ADHD: Above Average is Normal

The average spoken number of words per minute is 160.  While interviewing New York-based psychiatrist, therapist and author Dr. Don Kerson, I kept fighting an urge to pull out a stop watch and start counting.   He speaks like a cross between a MIT-trained theoretical physicist and a sports announcer on cocaine:  smart and impossibly fast.  (I considered writing up the interview without any punctuation to convey the speed of his speech.) 

I first came across his article published in ADD Resources September newsletter about two of my most beloved mental health topics: mindfulness practice and executive function enhancement

This led to my discovery of Dr. Kerson’s unique focus:  mindfulness training for adults with hyperactivity which is surprising.  Kind of like creating chocolate dipped deep-fried pizzas for anorexics… as helpful as it is unlikely. 

Me: How did you come to combine mindfulness training with psychiatry? 

Dr Kerson:  I became interested in neural plasticity and right brain ability through Daniel Siegel’s book The Mindful Brain.

Dr Lidia Zylowska, of the Mindful Awareness Research Center at UCLA, where Dr. Siegel also works  (www.marc.ucla.edu) adapted Dr Jon Kavat Zinn’s  (mindfulness Based Stress Reduction ) work for people with ADD shortening the required meditation time to 15 minutes.

We added to the meditation and psycho-education of Dr.Z’s paper attention to the effects of trauma on the developing person with ADD, and the use of neo-Ericksonian post-traumatic ego state therapies to address the procrastination and disorganization caused by that post-traumatic dissociation.

Me:  And so you decided to combine meditation with ADHD because….? 

Dr. K:  ADD is about difficulty turning on the prefrontal cortex.  If there’s more electricity (interest) in the brain then there is more available for the prefrontal cortex.  But if the left and right brain are less integrated, then there is less electricity in the prefrontal cortex. 

Meditation creates integration between executive functioning with the more experiential aspects of the self.    

In addition to meditation, I teach time management techniques such as time mapping, which is using our very well developed spatial abilities to track our activities.  ADD’ers have difficulty transitioning between activities.  Every event or activity can be sorted by frequency of occurrence such as one time, once per week, several times per week, once per month, several times per month, once per year, etc…  It’s like a musical score with its own rhythm.  By creating a map of the week you know what rhythm to anticipate.  The more you have the basics over-learned the more room you have to be spontaneous and creative. 

It’s the job of the left brain to create an atmosphere in which the right brain can emerge.

Me: How does this topic personally interest you? 

Dr. K:  I’m obviously a hyperactive guy.   I came from a high functioning family.  My mother was a psychiatric social worker and I had the best possible upbringing.

Me: For a family with an ADD kid, what is the best possible upbringing?    

Dr. K:  First of all, only one third of people with ADD get diagnosed in childhood.  Often we’re not recognized because the definitions emphasize the dysfunction

Smart people with ADD naturally used other brain systems; (adrenaline; fear and dopamine; will and pleasure) to compensate for their attentional difficulties.  When these systems wear down from overuse adults with ADD get depressed/ill  in a couple of different ways.  At that time that the undiagnosed adult with ADD needs to be identified. Two thirds of adults with ADD are undiagnosed in my estimation, and I think they make up the overwhelming majority of what is usually called “treatment resistant” depression.

The world is over-stimulating.  We were born to live in tribes and instead we live in boxes and look at glowing boxes in the dark.  Focus is comfortable and lack of focus is uncomfortable.   

Parents must notice the patterns of attention that their children have.  What does the child like to do which creates focus for them?  It’s all about letting the kid occupy himself in his own rhythm. 

The three things that ameliorate ADD are:   

  • The emotional tone of the home
  • The material and non material resources of the home
  • Intelligence

 Unleashed, ADD folks can do everything.  We are smarter and have more energy than the average person.  People with ADHD are 15% of the population but we do 80% of the (interesting) tasks.  We have more energy so we need to do more

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Dr. Kerson recently wrote and published Getting Unstuck, Unraveling the Knot of Depression, Attention and Trauma available through his website http://www.theattentiondoctor.com.   I have already ordered my copy.

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