SPECT Studies Across Generations
ADD is a generational disorder, meaning having ADD in a family significantly influences the development of each member. The level of influence is often determined by which parent has ADD, whether it is the father or mother. ADD mothers often have a more negative impact on children than ADD fathers, as they are still often the primary caretakers for children. In addition, ADD influences parenting, job choices, creativity, moves, and legal issues. Here are three examples of ADD across generations.
Paul, age twenty, came to see me because he was having trouble finishing his senior year at UC Berkeley. He was having trouble completing term papers, he could not focus in class, and he had little motivation. He began to believe that he should drop out of school and go to work for his father. He hated the idea of quitting school so close to graduation, so he came to see me on a referral from a friend who had a younger brother whom I had helped. Paul told me that he had bouts of depression that had been treated with Prozac with little benefit. Paul’s brain SPECT study was consistent with both depression and ADD. He had a wonderful response to a combination of an antidepressant and stimulant medication. He finished college and got the kind of job he wanted. Today, I would have started him on SAMe for Limbic ADD, along with exercise, fish oil, and a higher protein diet, and then evaluated how he did before prescribing the medication.
When Paul’s mother, Pam, saw what treatment had done for her son, she came to see me for herself. As a child, she had trouble learning. Even though she was very artistic, she had little motivation for school and her teachers labeled her as an underachiever. As an adult, Pam went back to school and earned her degree in elementary school teaching. In order to student teach, however, she had to pass the National Teacher’s Exam. She had failed the test four times. Pam was ready to give up and try a new avenue of study, but Paul’s improvement gave her hope that there might be help for her. In fact, she had a brain study very similar to Paul’s study and she responded to the same combination of medication. Four months later she passed the National Teacher’s Exam.
With two successes in the family, the mother then sent her nineteen-year-old daughter, Karen, to see me. Like her brother, Karen was a bright child who had underachieved in school. At the time she came to see me, she lived in Los Angeles and she was enrolled in a broadcast journalism course. She complained that learning the material was hard for her. She was also moody, restless, easily distracted, impulsive, and quick to anger. Several years earlier she was treated for alcohol and amphetamine abuse. She said that the alcohol settled her restlessness and the amphetamines helped her to concentrate. Karen’s brain SPECT study was very similar to her brother’s and mother’s. Once on medication, she could concentrate in class, and she finished her work in half the time she had before. Karen’s level of confidence increased to the point where she could go and look for work as a broadcaster, something she had been unable to do previously.
The most reluctant member of the family to see me was the father, Tim. Even though Pam, Paul, and Karen told him that he should see me, he balked at the idea. He said, “There’s nothing wrong with me; look at how successful I am.” But his family knew different. Even though Tim owned a successful grocery store, he was reclusive and distant. He got tired early in the day, he was easily distracted, and he was scattered in his approach to work. He was successful at work, in part, because he had very good people who took his ideas and made them happen. Tim enjoyed high stimulation activities, and he loved riding motorcycles, even at the age of fifty-five. Looking back, Tim had done poorly in high school, and he barely passed college, even though he had a very high IQ. He tended to drift from job to job until he was able to buy the grocery store. Tim’s wife finally convinced him to see me. She was getting ready to divorce him, because he would never talk with her in the evening. She felt that he didn’t care about her. He later told me that by evening he was physically and emotionally drained.
During my first session with Tim he told me that he couldn’t possibly have ADD because he was a success in business. But the more questions I asked him about his past, the more lights went on in his head. At the end of the interview I said, “If you really do have ADD, given what you have already accomplished, I wonder how successful you could be if we treat it.” Tim’s brain study showed the pattern for classic ADD. When he tried to concentrate, the frontal lobes of his brain shut down, rather than turned on. When I told him this, it really sunk in. “Maybe that is why it is hard for me to learn new games. When I’m in a social situation and I’m pressed to learn or respond, I just freeze up. So I avoid these situations.”
Tim had a remarkable response to Ritalin. He was more awake during the day, he accomplished more in less time, and his relationship with his wife dramatically improved. In fact, they both said they couldn’t believe that their relationship could be so good, after all the years of distance and hurt.
Nine-year-old Phillip was frightened when the police came to his school to talk to him. His teacher had noticed bruises on his legs and arms and she called Child Protective Services. He wasn’t sure if he should tell them that his father, Dennis, had beaten him up, or if he should say that he fell down a flight of stairs or something like that. Phillip did not want to get his dad into trouble and he felt responsible for the beating he received. After all, he thought, his father had told him ten times to clean his room and for some reason, unknown to Phillip, he hadn’t done it. Phillip and his father often fought, but it had never been apparent to people outside the home. Phillip decided to tell the truth, hoping that it would somehow help.
Indeed, Phillip’s family did get help. The court ordered the father to undergo a psychiatric evaluation and counseling for the family. The father was found to have a short fuse. He was impulsive and explosive in many different situations. He began to have problems with aggressiveness after he sustained a head injury in a car accident six years ago. His wife reported that when Phillip was first born, the father was loving, patient, and attentive, but after the accident, he was irritable, distant, and angry.
In family counseling sessions I noticed that Phillip was a very difficult child. He was restless, active, impulsive, and defiant. When his parents told him to stop doing annoying behaviors, he just ignored them and continued irritating those around him. I soon discovered it was the interaction between Phillip and his father that was the problem and counseling alone would not be helpful. I believed there was some underlying biological or physical “brain problem” that contributed to the abusive interactions. In an effort to further understand the biology of this family’s problems, I ordered brain SPECT studies on both Phillip and Dennis.
The brain SPECT studies for both Phillip and his father were abnormal. The father’s study clearly showed an area of decreased activity in his left temporal lobe (near the temples), probably a result from the car accident. Several researchers have demonstrated left temporal lobe problems to be associated with people who have a short fuse and a tendency toward violence. Phillip’s SPECT study revealed decreased activity in the front part of his brain when he tried to concentrate. This finding is often found in ADD kids who are impulsive, hyperactive, and conflict driven.
After taking a history, watching the family interact, and reviewing the SPECT studies, it was clear to me that Phillip’s and his father’s problems were, in large part, biological. I placed both of them on medication. The father was put on an antiseizure medication to calm his left temporal lobe, and Phillip was placed on a stimulant medication to increase activity in the front part of his brain.
Once the underlying biological problems were treated, the family was then able to benefit from psychotherapy and begin to heal the wounds of abuse. In counseling sessions Phillip was calmer and more attentive and the father was more able to constructively learn how to deal with Phillip’s difficult behavior.
Whenever child abuse occurs, it is a severe tragedy. It may become an even worse tragedy, however, if people ignore the underlying brain problems that may be contributing to the problems, and separate families before getting the proper help. In this case and in many others, it is often the interaction between a difficult child and an aggressive, impulsive parent that leads to the problem. These negative interactions may have a biological basis to them. To be effective in helping these families, it is very important to understand the underlying biological or “brain” contribution to the problem.
Jack and Monica had been married eleven years and had two children, ages six and nine. Both parents were physicians: Jack was an emergency room doctor and Monica was an internist. They came to see me from three hundred miles away because of chronic marital problems. There was recent talk of divorce, but they wanted to salvage the marriage for the sake of their children. Jack had been diagnosed with ADD (not uncommon among emergency physicians) by a local psychiatrist several years before they came to my clinic. Jack was disorganized, impulsive, inattentive, distractible, and forgetful. He did not follow through on his promises. He was also bad in business and frequently did not do the paperwork necessary to get reimbursed for his services. Unfortunately, Jack did not have a positive response to Ritalin or Dexedrine. The medications made him moody and irritable.
Monica was angry. She blamed every problem in their marriage on Jack’s ADD. There was chronic conflict and tension, exacerbated by the behavior of their youngest child, Matthew. He was hyperactive, impulsive, aggressive, and defiant. It seemed that, with their busy schedules and constant stress, the couple could never connect in a positive way.
During my first session with the couple I sensed that Monica had a cingulate problem. She talked about the same point over and over, held grudges from long ago, worried, and tended to automatically argue with everything that came out of Jack’s mouth. When I asked about Monica’s family, she told me about her father who “won first prize for overactive cingulate symptoms.” He was a physician with whom she shared an office. She described him as angry, rigid, and compulsive. If things didn’t go his way he would throw things, and he talked how managed care was ruining medicine at least five times every day. With such a history, I thought it might be a good idea to scan both Jack and Monica—even Monica’s dad, if he’d let me. Jack and Monica readily agreed. Monica said if she was part of the problem, she wanted to know about it.
Jack’s scan showed decreased activity in the prefrontal cortex and temporal lobes. The temporal lobe problems were probably making the stimulants ineffective. I placed Jack on Aricept, a memory enhancing medication used for Alzheimer’s disease that I have also found helpful for ADD adults who complain of memory problems. In addition, Jack exercised intensely, changed his diet, and also took L-tyrosine for focus.
Monica’s scan showed marked hyperactivity in the anterior cingulate gyrus. No doubt she was faced with a tough marriage, but her overactive cingulate was not helping her have the needed flexibility to roll with the regular ups and downs of living in an ADD family. I started her on St. John’s Wort and exercise.
In addition, I saw their son Matthew. He had Type 3 Overfocused ADD and oppositional defiant disorder. He had decreased prefrontal cortex activity and too much activity in the anterior cingulate gyrus (a combination of mom and dad). I started him on St. John’s Wort and Adderall and worked with his parents on developing the parenting skills needed to help him. The parent training really was effective. Up to that point, they just used their parenting style differences as another way to disagree.
Over about six months the family began to heal. There were fewer fights, more loving interactions, and a deeper understanding of the underlying problems. Jack became more focused and his memory was better. Monica became more flexible and able to let go of hurts. Matthew settled down and was becoming happier and more cooperative. After two years I finally got to meet Monica’s father. He came to a lecture I gave near his home. After the lecture he came up to me and thanked me for helping his children. He asked if I was doing any family studies. When I said yes, he volunteered for a scan. This delighted Monica very much. She continued to complain about her father’s negative behavior. To no one’s surprise, not even the father’s after he heard my lecture, he had a very overactive anterior cingulate gyrus. He agreed to take St. John’s Wort and exercise regularly. Within several weeks Monica e-mailed me, thanking me on behalf of three generations, for making life less stressful. She said her father was more relaxed, more flexible, and not talking anymore about managed care.
ADD in all its types can affect multiple generations. Understanding family history in light of the ADD types can bring healing and hope for generations of families to come.