concentration, but really none of the other symptoms, in fact often making them worse.

 Strattera works by preventing the reuptake (reloading in the synapses) of both Dopamine and Norepinephrine in the human brain.  Detailed studies show that this specific chemical mechanism/circuit does not work well in the ADHD brain, studies done with MRI, CAT and other scan technology give the physical evidence for this.  These two chemicals are primarily responsible for the regulation of what is now considered the executive function(s) of the human brain.

One way to think about the executive function(s) of the brain is like this:  Attention is far more than the metaphor of a Hollywood spotlight, trained on the subject of interest for a particular time.  One has also to consider the overall script of the entertainment, what the cues are, when to shine it on the subject, and when to remove it so as to not bring emphasis to the actor when "his part is no longer necessary."  Also executive function controls much more than the simple act of regulates alertness, regulates focus, and yes, even regulates will to act,  it helps maintain the focus for only as long as is necessary but no longer.  The Executive Function or EF, also is responsible for the organization & prioritization of what is currently held in memory (or "working memory") vs already established long term memories...regulated processing speed, modulates the emotions, monitors incoming & outgoing communications.

You see, then "Attention Deficit" is really only a partial description of the overall disorder that is ADHD.  As this phenomenon has been studied in well over 300 detailed medical and scientific studies, it is now coming to light that there is much more at stake in individuals with this disorder than the ability to pay attention.  Some could compare it to the Wizard behind the curtain in Oz, and they'll simply say "see, you ARE in control, you only have to work HARDER", but this is where this metaphor falls apart.  The EF of the human brain, makes hundreds, even thousand of decisions in an extremely short period of time,  but is an entirely unconscious process.  The EF cannot be trained or learned, if in fact this medical deficit exists.  Some skills can be improved, but double blind studies between "normally developed" and ADHD children and adults have shown time and again that out of three groups, one treated only with medication, one treated with therapy and other supports, and one with both prove some interesting things.  Time and again, the immediate relief of symptoms in over 80% of the medication only group was apparent, while those receiving interventions and therapies only showed negligible and even non existent improvement. Furthermore, those receiving medication, and those receiving both medication & therapies/intervention showed no differences whatsoever.

Also, in AgCC individuals EF is largely impaired, according to the many studies of Dr. Lynn Paul in the Caltech Emotion and Social Cognition Laboratory studies of individuals born acollosul (with AgCC.)  The Corpus Callosum or CC is in many ways a major part of the "fabric" of the brain's EF(s.)  Much of her research is to uncover answer to questions that defy both logic and intuition.

While the deficits of AgCC folk are permanent and apparent, we differ from those who have had the CC removed for other medical reasons.  Most often those who loose their CC to a surgical procedure can longer perform what is known as interhemispheric transfer (IT).  In short this means information present to one side of the body or brain being effectively transfered to the other.  An oddity is that many of us born with AgCC still have some significant IT, even if, compared to "normal people" we are lacking.

IT is now thought to play a major part in many different mental illnesses, from bipolar disorder to schizophrenia, OCD...

Its not my intent to be scholarly in my posts, I don't think such is within my ability...but I do hope to spark the curiosity of others who would learn more about disabilities like ADHD and AgCC.

Dr. Brown's book, mentioned above is a new paradigm for ADHD, perhaps not really new, but more clearly defined.  Before making up their minds on what ADHD is or isn't I think they owe it to themselves to read this book.

In short, all of our lives, adults with collosul disorders previously undiagnosed, as well as those even diagnosed with ADHD from childhood or adulthood, are told that we just need to "get that man behind the curtain to do his job better."  I hope that this post may help some to realize ADHD is not a question of willpower, if anything those of us with either or both of these disorders "will and will and will", try "harder and harder" to the point of exhaustion, not understanding what's missing or not working, until we learn what I have written about in my post.  If you think it frustrating for our parents, siblings and friends, I'd like you to imagine, just for a moment how frustrating, to the point of terrible self esteem it can be for many of us.

~Just Joe

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