As the neurological community currently understands the developmental disabilities of the ADD/ADHD circle, let us explore some specific fundamentals:
1. A PRIMARY PROBLEM IS IMBALANCE BETWEEN THE TWO HEMISPHERES.
The two halves of the brain are referred to as the cerebral and cerebellar hemispheres. These are separated into ‘lobes’ with particular and distinct functions. When we are discussing the ‘circle’ listed above, we are mainly talking about the frontal lobes, the part of the brain just behind the forehead. There are common neurological deficits in all the Frontal Lobe disorders, even though patients may still present with different symptoms.
The primary problem relates to the imbalance between both right and left frontal hemispheres, usually caused by an inflammatory process affecting the neurons and/or glial and microglial cells in the brain. Normal (asymptomatic) individuals exhibit an asymmetric distribution of nearly all human functions within the cerebral cortex including cognitive, motor, sensory, neuro-hormonal, immune, autonomic, and endocrine functions, (i.e. the left side of the brain controls things that the right does not and visa versa).
Failure to develop and maintain this balance of inter-hemispheric communication or damage affecting such balance between the two hemispheres results in a form of ‘functional independence’ of each hemisphere. This may result in high degrees of functioning in specific tasks and lesser function of others.
One may term this imbalance of developmental disabilities as a ‘functional disconnection syndrome’. Additionally, it will be noted that in these individuals, global functions may not be affected, but many specific functions are decreased while others are enhanced, demonstrating region specific brain effects.
In summary, ADD/ADHD is a ‘brain disconnect’, an imbalance, not so much a neurotransmitter issue and certainly not from a deficiency in Ritalin. The imbalance is usually exhibited as a decrease in Right Frontal Lobe Firing, most often caused by an inflammatory process that NEEDS to be squelched for success in treatment.
2. MOST CONDITIONS IN THIS CIRCLE OF DISORDERS ARE THE RESULT OF A RIGHT HEMISHPERE DEFICIENCY.
Most Frontal Lobe syndromes can clearly be related to dysfunction or delay in development of the right hemisphere. The right hemisphere is under-stimulated resulting in slower temporal processing within that hemisphere, especially in the frontal and pre-frontal cortex. This slower processing results in decreased effectiveness of the right hemisphere’s normal executive functions.
Decrease in activity has been shown with modern functional imaging of the brain, which has noted a decreased activity in the right frontal and pre-frontal cortex with an asymmetric distribution of activity in the basal ganglia (part of the midbrain) and cerebellum.
This right hemisphericity (right hypo-functioning) may also explain why males are affected more than females. Almost all of the specific disorders described earlier are found with significantly greater frequency in males. The frequency ranges from approximately 6 to 1 in ADD to 50 to 1 in high functioning autistic individuals. Male brains are more asymmetrical than female brains.
Male brains are more susceptible to prenatal and postnatal influences; these influences, which are thought to consist of maternal prenatal levels of estrogen, create this left greater than right cortical development characteristic of male brains.
It has been further noted that abnormal decreases in dopamine have a greater negative affect on right frontal cortex function than left due to the asymmetrical distribution of dopamine receptors in the brain (there are more dopamine receptors in the right frontal lobe, hence, more susceptible to losses).
3. ENVIRONMENTAL INFLUENCES CONTRIBUTE TO THE PROBLEM.
Some main factors in the causation of frontal lobe disabilities are hypothesized to be environmental, especially in the more severely afflicted.
Every ADD/ADHD patient we have treated has an autoimmune component causing ‘fire’ in the brain. Current socially acceptable behaviors, primarily those which are sedentary, such as a high proportion of time spent watching television, on the computer or playing video games (all highly left brain stimulants), are at least a factor for the dramatic increase in neurobehavioral problems.
The human brain is extremely plastic (moldable, changeable) allowing us to adapt to the environment in which we live. The window of time for the greatest development is between conception and the age of six. Motor activities facilitate this brain development, particularly in males.
A dramatic decrease in early motor activity in children will affect development of gross motor behavior, which is more specific to right hemisphere development, therefore, decreases in early motor activity equals decrease in right brain development.
In children, the increased use of TV, VCR, computers, game-boys, and video entertainment coupled with working parents, and parental fears for their children, all stimulate left-brain growth and lack of right brain stimulation.
Other environmental factors such as poor nutrition, increased poor caloric intake, environmental toxins, and early sensory deprivation are other important factors.
4. ALL OF THESE CONDITIONS ARE VARIATIONS OF THE SAME PROBLEM.
Most developmental disabilities are of similar etiology and are variations of the same underlying problem – a brain imbalance. The frontal lobes, cerebellum, basal ganglia, and thalamus have been implicated in all of these conditions.
This has been documented on static imaging such as CT scans and MRI, as well as functional imaging such as PET scans and fMRI. Though every individual is unique as far as the particular ‘cause’ in their case – from autoimmune gluten to inflammatory responses to an environmental toxin such as mercury, treatment MUST be aimed at eliminating the ‘cause’.
Frontal Lobe Disconnect is the primary cause of the symptoms. Inflammation due to a hidden Autoimmune Disorder is the primary cause of the Frontal Lobe Disconnect!
5. THESE PROBLEMS ARE CORRECTABLE.
As brain organization is plastic (changeable, moldable), many aspects of neurobehavioral disorders do not have to result in permanent impairment.
Appropriate forms of environmental stimulation (Brain Based Therapy) and behavioral modifications (Neural Cognitive Therapy) can significantly improve or completely correct the symptoms once the underlying problem (usually brain inflammation) is corrected.
Since motor and cognitive dysfunctions often coexist, improving the function of one affects change in the other.
Intervention strategies including Brain-based therapy and Metabolic Therapy, will affect objective change in the two cerebral hemispheres that are associated with positive change in both the cognitive and motor symptoms.
Besides increasing motor performance, timing, endurance, and posture, we will finally address the need for hemisphere specific treatment modalities.
Brain Based Therapy, sensory stimulation, and cognitive functions directed toward the under functioning hemisphere are the most important consideration in treatment.
Achieving a balance of activity between the two hemispheres is critical for allowing cognitive and bilateral motor binding to occur, which would reduce hemispheric neglect (hypofunction).
As the hemispheres achieve a normal coherence and synchronization, motor and cognitive performance will improve.