So what is this condition, and where has it been all these centuries? Is it just another fad, or is there some scientific basis to ADD?
ADD is not a new disorder, although it has not been clearly understood until recent years, and its definition will become even more refined as we learn more about it. Right now, we are like blind men describing an elephant. The elephant is there—this vast collection of people with varying attentional strengths and vulnerabilities. However, generating a definitive description, diagnostic workup, and treatment plan with replicable research findings still poses a challenge. As long ago as the 1940s, the term "minimal brain damage syndrome" was used to describe symptoms similar to what we now call ADD. Today, the standard manual of the mental health field, the DSM-IV, defines ADD as a syndrome of involuntary distractibility—a restless, constant wandering of the crucial beam of energy we call attention. That trait is the hallmark of this disorder. More specifically, the syndrome must include six or more symptoms of either inattention or hyperactivity and impulsivity—the latter variant is known as attention deficit disorder with hyperactivity, or ADHD.
To define a disorder solely in terms of attention is a true leap forward, since for centuries nobody paid any attention to attention. Attention was viewed as a choice, and if your mind wandered, you were simply allowing it to do so. Symptoms of ADD—not unlike those of depression, mania, or anxiety disorders—were considered deep and moral flaws.
When people ask me where ADD has been all these years, I respond that it has been in classrooms and offices and homes all over the world, right under our noses all along, only it has been called by different names: laziness, stupidity, rottenness, and worthlessness. For decades children with ADD have been shamed, beaten, punished, and humiliated. They have been told they suffered from a deficit not of attention but of motivation and effort. That approach fails as miserably as trying to beat nearsightedness out of a child—and the damage carries over into adulthood.
It's All In Your Head
The evidence that ADD has a biological basis has mounted over recent years. First, and most moving, there is the clinical evidence from the records of millions of patients who have met the diagnostic criteria and who have benefited spectacularly from standard treatment. These are human stories of salvaged lives. The fact that certain medications predictably relieve target symptoms of ADD means that these symptoms have roots in the physical world.
I recall watching an eighth grader named Noah receive a reward for "Most Improved" at graduation. This boy's mother had been told by an expert that Noah was so severely "disturbed" that she should look into residential placement. He was often in trouble at school. From my first meeting with Noah I was struck by his kindness and tenacity; no expert had understood that he suffered from ADD, as well as mild cerebral palsy. Like many ADDers he was intuitive, warm, and empathic. After coaching, teacher involvement, extra structure, and the medication Ritalin, Noah improved steadily, from the moment of diagnosis in sixth grade until graduation from eighth. As I watched him walk up to receive his award, awkward but proud, shake the hand of the principal, then turn and flash us all a grin, I felt inside a gigantic, "YES!" Yes for the triumph of this boy, yes for the triumph of knowledge and determination over misunderstanding, yes for all the children who in the future will not have to suffer. Standing in the back of the gym, leaning against the wall, I cried some of the happiest tears I've ever shed.
There is also intriguing biological evidence for the existence of ADD. One seems to inherit a susceptibility to this disorder, which appears to cluster in families just as manic-depression and other mental illnesses do. Though no scientist has been able to isolate a single causative gene in any mental disorder—and, in fact, we are coming to understand that a complex interaction of genes, neurotransmitters, hormones, and the environment comes into play in mental illness—there is solid evidence that vulnerability can be passed down through generations. One particularly careful review in The Journal of The American Academy of Child and Adolescent Psychiatry supported the heritability of ADD based upon family and twin-adoption studies and analysis of gene inheritance.
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