Message from Dr. Gross, the Editor

Hello from the editor, Monroe A. Gross, M.D., and welcome to the website of the ADD Medical Treatment Center of Santa Clara Valley.

I hope you find the information in this site of value to you, your family and your friends, and that it helps you better understand the genetics, how the diagnosis should be made, what to expect from effective treatment, and more, of the disorder now commonly referred to as ADD/ADHD.

Monroe A. Gross, M.D. is founder:

ADD Medical Treatment Center of Santa Clara Valley
2505 Samaritan Drive, Suite 402
San Jose, California 95124
U.S.A.
Tel: (408) 356-8636
Fax: (408) 356-5907
E-mail: mgrossmd@addmtc.com

Before we proceed to what is correct, let's start by doing away with at least the following ERRONEOUS ADD/ADHD notions and misunderstandings from the last century:

• INCORRECT BELIEF: Those with ADD/ADHD brain chemistry always have a "mental
  disorder" . . . This is NOT true. Many normally functioning,
  courageous, creative people have ADD/ADHD behavioral
  characteristics!
  
  

• INCORRECT BELIEF: The most effective treatment plan, when treatment is indicated,
  does not include medication . . . RARELY is this true!
  
  

• INCORRECT BELIEF: Children, as they mature, "outgrow" the ADD/ADHD brain chemistry
  that they were born with . . . . Wishful thinking. This is NOT
  more likely to happen than that your brown eyes will turn blue on
  your 21st birthday!
  
  

• INCORRECT BELIEF: ADD/ADHD medication treatment changes one's personality and often
  for the worse . . . NOT SO unless the individual is taking the
  wrong medication or the wrong dose of medication in which case
  lots of undesirable things can happen.
  
  

• INCORRECT BELIEF: The medical diagnosis of ADD/ADHD requires costly psychological
  testing, SPECT or PET brain scanning, and EEG-Biofeedback
  testing . . . NO! ADD/ADHD is a clinical diagnosis. Laboratory
  tests still cannot replace the judgment of a qualified physician.
  
  

• INCORRECT BELIEF: Those with ADD/ADHD all have low intelligence . . . . Sorry. NOT
  true! Just ask the lawyers, doctors and business people in my
  practice about this matter.
  
  

LET'S TURN NOW to an overview of what ADD/ADHD is rather than what it is not. As defined by the psychiatric "Bible," the DSM-IV, the diagnosis of ADD/ADHD in most instances requires, at a minimum, that the following BEHAVIORAL characteristics be part of the individual's medical history: hyperactivity, impulsivity and inattention. In my experience, however, there are up to SEVEN ADDITIONAL brain behaviors commonly present in the medical history of those with ADD/ADHD brain chemistry:

• Difficulty waking in the morning
  
  

• Trouble falling asleep at night
  
  

• Bedwetting after the age of four
  
  

• Troublesome dyslexia
  
  

• Negative thoughts and depression
  
  

• Chronic irritability and easy frustration
  
  

• Intermittent explosiveness, also called episodic outbursts or tantrums

While rarely talked about, it is important to realize that, in reality, there are two presentations of the ADD/ADHD picture.

At one end of the bell-shaped curve, there are those with ADD/ADHD brain chemistry who are NOT suffering from persistent and present distress (e.g., a painful symptom) or disability (i.e., impairment of one or more important areas of functioning), from a significantly increased risk of suffering death, pain, disabiity, or from an important loss of freedom [DSM-IV p. xxi]. These individuals should not be labeled as having a mental disorder and medication treatment rarely is indicated.

At the other end of the bell-shaped curve are individuals with ADD/ADHD brain chemistry who are suffering from distress or disability or increased risk of harm or important loss of freedom. Medically speaking, these individuals should be diagnosed as having ADD/ADHD, the mental disorder, and they are likely to benefit significantly from treatment.

Although scientifically simplistic, it is helpful conceptually and from a treatment point of view to remember that there are two sources of persistent distress affecting those with ADD/ADHD, the mental disorder.

One is their ADD/ADHD genetic make up that leads to handicapping behaviors including hyperactivity (especially being fidgety and squirming), inattention (for boring activities), and impulsivity (which is best described as hyperactivity of the mind or the poorly controlled, terribly disorganizing, racing of thoughts).

The other source of distress is the environment, especially the educational, social, cultural, and work environments in which they live. Persistent distress is an expected consequence for people with troublesome ADD/ADHD behaviors who are trying to survive and function in an unaccepting, critical, intolerant environment.

Science continues to describe more and more situations in which genetic make up in conjunction with environmental influences effect our complex behaviors such as performance at school or work. This modern understanding of behavior says that ADD/ADHD is not best described as nature vs. nurture but rather as the consequence of both nature and nurture on human thinking, feeling and motor behavior. Hopefully, future research will clarify more precisely the nature of this interaction between ADD/ADHD genetic make up and the environment as well as explain why those with ADD/ADHD, the mental disorder, so often grow up and adopt behaviors such as alcoholism, bulimia, chronic fatigue syndrome, compulsive gambling, Tourette's syndrome, drug dependence and depression.

By choice of the editor, Dr. Gross, this website focuses mainly on understanding and helping those with ADD/ADHD, the mental disorder, for whom medical treatment is often extremely helpful. ADD/ADHD information concerning diagnosis and treatment of children, teenagers and adults is dealt with in depth in my book, The ADD Brain.

Finally, please send me comments via "Send a Message" in the column to the left of this screen, complimentary or not, concerning the content of this website. You also may send questions which I will try to answer.