SAVANT SYNDROME

SAVANT SYNDROME —sometimes abbreviated as savantism—is not a recognized medical diagnosis, but researcher Darold Treffert defines it as a rare condition in which persons with developmental disorders (including autism spectrum disorders) have one or more areas of expertise, ability or brilliance that are in contrast with the individual's overall limitations. Treffert says the condition can be genetic, but can also be acquired, and coexists with other developmental disabilities "such as mental retardation or brain injury or disease that occurs before (pre-natal) during (peri-natal) or after birth (post-natal), or even later in childhood or adult life."

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According to Treffert, about half of persons with SAVANT SYNDROME have autistic disorder, while the other half have another developmental disability, mental retardation, brain injury or disease. He says, "... not all savants are autistic, and not all autistic persons are savants." Other researchers state that autistic traits and savant skills may be linked, or have challenged some earlier conclusions about SAVANT SYNDROME as "hearsay, uncorroborated by independent scrutiny".

What is SAVANT SYNDROME?

People with SAVANT SYNDROME are people who despite serious mental or physical disability have quite remarkable, and sometimes spectacular, talents. This is an exceedingly rare phenomena, although there are several well documented cases (see Sacks, 1986; 1995; Treffert, 1989), and recently the Academy Award winning movie Rain Man has led to the term SAVANT SYNDROME being much more widely known. SAVANT SYNDROME is perhaps one of the most fascinating phenomena in the study of human differences and cognitive psychology. It is often claimed that, because of the extraordinary abilities involved, we will never truly understand human memory and cognition until we understand the savant.

SAVANT SYNDROME was first properly recognised by Dr. J. Langdon Down, (n.b. he also originated the term Down’s syndrome). In 1887, he coined the term "idiot savant" - meaning low intelligence, and from the French, savoir, knowing or wise, to describe someone who had "extraordinary memory but with a great defect in reasoning power." This term is now little used because of its inappropriate connotations, and the term SAVANT SYNDROME has now been more or less adopted. Another term, AUTISTIC SAVANT, is also widely used, but this can be somewhat misleading. Although there is a strong association with autism, it is certainly not the case that all savants are autistic. It is estimated that about 50% of the cases of SAVANT SYNDROME are from the autistic population, and the other 50% from the population of developmental disabilities and CNS injuries. The estimated incidence of savant abilities in the autistic population is about 10%, whereas the incidence in the learning disability population (which is very much larger) is probably less than 1%. Nevertheless, in order to understand SAVANT SYNDROME, it is helpful to know something about autism, also it is important to realize that there is some confusion over these estimates of the incidence of the syndrome which stems from the different ways in which it is defined and described.

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What is Autism?

Autism is a moderately rare condition resulting from a complex developmental disability that typically appears during the first three years of life. It is a neurological disorder that affects the functioning of the developing brain, resulting in sometimes profound communicative, social and cognitive deficits. Autism is estimated to occur in as many as 1 in 500 individuals, and is four times more prevalent in boys than girls and does not seem to be associated with any demographic features, such as economic, class, racial, ethnic, etc. Autistic traits are also sometimes observed in connection with other developmental disabilities, and CNS injuries.

The term autistic was first used by Eugen Bleuler in 1908, but the condition of autism was first named and described by the psychiatrist, Leo Kanner, in a landmark paper published in 1943. It is a condition in which children and adults typically have a lowered level of intelligence, together with difficulties in verbal and non-verbal communication, in the skills of social interaction, and in play activities. The disorder makes it hard for them to relate to the outside world, and there is a marked tendency to withdraw from human interactions and become preoccupied with attachment to objects. There is a failure in human intersubjectivity, characterized by difficulties in joint action, turn taking, and shared activities. Aggressive and/or self-injurious behaviour may well be present. Often there will be continuous repetition of body movements (hand flapping, rocking), a rigidity of actions, resistance to changes in routine, and a "desire" for sameness. Independently of Kanner, in 1944 Hans Asperger, an Austrian physician, described a very similar condition, although there were some subtle differences. In 1981, Lorna Wing adopted the term Asperger’s syndrome in referring to a group of people who did not fit the strict criteria for autism, and were relatively high functioning (see Happé, 1994 for a fuller account).

It is probably best to think of autism as a spectrum disorder. For example, DSM-IV includes autism, grouped together with several related disorders, under the broad heading "Pervasive Developmental Disorder (PDD)." This is a general category of disorders which is characterized by severe and pervasive impairment in several areas of development. There are no medical criteria for diagnosing autism, a specific diagnosis is made when a specified number of characteristics are noted as present, based on the presence of specific behaviours indicated by observation and through parent consultation. Individuals who fall under the PDD category in DSM-IV exhibit commonalties in communication and social deficits, but may differ in terms of severity. Defining autism as a spectrum disorder, recognizes that the symptoms and characteristics of autism can present themselves in a wide variety of combinations, which may also range from mild to severe. Clearly, there is no standard "type" or "typical" person with autism, and the terminology in use includes: autistic traits, autistic tendencies, autism spectrum disorder, high-functioning or low-functioning autism. However, this lecture is not concerned directly with autism, its definition or diagnosis.

Characteristics of SAVANT SYNDROME

SAVANT SYNDROME is exceedingly rare, but a remarkable condition in which persons with autism, or other serious mental handicaps, or major mental illness, have astonishing islands of ability or brilliance that stand out in stark contrast to their overall disability. The condition can be congenital or be acquired by an otherwise normal individual following CNS injury or disease. It occurs in males more frequently than in females in an approximate ratio of 6 to 1. The skills can appear suddenly, without explanation, and have been reported as sometimes disappearing just as suddenly. It is useful to put these special skills into the following three categories: Splinter Skills where the individual possesses specific skills that stand in contrast to their overall level of functioning, Talented Savants where the individual displays a high level of ability that is in contrast to their disability, and Prodigious Savants which involves a much rarer form of the condition, where the ability or brilliance is not only spectacular in contrast to the disability, but would be spectacular even if viewed in a non-disabled person. It is very likely that many savants do go unnoticed, and depending upon whether the three categories above are recognized, estimates of the incidence of savant syndrome can vary widely. In the case of prodigious savants it has been estimated that there may be fewer than 100 cases reported in the world literature in the past 100 years.

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#Categories of SAVANT SYNDROME Skill

SAVANT SYNDROME skills occur within a narrow but fairly constant range of human mental functions. If they have anything in common it is that they all more or less involve considerable feats of memory. In some cases a specific skill might exist, while in others there may be several skills that co-exist simultaneously. An important observation is that the skills tend to be right hemisphere oriented: i.e. non-symbolic, artistic, concrete, directly perceived. Table 1 describes some of the striking abilities that have been found in savants.

Table 1: SAVANT SYNDROME Skills
(n.b. the focus here is on examples of prodigious savants)


Memorization - superior memory is a common feature of SAVANT SYNDROME, but it also can be a special skill in its own right. There are cases of savants who have memorized population statistics, telephone books, bus scheduals, and in one remarkable case the 9 volume edition of Grove’s Dictionary of Music and Musicians (The Walking Grove, Sacks, 1986).

Lightening calculation - this is exhibited in the instantaneous calculation of multiplications, square roots, etc, the determination of prime numbers, or subitizing (The Twins, Sacks, 1986).

Calender calculating - often involving the ability to identify the day of the week upon which a particular date falls, in one case any time in the last, or next, forty thousand years!! (The Twins, Sacks, 1986).

Musical ability - this is a relatively common savant skill, the co-occurrence of musical genius, blindness and learning disability is a striking feature here. Savants will have perfect pitch, and can play a complete piece of music after hearing it only once (see Hermelin, 2001).

Artistic ability - not as common as musical abilities, but there are savants with exceptional painting, sculpture and especially drawing skills. e.g. Nadia (Selfe, 1977) and Stephen Wiltshire (1987; 1991; see also Sacks, 1995; Hermelin, 2001). See also The Autistic Artist in Sacks (1986).

Language ability - this is fairly rare, but there is one well documented case of a savant with CNS damage since birth who could read write and translate 15 to 20 languages (Smith & Tsimpli, 1995; Hermelin, 2001). Hermelin also includes a case of a savant poet.

#Theories of SAVANT SYNDROME

The reason why some autistic and disabled individuals have savant abilities is not understood, however, the strong link with autism does offer a good starting point. There have been many theories, but it is clear that no one theory is sufficient. Theories include: Biological-Developmental - such as genetic, neurochemical, left hemisphere dysfunction, frontal and temporal lobe damage, and the DSM IV diagnostic category is Pervasive Developmental Disorder (PDD); Cognitive - such as deficits in executive function and abstract thinking; weak coherence theory; highly developed procedural memory and eidetic imagery (Happé, 1994; Schopler & Mesibov, 1995). Other theories include a deficit in theory of mind (Frith, 1989), compensation for sensory disabilities (especially blindness) and social isolation, and the modularity of mind hypothesis which proposes that particularly when executive cognitive functions are disrupted the mind exhibits a striking modular organization (see Smith & Tsimpli, 1995). However, any theory would need to explain the link with autism, the islands of exceptional ability, the bias towards male savants, and recent research that includes a finding of the emergence of savant abilities in fronto-temporal dementia patients, and the suggestion of a neurotoxic effect of circulating testosterone on the left hemisphere in the male fetus possibly related to autism.

#Some Management Issues

There are two necessary components of the SAVANT SYNDROME: (i) a remarkable ability to memorize, to record detail, or repeat an operation endlessly and efficiently, and (ii) a means of giving expression to this ability. The importance of (ii) should not be underestimated. Not only are savants noticed by this expression of their special abilities, but also savants like doing something, and doing it again, again and again. No one has any idea how many savants go unnoticed. In the case of prodigious savants it is possible that early recognition and careful encouragement are important contributory factors to how the talent develops. It has been proposed that helping the savant to achieve a higher level of general functioning may result in a loss of the special savant skills. However, there is little evidence for this, and it may well be that "training the talent" could be a valuable approach towards improving socialization, communication and self-esteem.

#A illustrative case example: Tim, age 40+

Tim has profound sensory and communicative disabilities (his identity has been concealed). He lives in a residential home with day care facilities for adults with learning difficulties, and has been in residential or institutional care since the age of 15. He has no hearing and consequently no speech. He has moderate physical difficulties and sometimes he requires a wheelchair. Tim has probably been disabled since very early childhood, and it is believed that he has been diagnosed as having "autistic traits." But, as far as it is known, his medical records have been destroyed. He has a previous history of challenging behaviour and mood swings, which has in the past been controlled with powerful anti-psychotic drugs. These have been greatly reduced over the 5 years that he has been living at his current residential home, during which time there have been striking changes in his behaviour, including a particularly marked reduction in his challenging behviour. The most likely reason for this is due mainly to communication barriers being greatly decreased. Despite Tim’s profound disabilities, he is relatively outgoing and is not withdrawn, and he shows a remarkable intelligence (although this would be very difficult to measure formally). He is strong willed, and will only do things that he wants to do. He is helpful, he values affection, and he is considerate to other residents, especially in being tolerant of younger residents. Tim has probably received very little education, he cannot read or write (although he can recognize his name and a few words, and copy any shape that he wishes), but he has been taught a system of alternative communication called Makaton. This is a visual and signing process, usually used alongside speech, which is widely used in the UK by people with learning disabilities. The Makaton Vocabulary was designed in 1972 by Margaret Walker, a UK Speech and language Therapist. She developed Makaton in response to the needs of deaf adults with severe learning disabilities, particularly who were residents in an institution, because other sign communication systems were not very satisfactory. Without Makaton, Tim would only be able to make himself understood with a few crude gestures, and his life could and would be very confusing and frustrating. Tim uses Makaton to initiate conversations, to ask questions, and clarify any situation.

Table 2: Some observations of Tim

Tim draws from memory, and from life
He draws with accurate perspective
He draws with attention to detail
He can draw a good likeness, and can draw a self-portrait
He can draw a "building plan" with a ruler
He finds "hair" very difficult

Tim’s drawing involves deliberate use of lines - "as if tracing an image"
He has a high level of concentration
He is reflective, pausing to think
He chooses his pencils, colours carefully (he knows which pencil/crayon he needs, which box it is in, and he will make a very special effort to match "eye colour")
When drawing from life he takes brief infrequent glimpses

Tim draws what he wants to draw
He likes to draw batteries, light bulbs and lifts
In the past, he did not share his drawings with others, he folded them up very small and put them in his pocket, but kept them all in his room
He has developed his own narrative style of drawing
In addition, he has excellent assembly skills (e.g. IKEA furniture)
His rigidity has relaxed with improved communication

When placed within the context of all these disabilities, Tim possesses extraordinary abilities which primarily are illustrated by his drawing and his photographic memory. As far as it is known, these extraordinary abilities have gone unnoticed, or unrecognized, for most of his life. It was my wife, Elaine, who was the first to recognize Tim’s special abilities. It seems very clear that Tim falls into the category of a savant. What is particularly interesting is that very few cases of savants who are profoundly deaf have ever been documented (the one exception seems to be the case of James Henry Pullen, see Treffert, 1989). I will demonstrate what I am talking about by showing you a selection of his drawings. I will point out a number of features that show how his abilities fit well with those usually attributed to savant syndrome (see Table 2). His drawings are deceptively simple, and it is easy to underestimate the level of his achievements. I will draw especially upon the work of David Hockney (2001) who has recently uncovered some of the techniques used by the old masters in their paintings. Tim has very little difficulty drawing images in accurate perspective that the old masters could only do with sophisticated technical aids. What most people, including skilled artists, would find very difficult to do "by eye", Tim can do with little effort, from memory, sometimes months later, and without any formal instruction or training.


At this time, Tim is clearly a talented savant, he may even be prodigious. His special skills and abilities are highly specialized, and are obviously conspicuous when viewed over against his over-all handicap, he can draw in ways that most professional artists would find impossible. Tim seems to fit with one view of savant syndrome as resulting from a compensation for a sensory deficit, i.e. his deafness, and the possession of a remarkable photographic memory. My wife has adopted the position that Tim’s drawing ability would not have become so apparent if the communication barriers had not been bridged. Tim has a need to be sure of, and trust, what is happening around him. Without this need being met, Tim’s exceptional abilities would not have had the chance to develop in the way that they have. Indeed, it is highly unlikely that they would ever have been noticed at all.

For More information on AUTISM

Oppositional Defiant Disorder

What is oppositional defiant disorder (ODD)?
Oppositional defiant disorder (ODD) is a behavior disorder, usually diagnosed in childhood, that is characterized by uncooperative, defiant, negativistic, irritable, and annoying behaviors toward parents, peers, teachers, and other authority figures. Children and adolescents with ODD are more distressing or troubling to others than they are distressed or troubled themselves.

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What causes oppositional defiant disorder?
While the cause of ODD is not known, there are two primary theories offered to explain the development of ODD. A developmental theory suggests that the problems begin when children are toddlers. Children and adolescents who develop ODD may have had a difficult time learning to separate from their primary attachment figure and developing autonomous skills. The bad attitudes characteristic of ODD are viewed as a continuation of the normal developmental issues that were not adequately resolved during the toddler years.

Learning theory suggests, however, that the negativistic characteristics of ODD are learned attitudes reflecting the effects of negative reinforcement techniques used by parents and authority figures. The use of negative reinforcers by parents is viewed as increasing the rate and intensity of oppositional behaviors in the child as it achieves the desired attention, time, concern, and interaction with parents or authority figures.

Who is affected by oppositional defiant disorder?
Behavior disorders, as a category, are, by far, the most common reason for referrals to mental health services for children and adolescents. Oppositional defiant disorder is reported to affect 20 percent of the school-age population. ODD is more common in boys than in girls.

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What are the symptoms of oppositional defiant disorder?
Most symptoms seen in children and adolescents with oppositional defiant disorder also occur at times in children without this disorder, especially around the ages or 2 or 3, or during the teenage years. Many children, especially when they are tired, hungry, or upset, tend to disobey, argue with parents, or defy authority. However, in children and adolescents with oppositional defiant disorder, these symptoms occur more frequently and interfere with learning, school adjustment, and, sometimes, with the child's (adolescent's) relationships with others.

Symptoms of oppositional defiant disorder may include:

frequent temper tantrums
excessive arguments with adults
refusal to comply with adult requests
always questioning rules; refusal to follow rules
behavior intended to annoy or upset others, including adults
blaming others for his/her misbehaviors or mistakes
easily annoyed by others
frequently has an angry attitude
speaking harshly, or unkind
deliberately behaving in ways that seek revenge
The symptoms of ODD may resemble other medical conditions or behavior problems. Always consult your child's (adolescent's) physician for a diagnosis.

How is oppositional defiant disorder diagnosed?
Parents, teachers, and other authority figures in child and adolescent settings often identify the child or adolescent with ODD. However, a child psychiatrist or a qualified mental health professional usually diagnoses ODD in children and adolescents. A detailed history of the child's behavior from parents and teachers, clinical observations of the child's behavior, and, sometimes, psychological testing contribute to the diagnosis. Parents who note symptoms of ODD in their child or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.

Further, oppositional defiant disorder often coexists with other mental health disorders, including mood disorders, anxiety disorders, conduct disorder, and attention-deficit/hyperactivity disorder, increasing the need for early diagnosis and treatment. Always consult your child's (adolescent's) physician for more information.

Treatment for oppositional defiant disorder:
Specific treatment for children with oppositional defiant disorder will be determined by your child's (adolescent's) physician based on:

your child's (adolescent's) age, overall health, and medical history
extent of your child's (adolescent's) symptoms
your child's (adolescent's) tolerance for specific medications, procedures, or therapies
expectations for the course of the condition
your opinion or preference
Treatment may include:

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individual psychotherapy
Individual psychotherapy for ODD often uses cognitive-behavioral approaches to improve problem solving skills, communication skills, impulse control, and anger management skills.
family therapy
Family therapy is often focused on making changes within the family system, such as improving communication skills and family interactions. Parenting children with ODD can be very difficult and trying for parents. Parents need support and understanding as well as developing more effective parenting approaches.
peer group therapy
Peer group therapy is often focused on developing social skills and interpersonal skills.
medication
While not considered effective in treating ODD, medication may be used if other symptoms or disorders are present and responsive to medication.
Prevention of oppositional defiant disorder in childhood:
Some experts believe that a developmental sequence of experiences occurs in the development of oppositional defiant disorder. This sequence may start with ineffective parenting practices, followed by difficulty with other authority figures and poor peer interactions. As these experiences compound and continue, oppositional and defiant behaviors develop into a pattern of behavior. Early detection and intervention into negative family and social experiences may be helpful in disrupting the sequence of experiences leading to more oppositional and defiant behaviors. Early detection and intervention with more effective communication skills, parenting skills, conflict resolution skills, and anger management skills can disrupt the pattern of negative behaviors and decrease the interference of oppositional and defiant behaviors in interpersonal relationships with adults and peers, and school and social adjustment. The goal of early intervention is to enhance the child's normal growth and developmental process, and improve the quality of life experienced by children or adolescents with oppositional defiant disorder.

ADD ADHD and Addictions

Living in families, and raising children can be difficult under the best of circumstances. Many of us had a hard time living in the families that we grew up in. It may be difficult today, living together in the families that we have created. We may feel guilty for not giving our children or partner what we feel they deserve. We may feel painfully aware of how we are not taking care of our own needs. This is especially true if a member, or several members of our family have Attention Deficit Disorder.

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As our knowledge of Attention Deficit Disorder grows, we are learning that ADD is not simply a disorder of childhood. ADD is life long condition. Children with ADD grow up to be adults with ADD. People with ADD do not live and grow in a vacuum. They have relationships, children, and create families with people who may or may not have ADD. Therefore, it is essential to help not only the person directly affected by ADD, but the entire family. Attention Deficit Disorder, similar to addictions affects every member in the family. Families do not cause ADD, and yet families need help to live and thrive in spite of the impact of ADD.

We now know that ADD runs in families. It has been estimated that there is a 30% chance that a child with ADD has at least one parent who has ADD. It has also been estimate that there is a 30% chance that that same child will have a sibling with ADD. I frequently work with families where one or both parents have ADD, and one or two of their children also have the condition. Living in a family with ADD can be like living in a five ring circus. There is always someone or something that demands attention.

As parents we want the best for our children, and are often willing to sacrifice our needs for theirs. But what is the impact on the family if one of the parents has untreated Attention Deficit Disorder? Too many times, I hear caring parents say, "Please help my son or daughter. I've dealt with this all my life and can continue to." The problem with this is that it can be incredibly difficult to provide consistent parenting for any child, let alone a child with ADD, if you as the parent have untreated ADD. There is a reason why the airlines request that adults put their oxygen mask on first, so that they are then able to help the children.

Families with ADD have higher incidents of physical, and verbal abuse. Substances such as alcohol, food and drugs are often used to self-medicate the pain and frustration of family ADD. Some parents of children with ADD suffer from Post-traumatic Stress Disorder (PTSD). PTSD is a condition that occurs when people are subjected to extreme, ongoing stress that is beyond the realm of normal experience. PTSD symptoms include depression, anxiety, sleep disturbances, hyper-vigilance, and re-experiencing of the trauma.

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For the for mention reasons, it is imperative that ADD is viewed in the context of the family, or persons environment. Relationship therapy that is specific to addressing the impact of ADD is essential. Family therapy which includes parents and siblings with and without ADD is critical. So often the non-ADD siblings are left out, or feel that they have to somehow make up for the difficulties that their ADD sibling(s) are causing. Educating and treating all members of the family system promotes family wellness.

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We have learned from the evolution of the chemical dependency field over that past two decades that treating alcoholics and addicts outside of the context of their relationships is less than helpful. We have also learned that family members of the chemically dependent person also need treatment, so that they too can recover. The same is true with Attention Deficit Disorder. Let us continue to be quick learners as our knowledge of ADD expands. ADD is not caused by poor parenting, or dysfunctional families, and yet the entire family deserves treatment. No one in the family is immune from the impact of Attention Deficit Disorder.

Wendy Richardson M.A., LMFCC specializes in the treatment of ADD and co-related substance abuse. She provides education and therapy for couples and families where ADD is present. She is a writer who speaks nationally ,and provides workshops and trainings on Attention Deficit Disorder.

THE LINK BETWEEN ADD/HD AND EATING DISORDERS

SELF-MEDICATING WITH FOOD

As human beings we find creative ways to decrease our emotional, physical, and spiritual pain. Some people use alcohol and other drugs to ease the pain and frustration of their ADD symptoms. Others use compulsive behaviors such as gambling, spending, or sexual addictions. Eating in ways that are not good for us, but temporarily make us feel better is also a form of self-medicating. Self-medicating is when we use substances and behaviors to change how we feel. The problem with self-medicating is that it initially works, but soon leads to a host of new problems.

Eating can temporarily calm ADD physical and mental restlessness. Eating can be grounding for some people with ADD, helping them focus better while reading, studying, watching television or movies. If your brain is not quick to contain your impulses, you may eat without thinking. Some compulsive overeaters are shocked to realize they have finished a carton of ice cream or a king-size tub of theater popcorn. They were not consciously aware of how much they were eating. Eating puts them into a pleasant trance like state that is a respite from their often active and chaotic ADD brain.

Although we don't think of food as a drug, it can be used as one. We have to eat, but eating too much or too little of certain types of food has consequences. Since there is no way to totally abstain from food, eating disorders are extremely hard to recover from. You may have to abstain from certain foods, perhaps those containing sugar, because they trigger a compulsion for more, yet everywhere you look you see and smell these foods.

WHY FOOD?

Food is legal. It is a culturally acceptable way to comfort ourselves. For some people with ADD food is the first substance that helped them feel calm. Children with ADD will often seek out foods rich with sugar and refined carbohydrates such as candy, cookies, cakes, and pasta. People who compulsively over eat, binge, or binge and purge also eat these types of foods.

It is no accident that binge food is usually high in sugars and carbohydrates, especially when you take into consideration how the ADD brain is slow to absorb glucose. One of the Zametkin PET scan studies, results indicated that "Global cerebral glucose metabolism was 8.1 percent lower in the adults with hyperactivity than in the normal controls..."1 Other research has also confirmed slower glucose metabolism in ADD adults with and without hyperactivity. This suggests that the binge eater is using these foods to change his or her neurochemistry.

SUGAR CRAVING AND HYPERACTIVITY

Researchers have searched for the connection between sugar and hyperactivity. Some studies have reported that sugar causes hyperactivity in children. When these studies have been duplicated, however, the results were not always consistent. The idea that sugar causes hyperactivity is relatively new in our culture, and has not been passed on from previous generations. This is why grandparents are often miffed when they are told not to give their grandchild any sugar. They haven't had the experience of sugar causing hyperactivity.

What if we have been looking at the question backward? What if ADD hyperactivity actually causes people to crave sweets? If the ADD brain is slower to absorb glucose, it would make sense the body would find a way to increase the supply of glucose to the brain as quickly as possible.

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I have worked with many ADD adults who are addicted to sugar, especially chocolate which also contains caffeine. They find that eating sugar helps them stay alert, calm, and focused. Prior to ADD treatment many report drinking 6-12 sugar sodas, several cups of coffee with sugar, and constantly nibbling on candy and sweets throughout the day. It is impossible to sort out what is pure sugar craving when it is mixed with the stimulating effects of caffeine on the ADD brain.

THE SEROTONIN CONNECTION

Serotonin is a neurotransmitter that has been associated with symptoms of depression. Serotonin helps regulate sleep, sexual energy, mood, impulses and appetite. Low levels of serotonin can cause us to feel irritable, anxious, and depressed. One way to temporarily increase our serotonin level is to eat foods that are high in sugar and carbohydrates. Our attempts to change our neurochemistry are short lived, however, and we have to eat more and more to maintain feeling of well being. Medications such as Prozac, Paxil and Zoloft work to regulate serotonin. These medications are frequently helpful when used in combination with ADD and eating disorder treatment. Proper levels of serotonin can also help improve impulse control giving the person time to think before they eat.

COMPULSIVE OVER EATING

Most of us overeat at times. We may eat for sheer enjoyment even if we're not hungry, or we may eat more than we intend at a dinner party or celebration. But for some, overeating becomes a compulsion they cannot stop. Compulsive overeaters lose control of their ability to stop eating. They use food to alter their feelings rather than satisfy hunger. Compulsive overeaters tend to crave foods high in carbohydrates, sugars, and salt.

BINGE EATING

Binge eating differs from compulsive overeating in that the binge eater enjoys the rush and stimulation of planning the binge. Buying the food and finding the time and place to binge in secret creates a level of risk and excitement that the ADD brain craves. Large amounts of foods high in carbohydrates and sugars are rapidly consumed in a short period of time. The binge itself may only last fifteen to twenty minutes. Proper levels of serotonin and dopamine aid in impulse control problems that contribute to binge eating and Bulimia.

BULIMIA

Bulimia is binge eating accompanied by purging. The bulimic experiences the rush of planning the binge, which can be very stimulating for the person with ADD. In addition, the bulimic may be stimulated by the satiation binging provides; then, he or she adds an additional dimension to the process: the relief of purging. Many bulimics report entering an altered state of consciousness, experiencing feelings of calmness and euphoria after they vomit. This cleansing provides relief which is short lived, and so the bulimic is soon binging again.

ANOREXIA

Our culture is obsessed with thinness. "Food is OK, but, don't gain weight." No wonder so many adolescent boys and girls, as well as women and men, become imprisoned in binge and purge cycles, chronic dieting, and anorexia nervosa. Anorexia can be deadly. Anorectics have lost their ability to eat in a healthy way. Self-starvation is characterized by loss of control. They are obsessed with thoughts of food, body image, and diet. Anorectics can also use laxatives, diuretics, enemas, and compulsive exercise to maintain their distorted image of thinness.

As we learn more about ADD, we discover that people manifest ADD traits differently. Obsessing on food, exercise, and thinness gives the anorectic a way to focus their chaotic ADD brains. They become over focused on thoughts and behaviors that related to food.

Frequently these people will only become aware of their high level of activity, distractibility, and impulsiveness after they have been in recovery for anorexia. Self starvation curtails hyperactivity.

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Distractibility and spaceyness are characteristics of both anorexia and bulimia, whether or not they're accompanied by ADD. In each case the inability to concentrate or focus results because the brain is not being properly nourished. For people with ADD, however, there is a history of attention difficulties that predates the eating disorder. Their concentration, impulse problems, and activity level may not improve when their eating disorder is treated. As a matter of fact, their ADD traits can get worse once they are no longer self-medicating with food, or organizing their lives around food and exercise. If you are someone who has struggled with eating disorders, and suspect you may have ADD, it is important to get an evaluation. Both your eating disorders and your ADD must be treated.

COMPREHENSIVE TREATMENT

It is essential that both ADD and eating disorders are treated. Too many people are struggling with their eating disorders because they have undiagnosed or untreated ADD. When ADD is properly treated the individual is better able to focus and follow through with treatment for their eating disorders. They also have greater control of their impulses, and less of a need to self-medicate their ADD symptoms.

Stimulant medications such as Dexedrine, Ritalin, Desoxyn, and Adderall that work with the neurotransmitter dopamine can be helpful in treating ADD restlessness, impulsiveness, attentional problems, and problems with obsessive thoughts. Medications such as Paxil, Prozac, and Zoloft are useful because they increase serotonin levels, thus helping with impulse control, obsessive thoughts, and decrease agitation.

The key to successful treatment lies in a comprehensive treatment program that address the medical, emotional, social, and physical aspects of both ADD and eating disorders. Recovering from eating disorders takes time, hard work and commitment. Recovering from eating disorders when you have ADD is even tougher. I encourage you to be patient. Put away the whip of contempt, and have compassion for yourself. You've been through a lot. Over the years I have seen many people who were once hopeless and despondent because they could not recover from their eating disorders chart solid courses of recovery once their ADD was treated.

1. Zametkin, Nordahl, Gross, King, Semple, Rumsey, Hamburger, and Cohen, "Cerebral Glucose Metabolism in Adults with Hyperactivity of Childhood Onset," {The New England Journal of Medicine}, 30 (1990).

Wendy Richardson, MA., LMFT, the author of The Link Between ADD And Addiction: Getting The Help You Deserve, is a licensed marriage, family, child therapist and Certified Addiction Specialist in private practice. She is also a consultant, trainer, and speaks at national and international ADD, chemical dependency, and learning disability conferences.

The Link Between ADHD & Addiction

It is common for people with ADHD to turn to addictive substances such as alcohol, marijuana, heroin, prescription tranquilizers, pain medication, nicotine, caffeine, sugar, cocaine and street amphetamines in attempts to soothe their restless brains and bodies. Using substances to improve our abilities, help us feel better, or decrease and numb our feelings is called self-medicating.

Putting Out Fires With Gasoline

The problem is that self-medicating works at first. It provides the person with ADHD relief from their restless bodies and brains. For some, drugs such as nicotine, caffeine, cocaine, diet pills and "speed" enable them to focus, think clearly, and follow through with ideas and tasks. Others chose to soothe their ADHD symptoms with alcohol and marijuana. People who abuse substances, or have a history of substance abuse are not "bad" people. They are people who desperately attempt to self-medicate their feelings, and ADHD symptoms. Self-medicating can feel comforting. The problem is, that self-medicating brings on a host of addiction related problem which over time make people's lives much more difficult. What starts out as a "solution", can cause problems including addiction, impulsive crimes, domestic violence, increased high risk behaviors, lost jobs, relationships, families, and death. Too many people with untreated ADHD, learning, and perceptual disabilities are incarcerated, or dying from co-occurring addiction.

Self-medicating ADD with alcohol and other drugs is like putting out fires with gasoline. You have pain and problems that are burning out of control, and what you use to put out the fires is gasoline. Your life may explode as you attempt to douse the flames of ADD.

A 1996 article in American Scientists states that "In the United States alone there are 18 million alcoholics, 28 million children of alcoholics, 6 million cocaine addicts, 14.9 million who abuse other substances, 25 million addicted to nicotine."1

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Who Will Become Addicted?

Everyone is vulnerable to abusing any mind altering substance to diminish the gut wrenching feelings that accompany ADHD. There are a variety of reasons why one person becomes addicted and another does not. No single cause for addictions exists; rather, a combination of factors is usually involved. Genetic predisposition, neurochemistry, family history, trauma, life stress, and other physical and emotional problems contribute. Part of what determines who becomes addicted and who does not is the combination and timing of these factors. People may have genetic predispositions for alcoholism, but if they choose not to drink they will not become alcoholic. The same is true for drug addictions. If an individual never smokes pot, snorts cocaine, shoots or smokes heroin, he or she will never become a pot, coke, or heroin addict.

The bottom line is that people with ADHD as a whole are more likely to medicate themselves with substances than those who do not have ADHD. Dr.s Hallowell and Ratey estimate that 8 to 15 million Americans suffer from ADD, other researchers estimated that as many as 30-50% of them use drugs and alcohol to self-medicate their ADHD symptoms.2 This does not include those who use food, and compulsive behaviors to self-medicate their ADD brains and the many painful feelings associated with ADHD. When we see ADD it is important to look for substance abuse and addictions. And when we see substance abuse and addictions, it is equally important to look for ADHD.

Prevention and Early Intervention

"Just Say No!" may sound simple, but if it was that simple we would not have millions of children, adolescents, and adults using drugs every day. For some their biological and emotional attraction to drugs is so powerful, that they cannot conceptualize the risks of self-medication. This is especially true for the person with ADHD who may have an affinity for risky, stimulating experiences. This also applies to the person with ADHD who is physically and emotionally suffering from untreated ADHD restlessness, impulsiveness, low energy, shame, attention and organization problems, and a wide range of social pain.3 It is very difficult to say no to drugs when you have difficulties controlling your impulses, concentrating, and are tormented by a restless brain or body.

The sooner we treat children, adolescents, and adults with ADHD the more likely we are to help them to minimize or eliminate self-medicating. Many well meaning parents, therapists and medical doctors are fearful that treating ADHD with medication will lead to addiction. Not all people with ADHD need to take medication. For those who do, however, prescribed medication that is closely monitored can actually prevent and minimize the need to self-medicate. When medication helps people to concentrate, control their impulses, and regulate their energy level, they are less likely to self-medicate.

Untreated ADHD and Addiction Relapse

Untreated ADHD contributes to addictive relapse, and at best can be a huge factor in recovering people feeling miserable, depressed, unfulfilled, and suicidal. Many individuals in recovery have spent countless hours in therapy working through childhood issues, getting to know their inner child, and analyzing why they abuse substances and engage in addictive behaviors. Much of this soul searching, insight, and release of feelings is absolutely necessary to maintain recovery. But what if after years of group and individual therapy, and continued involvement in addiction programs your client still impulsively quit jobs and relationships, can't follow through with their goals, and has a fast chaotic, or slow energy level. What if, along with addiction your client also has ADHD?

Treating Both ADHD and Addictions

It is not enough to treat addictions and not treat ADHD, nor is it enough to treat ADHD and not treat co-occurring addiction. Both need to be diagnosed, and treated for the individual to have a chance at ongoing recovery. Now is the time to share information so that addiction specialists, and those treating ADHD can work together. It is critical that chemical dependency practitioners understand that ADHD is based in one's biology and responds well to a comprehensive treatment program that sometimes includes medications. It is also important for practitioners to support the recovering persons involvement in Twelve Step programs and help them to work with their fear about taking medication.

A COMPREHENSIVE TREATMENT PROGRAM CONSISTS OF:

A professional evaluation for ADHD and co-occurring addiction.
Continued involvement in addiction recovery groups or Twelve Step programs.
Education on how ADHD impacts each individual's life, and the lives of those who love them.
Building social, organization, communication, and work or school skills.
ADHD coaching and support groups.
Closely monitored medication when medication is indicated.
Supporting individuals decisions to take medication or not ( in time they may realize on their own that medication is an essential part of their recovery).
Stages of Recovery
It is important to treat people with ADHD and addiction according to their stage of recovery. Recovery is a process that can be divided into four stages, pre-recovery, early recovery, middle recovery, and long term recovery.

PRE-RECOVERY: Is the period before a person enters treatment for their addictions. It can be difficult to sort out ADHD symptoms from addictive behavior and intoxication. The focus at this point is to get the person into treatment for their chemical and/or behavioral addiction. This is NOT the time to treat ADHD with psycho stimulant medication.

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EARLY RECOVERY: During this period it is also difficult, but not impossible to sort out ADHD from the symptoms of abstinence which include, distractibility, restlessness, mood swings, confusions, and impulsivity. Much of what looks like ADHD can disappear with time in recovery. The key is in the life long history of ADHD symptoms dating back to childhood. In most cases early recovery is NOT the time to use psycho stimulant medication, unless the individual's ADHD is impacting his or her ability to attain sobriety.

MIDDLE RECOVERY: By now addicts, and alcoholics, are settling into recovery. This is usually the time when they seek therapy for problems that did not disappear with recovery. It is much easier to diagnose ADHD at this stage; and medication can be very effective when indicated.

LONG TERM RECOVERY: This is an excellent time to treat ADHD with medications when warranted. By now most people in recovery have lives that have expanded beyond intense focus on staying clean and sober. Their recovery is an important part of their life, and they also have the flexibility to deal with other problems such as ADHD.

Medication and Addiction

Psychostimulant medication when properly prescribed and monitored is effective for approximately 75-80% of people with ADHD. These medications include Ritalin, Dexedrine, Adderall, and Desoxyn. It is important to note that when these medications are used to treat ADHD the dosage is much less that what addicts use to get high. When people are properly medicated they should not feel high or "speedy, instead they will report increases in their abilities to concentrate, control their impulses, and moderate their activity level. The route of delivery is also quite different. Medication to treat ADHD is taken orally, where street amphetamines are frequently injected and smoked.

Non stimulant medications such as Wellbutrin, Prozac, Nortriptyline, Effexor and Zoloft can also be effective in relieving ADHD symptoms for some people. These medications are frequently used in combination with a small dose of a psychostimulant. Recovering alcoholics and addicts are not flocking to doctors to get psychostimulant medication to treat their ADHD. The problem is that many are hesitant for good reasons to use medication, especially psycho stimulants. It has been my experience that once a recovering person becomes willing to try medication the chance of abuse is very rare. Again the key is a comprehensive treatment program that involves close monitoring of medication, behavioral interventions, ADHD coaching and support groups, and continued participation in addiction recovery programs.

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There is Hope

For the last few years I have witnessed the transformation of lives that were once ravaged by untreated ADHD and addiction. I have worked with people who had relapsed in and out of treatment programs for ten to twenty years attain ongoing and fulfilling sobriety once their ADHD was treated. I have Witnessed people with ADHD achieve recovery once their addictions were treated.

"Each day I understand more about how pervasive ADHD is in my life. My clients, friends, family and colleagues are my teachers. I wouldn't wish ADHD and addictions on anyone, but if these are the genetic cards that you have been dealt, your life can still be fascinating and fulfilling."