I agree with Dunx that the problem is really one of society not being able to handle people who are different. It's terrible that children, in particular, who have a different way of learning, get straitjacketed into the traditional methods and classed as having a problem if they don't fit in. It's especially ridiculous given how much society actually prizes ADD traits in many ways - such as creativity and spontaneity - which is how people like Billy Connolly, Robin Williams, and Ozzy Osbourne got to where they are today. Bill Clinton, of course, is the classic ADD kid made good. But at the same time, I do think that there is good evidence that ADD, in particular, is a discrete and specific disorder, with specific physiological causes, rather than a handy name for a bunch of sometimes associated phenomena. Raak is wrong to say that the genetic correlations of ADD are vague: they are not vague at all, and there is very good evidence for a strictly physiological basis, although of course how that basis manifests itself will vary according to conditions. Certainly ADD behaviours do vary from person to person in type and degree, which is one of the things that make it hard to diagnose, but it doesn't follow that the underlying cause varies - at least where ADD is the correct diagnosis. We have a rather skewed view of it in the UK because, as he says, it hasn't been officially recognised here for very long, compared to the US; in fact, some of the newer treatments for it, such as Concerta (essentially slow-release Ritalin) are unheard of to many supposed experts in this country. Plus, of course, the media like to fixate on issues of medication and horror stories about it. By the same token, it would be better if society could change to accommodate those of us who are different, but given that it can't, medication is a whole lot better than nothing. I have known people whose lives have been utterly ruined by ADD as well as by OCD. If they had been diagnosed earlier and given the help they needed - medication as well as proper counselling and behavioural therapy - who knows how things might have been different.

Something happened to my paragraph marks. I do apologise - as if my tedious exhalations aren't bad enough as it is...

[BM] So what are the discrete physiological causes of ADD popularly supposed to be, then?

[Projoy] Primarily temporal lobe dysfunction, at least according to Dr Daniel Amens who was one of the first to use brain scans to try and figure out what is different in an ADD brain. I've read his book Amens' "Healing ADD" where he describes the different areas of brain activation in the six varieties of ADD which he identifies. All of them share some degree of temporal lobe dysfunction.

The temporal lobe controls your ability to concentrate, and is more active when a brain is concentrating on something. A typical pattern in an ADD brain is that when it is used to concentrate deliberately on something then the temporal lobe is actually deactivated (ie there is less neural activity). I say "deliberately" because a common ADD behaviour is 'hyperfocus' where the brain will concentrate on something novel¹ to the exclusion of all else, but this is rarely deliberate.

Note that there is another book called "Healing ADD" by Thom Hartmann, that I would also recommend, but which is entirely different. In particular, Mr Hartmann specifically attacks Amens' work in scanning brains. But there we are.

[1] another very annoying aspect of this is that I cannot go to sleep if there is speech in earshot. I'll be drifting off quite satisfactorily when my brain will latch on to the interesting noises and amplify them in my perception. Similarly, I need silence or at least white noise if I need to think about a task which I am not entirely involved in, because otherwise my mind will concentrate on the novel rather than what I'm supposed to be doing.

Right, but that still leaves Raak's point unchallenged, doesn't it? There's nothing to suggest that there's a single cause for that particular pattern of brain activity.

Quite right.

For instance, even the mechanisms by which ADD brain patterns arise in the individual are not certain. There is a high correlation between ADD in parents and in their offspring (a figure of 70% is often quoted) which might suggest a genetic link, but it could equally be due to upbringing: the brain is plastic enough that learning will change its structure (no specific references, I'm afraid - I read this recently but can't remember where), and if much of a child's early development is achieved through mimicry then it's quite possible to imagine that parental ADD behaviours might imprint on the child.

It may well be that the role of genetics in mental development is overstated. There is some work (this book, for instance) which puts forward the argument that:

1. there is a common perception that genetic factors are the largest causative agent in mental illness
2. there is almost no evidence of a correlation between mental illness in children and in their parents (the book linked to states that the strongest correlation is in schizophrenia where there is a 50% correlation; nothing about ADD though)
3. if hypothesis (1) is wrong, then it must be environmental
4. the most pervasive environmental influence on children is their parenting
5. therefore the way you are raised is why your head works the way it does.

So, ADD may be at least as much a social phenomenon as a genetic one, although I also think that any learning which has this effect would have been at such a young age that there is no element of choice to it .

I wonder if I could change the subject. Feel free to ignore me. A co-worker is driving me crazy. Her husband hit her and one of the kids and she got a court order that he stay away. Since then, she is trying to find ways to meet him or to justify meeting him. He is possibly suicidal and she thinks this means she should help him. I point out how these suicidal guys sometimes take the family with them (to death), but she still vacillates. She is obsessed and talks about it constantly: outside on breaks, at my workstation, on the phone, in e-mail. She also obsesses about how she wants sex with him and graphically tells me stuff. Oddly, she listens to my advice, which is quite blunt and includes telling her she is not rational now, but I have a law background, not a psychological one. What do I do to get her to get the help she needs? How do I keep her from putting herself in harm's way? How do I (a gazillion other things)?

Personally, apart from - as you mention - trying to convince her to get some professional assistance I'd stay well out, Tina. If she truly is irrational, heaven knows what affect any well meant advice may have on her. If you do attempt to convince her to get some help I think I'd leave the broken relationship out of any coaxing and simply concentrate on the fact that she is under stress at this time ... Then again, I'm no psychologist!

[cross-posted with Duj] How very difficult for you. Are you in the UK? Can you point her towards the Samaritans or even Relate? In my experience [I've been a voluntary counsellor for some years] you are doing the right thing, in that you are listening. If you are happy to be just a sounding-board, for that is all you are, try not be too disappointed if she fails to heed your warnings. By confiding in you, I'm afraid it looks as though she is seeking justification and perhaps your approval for her future actions, ie. she is likely to meet up with him. I would say, your main problem is that her irrationality appears to have transmuted into outrageously selfish and controlling behaviour [towards you] and you have to guage how much more you can cope with. When she's next in 'listening' mode, you might gently point out that you have a life aswell. But unless she admits she needs professional help, there is little you can do, short of frog-marching her into a doctor's surgery. [Blimey! Do I sound like an agony aunt or what?]

Yes, this is what my sister says as well. I'm in the US and our employer has a counseling plan. My sister says, make excues when she comes to my cubicle. Yes, she is always seeking my approval. She will announce some awful plan, come to my desk, and ask what I think. I say I disapprove, and so far that works. But it's not right really. I'm not the professional. And she is selfish now. There is nothing in her life except her crisis. She lost maybe 20 pounds. She writes me at 3 a.m. and is not sleeping. Thanks for all your help. I just don't want to open the paper and find her dead.

I cannot put myself in your position and therefore cannot really understand, but it sounds like you are in a most awkward position - particularly if you feel obligated to your co-worker. Chalky is undoubtedly correct when she mentions listening but this, long term, could interfere with your own work. In view of the fact that your employer has a counseling service, why don't you have a talk with their staff? Depending on legal contingencies you may have to keep the name of your fellow worker out of any discussion, but at least you may receive 'proper' advice (and by that please do not think that I am denigrating Chalky's input.)

Tina] If you are concerned for her life then she definitely needs professional help. I think you have demonstrated the characteristics of a good listener - but you are not responsible for her situation. She has to be, so it may help to explain this to her in a kindly and assertive way. She may thank you for it.

Thanks to you all for the good advice.

I would echo what Dujon said in his last post - counsellors can be extremely useful even if you aren't the one who is in direct need of their services. It allows one to perspectivise the situation. Obviously the best case scenario is if somehow your colleague manages to sort her situation out; the worst case scenario is if this doesn't happen and you get dragged down with it. I found a counsellor was enormously helpful in staving off the latter when I was in a tricky situation.

To keep the competitive daughter away from MY Daq account - I suggested she sign up herself. She thinks she can knock spots of the rest of us. What a challenge. Any chance of slipping her into our mini-league? [x_sugarbabe_x - 3509835]

Some people have to work you know, others sit around waiting for the server to get back up ... so in between this and that, I've added x_sugarbabe_x.

Well, I'm going to have to waste about £600,000 in my NI-capping. Feh!

Coincedentally, the R4 programme "All In The Mind" had a segment on OCD on the 28th October edition.

... or rather, I should say, about hoarding. Slight misadvertising there. It's the first segment after the intro.

I've nothing much to add to the above (having just caught up with the foregoing) except to wish Tina luck with her situation and to thank those who've talked about such personal issues so openly in the ADD/OCD debate.
My own feelings are that I feel myself to be somewhat... eccentric, particularly socially. Some days I seem to fire on all cylinders and participate on all levels with "the group" (meaning colleagues & students) - cracking jokes and fitting into the ongoing banter as we work, but other days it's like I'm out of sync or speaking a different language.
I don't feel this or any other of my eccentricities are anything like extreme enough to warrant labelling as a disorder - and my feeling has been reinforced by some of the above - it's seldom if ever a real interference in my life. As Projoy suggested, when you hear stories from people who have suffered it humbles your own pretentions to such things!
I've often remarked flippantly that no-one worth knowing is "normal" or 100% sane - and I do believe it's the oddnesses about people that make them interesting day-to-day. Not so much that these traits are odd perhaps as that they're different, new and interesting. They characterise people, and make them unique.

I was also struck by Dunx's comments about difficulty falling asleep if there's audible conversation going on - I find falling asleep very difficult generally, and any sort of distraction is a killer: conversation (especially other people in the house talking, but also just tv) light - especially ambient light through the window, strong wind & rain (although they're kind of nice to listen to...) I've found music helps, although it needs to be the right sort of music - usually but not always without lyrics, often ambient. Dead Can Dance, Brian Eno's ambient classic Music For Airports and William Orbit's Strange Cargo III are all favourites to drop off to. They help shut out the rest.
Hmmm - this has turned into an insomnia post really...
[Celebdaq] I'm flabbergasted that Keanu Reeves is still dropping despite the last Matrix films opening... I was doing so well with Arnie before that too... ho hum.

[bl] "The only normal people are the ones you don't know very well."

Could it be because the last Matrix film is getting bad reviews, rather than good?

[blamelewis] I sympathise greatly. I have always suffered terribly from this. I have been known, on more than one occasion, to be kept awake by my own heartbeat. This is an example of how diagnosis helps, however: now that I know I have OCD, I recognise much of this as silly obsessiveness within my own head. I don't really need conditions to be perfect before I fall asleep, I just think I do, and it's the obsessing about it that actually keeps me awake. And that alone makes things much easier. However, I still cannot sleep through any kind of human-made noise. Those damn humans!

Dunx/Blame/Bread] Sleep is something I adore. I could easily (and and often have) fallen asleep within earshot of conversation - que joke about boring conversations. But to try and fall asleep to music, even Brian Eno, would be impossible for me. I'd be far too wrapped up in thinking about the music to let it lull me. I prefer natural darkness and scilence - as experienced on Shetland - where there is vitually no man-made background light or sound.

[Bob] I've noticed a big difference since moving out of Glasgow - there's no longer a streetlight glaring in my window, and only very occasionally do the sounds of drunken revelry intrude. {Bread] i feel sometimes it's the whirl of thoughts in my head keeping me awake - that and being insufficiently tired - I know part of the problem is my lack of regular exercise also. [JLE - Matrix] Bad press should count as much as good - look at Prince Charles this week!

I fall asleep listening to Radio 4 - I like the noise of voices as I doze off. If there are too many of my thoughts whirling around in my head, (and this is where I start to think I'm odd, after reading everyone else's confessions) I kind of 'take dictation' from the shipping forecast or the news or whatever is broadcast. I hear the words, then see them in my mind's eye on the page, the shape of the letters and the shape and length of the word. It leaves no room for other thoughts and I'm asleep within minutes. I can't listen to music to fall asleep - it has a stuimulant effect, no matter what kind of music it is.

Adult to small child who has just answered the door: "Is your Mummy in?"
Small child: "She's asleep listening to Woman's Hour."

I don't seem to have this trouble. Diet and preoccupation seem to be pretty much the only factors that affects whether I sleep. Thus I must not eat after 7 if I want to fall asleep by 11. And almost nothing wakes me. Someone was stabbed to death on my street once and I slept through the whole incident. Provided I have followed the eating rule, I can fall asleep to any music or stimulus, even violent atonal C20th music. I fully expect to die in a fire someday.

I am fortunate. I fall asleep when I want to, which means when I am tired. I sleep lightly but it never really bothers me if I wake in the night [or if I am woken] because a cup of tea usually sorts me out. I wake when I need to. How dull.

Not really - BUT - come on, Dr.Q+ - you are within sight of the line (or at least in line of site.) You can make it ... deep breath ... push ... push ... only a bit to go ...

I'm afraid that Doris_Newbold and ffiish are about to lose a bit of well earned dosh, Doris though having just made the finishing post.

[Chalky] not at all, sounds blissful! [celebdaq] That's it, I've sold Keanu, his usefulness offscreen clearly not in proportion to his arboresence on screen... it Prince Charles for me! (As the Butler said) (allegedly)

I like sleep but sleep doesn't like me. I can't do it properly at all. And following on another comment, I fully expect to die by being stabbed to death as I set fire to Projoy's house.

At the beginning of the week, when I have classes, I get about 3-5 hours of sleep a night. At the end of the week, I get 10-12. Plus, any night of the week, I might decide not to sleep at all. In this fashion, I am training my body not to expect any particular amount of sleep at any particular time. I'll never be jet-lagged again!
[noise] I can't handle TV or conversation when trying to sleep at all, but I can handle music if it doesn't have lyrics, and is very repetative. For instance, I've fallen asleep underneath tables in the middle of raves a couple of times. Of course, driving all day to get there and then having to unload all the speakers undoubtedly helped.