Attention Deficit Disorder: Practical Coping Mechanisms

408 Pages·2006·3.91 MB·English

by  C. Fisher Barbara

TLFeBOOK
Attention
Deficit
Disorder
Practical Coping
Mechanisms
Second Edition
Edited by
Barbara C. Fisher, Ph.D.
Brain Evaluation/United Psychological Services
Washington Township, Michigan, U.S.A.
New York London
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International Standard Book Number‑13: 978‑0‑8493‑3099‑5 (Hardcover)
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I dedicate this book to my father and to my son:
My father, whose will and determination carried him through so many
serious medical crises this year. He is a man of great strength,
and our family feels blessed to have him with us still.
My son, who has risen to the occasion to become my partner in business and
whose wisdom, insight, and counsel I have come to rely upon so much.

Acknowledgments
I would like to express my appreciation first and foremost to Kristine Dulapa for
her tireless efforts in assisting me in editing and for the organization so crucial
tobringingthisbooktoitsfruition.Sheistrulyanorganizedwonderandaskilled
writer. I would also like to thank my ‘‘right arm,’’ Nicole Mos whose astute skill
and ability allow me to practice on a daily basis and have the time to write this
book. I am surrounded by a wonderful group of people who create just about
the best environment you could hope for as we work as a team to help people
every day. Finally, I wish to thank every one of the contributors to this book for
their time and energy. I am truly honored to publish a book collaboratively in
the company of such great minds.
v

Preface
The biggest challenge of specializing in the diagnosis and treatment of attention
deficit disorder andattention deficit hyperactivity disorder (ADD/ADHD) for the
last15,goingon20,yearshasbeenthecontroversyandthevastarrayofopinions
regarding one disorder. I recall being on a panel with rather esteemed colleagues
for a large pediatric conference several years ago. Every time the audience asked
aquestion,none ofusagreedwithoneanother.Whileattemptingtobepoliteand
nottodisputeoneanotherpublicly,itwasratherclearthatnooneagreedonwhat
ADD/ADHDwasandwhatitwasn’t.Theresultwasalotofconfusionforthepub-
lic,whoprobablyleftthismeetingwithmorequestionsthananswers.
Since that day I have always dreamed of having a book in which profes-
sionals from all types of disciplines could express their opinions about this
rather controversial and disputed over- and under-diagnosed disorder in order
to help other professionals and the public to have a better sense of exactly what
ADDis.Althoughthereareopinionsexpressedinthisbookthatdifferbasedupon
the discipline of the writer, there are even more themes that are similar and rep-
resent agreement in the field. Many, many books have been published on ADD/
ADHD.Whatmakesthisbookdifferentisthatitscontributorsandthewiderange
ofprofessionalswhocontributedtheiropinionrepresentoneofthefirsttimes—if
notthefirsttime—thatexpertsfromalloftheprofessionalfields—functionalmedi-
cine; neurology; sleep medicine; psychiatry; cardiology; neuropsychology;
psychology; family practice; academic, speech and language pathology; tutorial,
weight/nutrition, and respiratory therapy,—united their efforts. I hope that this
will be the beginning of a new era in the world of ADD/ADHD, where profes-
sionals from different disciplines gather to exchange knowledge rather than to
disputeoneanotherintheircorrectopinion.Iamalsohopefulthattherewillcome
adaywhenprofessionalsagreewholeheartedlyonaspecifictestbatterytoevalu-
ate ADD/ADHD (similar to what we already have in terms of cognitive,
intellectual,andachievementassessment).WhenthisoccursIpredictthatthecon-
fusion around what ADD is, and what it isn’t, will be resolved rather quickly. In
using a test battery to evaluate ADD/ADHD, the process starts with evaluation
and then rules in clinical symptoms—as opposed to beginning with symptoms
and trying to prove their existence by evaluation. The latter process has not been
successfulandcontinuestobeunsuccessful,succeedingonlyincreatingmorecon-
fusion and more controversy as professionals cling to their belief system, which
has not been validated by evaluation. What we have been doing so far has not
worked. Everyone agrees that ADD/ADHD is overdiagnosed and underdiag-
nosed—that the diagnosis of ADHD masks disorders that become worse due
to lack of diagnosis, and that treatment becomes equally problematic for the
same reasons.
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viii Preface
The various chapters describing sleep disorders will serve to illustrate the
tremendousoverlapwearefindingbetweenattentiondeficitdisorderwithhyper-
activity and sleep deprivation, upper airway resistance syndrome, frank sleep
apnea, periodic limb movement disorder, and restless legs syndrome. In citing
the various sleep disorders that can create sleep deprivation and/or daytime
sleepiness, it is essential to rule out such possibilities prior to the diagnosis of
attentiondeficitdisorderwithhyperactivity.Treatmentbeginswiththeassessment
process and encompasses a range of interventions—from medication to cognitive
therapies to compensatory strategies and various tools that can be implemented
to improve anyone’s quality of life—with the goal being graceful aging. Accurate
assessmentisapivotalcomponentinthedevelopmentofatreatmentplanthathas
greater odds of being successful due to the clear delineation of primary versus
secondary problematic attention symptoms.
This book illustrates that attention deficit disorder with hyperactivity is
not solely a behavioral problem, nor is it solely a cognitive issue, and it certainly
is not immune to the overlap of an assortment of undiagnosed syndromes
and disorders that contribute to its symptom manifestation. Treatment takes its
power from the accuracy of the diagnosis and the combined forces of treating
professionals from diverse backgrounds working together to solve an equally
diverse disorder.
Iamgratefultotheauthors,leadersintheirrespectivefields,whosecontribu-
tions are contained in this book, and I hope that this book will set the stage for
professionals to work together, exchanging information with one another and
workingtowardsthecommongoalofhelpingachild,adolescent,adult,andaged
personto bethe bestthattheycanbe. ADD/ADHDnever needsto bethe reason
thatapersondoesnotmaximizetheirskillsorfulfilltheirdreams.Wecancontrol
the symptoms of ADD/ADHD with knowledge; there is absolutely no reason it
ever has to control us. It is a new day with new horizons, new treatments, and
new solutions to a problem affecting so many—we have many choices and more
solutions than we know.
Barbara C. Fisher
Contents
Acknowledgments . . . . v
Preface . . . . vii
Contributors . . . . xv
SECTIONA:DEFININGADHDANDITSSUBTYPES
Part I: What Is ADD/ADHD? Diagnosing This Disorder
Through Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Barbara C. Fisher
Part II: Recognized Subtypes of ADHD: Inattentive,
Combined, and Hyperactive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Barbara C. Fisher
1. Will the Real ADD (ADHD Inattentive Type) Please
Stand Up? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Barbara C. Fisher
2. Is the Combined Subtype Really ADHD or Is It
Something Else? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Barbara C. Fisher
3. Disorders that Mimic ADHD Hyperactive Subtype . . . . . . . . . . . . . . . 35
Barbara C. Fisher
4. Adult ADD/ADHD: What It Is and What It Is Not . . . . . . . . . . . . . . . 43
Barbara C. Fisher
Part III: Reasons for the Overdiagnosis and Misdiagnosis
of ADD/ADHD: An Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Barbara C. Fisher
5. Misconceptions in the Scientific Community . . . . . . . . . . . . . . . . . . . . 53
Barbara C. Fisher
6. Diagnostic Concerns When Using Self-Report Measures
as the ’’Gold Standard’’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Barbara C. Fisher
ix