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I have been reading a wonderful book, DRIVEN TO DISTRACTION: Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood by Edward M. Hallowell, M.D., and John Ratey. M.D.

This book brings to a general trade audience wisdom gained from peer-reviewed studies and research. Unlike some books on this topic, there is no ax to grind or ideology to defend. The authors have expertise in both the medical, cognitive, and behavioral treatment of this problem. Much of the attention has looked at boys with ADD; their antics can test the patience of teacher, parent, or saint. Many think boys are overdiagnosed with this disorder. However, girls and adults may be underdiagnosed. The authors offer screening tests and DSM IV criteria for ADD. These can be used as a first step and are obviously not valid for diagnosis.

There are helpful chapters on how ADD enters a family or a marriage and whose presence reverberates around all relationships. This knowledge forms a basis for connecting the person with ADD back into meaningful relationships with those who can offer great support–if the problem is acknowledged, diagnosed, and talked about.

I discovered great wisdom in the chapter that teaches us how to discern the presence of ADD with anxiety, depression, substance abuse, borderline states, and family problems. Are these different manifestations of ADD + another condition or are there many different and unique disorders? Perhaps brain imaging studies and further research and understanding will lead to new categorizations in DSM V and VI.

There are 50 tips on how to manage ADD–each helpful and practical. I especially like this one: “Recharge your batteries. Related to number 30, most adults with ADD need, on a daily basis some time to waste without feeling guilty about it. One guilt-free way to conceptualize it is to call it time to recharge your batteries. Take a nap, watch TV, meditate. Something calm, restful, at ease.” (p. 250). Those without ADD may find many of the approaches helpful!

For parents and teachers, there is a section on 50 classroom management tips. This chapter would be especially helpful to therapists who consult in schools.

Is there a genetic link to ADD? Is it present at birth? Is is strictly a neurological disease? How do small environments or even the environment of our culture itself potentiate or even cause the problem?
Many theorists and researchers grapple with this as I write.

Freud started his career as a neurologist and believed that psychiatric conditions over time would be reformulated into neurological ones as our understanding of the brain increased. This poses an interesting challenge to psychodynamic therapists: how do you talk about the presence of this gorilla in the living room, present and powerful in the developmental years of early childhood, cunning and able to disrupt even the best of families, and complicated enough to challenge even the most competent diagnostician? I believe this challenge will be met, and to the benefit of very many people.

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