When I was in high school I had a study buddy by the name of Zuriel Weiner. “Zook” as only his close friends called him, and I was one of few, noted that I tended to immerse myself only in topics that interested me. I didn’t think that was so unusual until one afternoon while we were supposed to be engaged in a text assigned by our teacher he turned to me and said matter-of-factly: “Press, you have the attention span of a fly.” Flies often seem distracted, and at times hyperactive with restless leg syndrome, but that incessant rubbing of legs back and forth is part of their ongoing cleaning to keep their compound eyes pristine enabling them to see in 360 degree surround sight.
I was not diagnosed as having ADD in school as there was no such formal diagnosis, but it would not surprise me, if I were going to school today, to have been assigned this label. As David Anderson from Caltech observes in the TEDx video above, it is frightening to consider what we identify as mental illness today, and even more so how society treats conditions such as AD/HD. My colleague Dr. Hong and I have addressedvisual factors in childhood behavioral disorders, and Dr. Anderson makes a significant point about the overly simplistic notion that complex and multifactorial disorders such as AD/HD can somehow be treated effectively by the types of drugs we use now. We treat the brain as if it were a bag of chemical soup, awash in dopamine, serotonin and norepinephrine, and the drugs used to globally alter brain function presume some sort of chemical imbalance, a simplified and outmoded view. Psychoactive drugs are so global that alot of people stop taking them because of unpleasant side effects. Parents are reticent to place or maintain their children on AD/HD medications, concerned about the unknown long-term effects of amphetamines on a child’s developing brain. Dr. Anderson’s analogy is elegant here: using these drugs to treat complex disorders of motion, mood, affect or cognition is a bit like trying to change your car’s oil by opening a container and pouring it all over the engine block. Some of it will dribble in to the right places, but alot of it will do more harm than good. We need to pinpoint the intended locations in the brain where these chemicals act, otherwise we’re going to keep pouring oil all over our mental engines and suffering the consequences.
We each have seen children in our practices who touch everything in sight and are so distracted that it makes it difficult to engage them in conversation necessary to conduct the so-called subjective examination. We always try to tease out those children who appear to be globally ADD vs. those who have more of a visual ADD. Answering a question from a parent as to your take on the advisability of their child being medicated poses a similar conundrum to answering a question from a parent seeking your opinion on whether or not their child should repeat a grade. Our opinion is being sought much as a parent would seek an opinion from their pediatrician as a trusted professional. A pediatrician is no more an expert on AD/HD or education than you are, and empowered parents seek input from a variety of trusted sources before making a determination as to what’s best for their child.
Leonard J. Press, O.D., FAAO, FCOVD