Innate Intelligence and Chiropractic in the Care of Obsessive/Compulsive and Addictive Behaviors

J G Moellendorf, D.C., N.D., L.C.P. (Hon.) © 2003 JGM

 

INTRODUCTION

 

            The philosophy of Chiropractic centers on how Innate Intelligence works through the nervous system for the benefit of the body’s growth and survival.  Persons with the A1 allele of the DRD2 dopamine receptor gene are at great risk of developing obsessive/compulsive and addictive behaviors.  This raises the following questions.  Are these behaviors a form of dis-ease?  Are these behaviors caused by the interference to the flow of mental impulses from Innate Intelligence as it attempts to compensate for a defective gene and the resulting limitations of matter?  Or is Innate Intelligence working perfectly to adapt to the limitations of matter due to a genetic defect?  Or is it merely our perception that determines that these are behavioral problems?  Or is the A1 allele of the DRD2 gene a beneficial adaptation of Innate Intelligence?

            Let’s take a look at the Chiropractic Textbook by Ralph W. Stephenson, D.C., Ph.C. for the definition of what Innate Intelligence is, and what is its purpose.

 

DEFINITION AND PURPOSE OF INNATE INTELLIGENCE

 

            The following principles are quoted from Stephenson’s 33 Principles of Chiropractic.  His notable opus is based on the philosophy, teachings, and writings of Chiropractic’s founder, D. D. Palmer, D.C. and D. D.’s son and developer of Chiropractic, B. J. Palmer, D.C., Ph.C.

Principle Number 20.  Innate Intelligence.  A “living thing” has an inborn intelligence within its body, called Innate Intelligence.

As Stephenson says, “It is the local intelligence which has built a house for itself and keeps that house in repair, and is the intelligence to which the condition of the structure is of supreme importance….The cells and the bodies are built according to a plan.  It takes an infinitely wise Architect to make those plans.”  [Stephenson 1927, 257]  All of the structures and functions of the body are under the guardianship and care of Innate Intelligence for the body’s self-preservation in the best way possible.

Principle Number 21.  The Mission of Innate Intelligence.  The mission of Innate Intelligence is to maintain the material of the body of a “living thing” in active organization.

“It is the ambition of Innate Intelligence to build the body and then keep it actively organic….(The) universe could not be complete with only unadapted forces and universal laws of the destructive kind.  In order to complete the cycle, there must be construction.”  [Stephenson 1927, 258]  Left to itself, everything in the universe regresses from a state of higher organization and order to a state of lower organization and finally chaos.  This is known as the Law of Entropy.  Higher organization in the universe can only be accomplished by an application of intelligence.  Innate Intelligence employs the forces of the universe to construct, maintain, and preserve the body in a highly organized, organic state as best as it is capable with what it has available to work with.

Principle Number 23.  The Function of Innate Intelligence.  The function of Innate Intelligence is to adapt universal forces and matter for use in the body, so that all parts of the body will have co-ordinated action for mutual benefit.

“Innate Intelligence, the law of organization, continually co-ordinates the forces and materials within the organism to keep it actively organized.  That is to say, creating….Innate takes elements of no adaptive character, puts them together, ‘investing with new character,’ and now a new structure is brought into being, and is so maintained.

“Nothing less than intelligence could do this.  It is all accomplished, not by creating new forces and matter ‘out of nothing,’ but ‘investing’ what is already existing with new character.  Thus the natural energies within the body are assembled and made to do the work of organization.”  [Stephenson 1927, 262]

Innate Intelligence performs whatever is necessary to construct, maintain, and preserve the body in as highly organized and active a state as possible by organizing, adapting, and coordinating the materials and forces at its disposal, without our consciously attending to these vital matters.

Principle Number 24.   The Limits of Adaptation.  Innate Intelligence adapts forces and matter for the body as long as it can do so without breaking a universal law, or Innate Intelligence is limited by the limitations of matter.

            “Adaptation of matter can only be to the point where molecules and atoms must obey physical and chemical laws.  Innate can manage these laws up to a certain point by manipulation, but cannot change or destroy them.  She can only use them to the limits of matter….Should Innate fail in these adaptations for any cause, these forces will injure or destroy her tissues.”  [Stephenson 1927, 263]

            Innate Intelligence can only work within universal law.  It uses universal forces and universal matter as best as it is able for the benefit of the body, without breaking universal law.  When a needed material is not available, Innate Intelligence will attempt to locate it, or adapt in another way to preserve the body.  Universal forces will injure or destroy the body’s cells when Innate Intelligence is not able to make a full adaptation.  This becomes a matter of survival for the body.  Because of the limitations of matter, materials or forces may be used to accomplish short-term survival, even though this may be lethal for long-term survival.  The benefits of long-term survival are non-existent if there is a failure of short-term survival.  This will be considered later in the consideration of obsessive/compulsive and addictive behaviors.

Principle Number 25.  The Character of Innate Forces.  The forces of Innate Intelligence never injure or destroy the structures in which they work.

“The forces of Innate are constructive—not destructive.  While there is wear on the part that functions at the bidding of Innate, these parts are just as rapidly repaired….It builds all these, provides all their needs, circumvents adversity, repairs them when damaged, and maintains them until death.  Then, this power leaves them and they rapidly return to their elemental state—molecules and atoms.”  [Stephenson 1927, 263-265]

The forces used by Innate Intelligence are always used for constructive, never destructive purposes in constructing, maintaining, and preserving the body as best as possible.  The destructive forces of universal law may cause wear and tear to parts of the body.  Innate Intelligence repairs these damaged parts as quickly as possible.  When Innate Intelligence no longer sustains these parts, they rapidly disintegrate into their basic parts.

Principle Number 27.  The Normality of Innate Intelligence.  Innate Intelligence is always normal and its function is always normal.

            “Intelligence is always perfect—always one hundred per cent.  The forces which it assembles are always correct.  They are not correct when they reach Tissue Cell if there is interference with transmission, but that is not because of imperfection in Innate’s work, but because of the limitations of matter.”  [Stephenson 1927, 269]

            Because the workings of Innate Intelligence are always perfect, the forces that is assembles are always perfect.  However, because of the limitations of matter, the materials used by Innate Intelligence are not always perfect for its needs.  It must then adapt to this limitation.  The limitations of matter can also interfere with Innate Intelligence’s transmission or reception of messages to or from the tissue cells.

Principle No. 28.  The Conductors of Innate Forces.  The forces of Innate Intelligence operate through or over the nervous system in animal bodies.

            “The brain is the headquarters of Innate’s control—the seat of the mind….Every tissue cell in the periphery has its nerve supply.  That means that every tissue cell has nerves which carry to it mental impulses.”  [Stephenson 1927, 270-272]

            The center from which Innate Intelligence works is the brain.  The nervous system is used to carry its messages.  Its knowledge and awareness of the internal and external environments is collected through the nervous system.  Until recently, it was thought that the spinal cord was merely a transmitter of messages between the brain and the end organs.  Recent research proves that the dorsal roots of the spinal nerves and the dorsal horn of the spinal cord are part of the limbic system and function as an extension of the brain, particularly in the realm of emotions.  [Pert and Dienstrey 1988;  Lewis et al. 1981]

Principle No. 29.  Interference with Transmission of Innate Forces.  There can be interference with the transmission of Innate forces.

            There will be adverse effects whenever there is any interference with the communication between Innate Intelligence and the tissue cells.  There will be a lack of coordination between the cells of the body.  The cell will continue to function for its own survival, but this is not necessarily advantageous for the body as a whole. 

Stephenson expounds three theories to explain the interference with the communication of Innate’s forces.  1)  “If a nerve is made abnormal in any part (as by impingement) there cannot be normal function of that nerve cell, which is a living organism.  The mental impulse is robbed of some of its values and hence forth is (partially or wholly) not a perfectly assembled unit of energies as Innate sent it, but a somewhat dis-sembled unit.”  [Stephenson 1927, 295]  2)  “Interference with transmission of the message, that is interference with the vehicle of the message.  If the conductor of the current which is conveying the message goes wrong, the message becomes garbled, so that Tissue Cell does not understand it fully….The message is full of ‘static’ and unintelligible.”  [Stephenson 1927, 299]  3)  “A nerve cell which is impinged is not a cell ‘at ease.’  Therefore, it will not ‘vibrate’ normally in function….Therefore the tissue receives a message which does not ‘read true.’”  [Stephenson 1927, 299-300]

It is now over 75 years since Stephenson wrote the above.  Many questions remain as to just what this interference is and what causes it.  Adverse effects throughout the body are the consequence of this interference.  Chiropractic has had phenomenal success reducing this interference, empowering the body in healing itself.

Principle Number 30.  The Causes of Dis-ease.  Interference with the transmission of Innate forces causes incoordination or dis-ease.

 

            “Interference with transmission prevents Innate from adaptating (sic) things universal for use in the body and from coordinating the actions of the tissue cells for the mutual benefit of all cells.”  [Stephenson 1927, 301]

            When Innate Intelligence receives a distorted picture of reality because of interference with transmission in the nervous system, it is then neither able to recognize its circumstances, both internal and external, nor respond appropriately.  It then fails to properly adapt universal forces to coordinate the tissue cell’s activities to harmonize with each other for their mutual benefit and the body’s overall health.  This is referred to as GIGO in computer technology:  garbage in equals garbage out.  The consequence of distorted input is distorted output.

Principle Number 31.  Subluxations.  Interference with transmission in the body is always directly or indirectly due to subluxations in the spinal column.

B. J. Palmer defined the vertebral subluxation in Stephenson’s Chiropractic Textbook:  “Chiropractic definition:  a subluxation is the condition of a vertebra that has lost its proper juxtaposition with the one above, or the one below, or both; to an extent less than a luxation; and which impinges nerves and interferes with the transmission of mental impulses.  All the factors of the foregoing definition must be included in order that it be a Chiropractic definition….any abnormal position of a vertebra, such as posteriority, rotations, curvatures, and tilts, are subluxations if they impinge nerves and interfere with the transmission of mental impulses.”  [Stephenson 1927, 320]

The vertebral subluxation was defined in the July 1996 policy statement of the Association of Chiropractic Colleges as follows:  A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health.  [Association of Chiropractic Colleges 1996]

Since Chiropractic’s beginning in 1895, hundreds of different Chiropractic techniques and forms of analysis have evolved to care for the vertebral subluxation and its effects on health.  Most techniques fall into one of two categories:  those who view the subluxation as a structural problem, and those who view it as an interference in the meningeal system. 

Structural subluxation theory views the subluxation as an improper alignment in the spine, either in a single joint or globally, resulting in either an impingement of the nerve root, or a tractioning of the spinal cord and/or nerve roots.  Meningeal system subluxation theory views the subluxation as a tension on, or a torquing of, the meninges resulting in a tractioning of the spinal cord and/or nerve roots, and a blocking of the flow of cerebrospinal fluid which causes improper metabolism in the nerves.  The truth probably encompasses both views. 

In summation, Chiropractic holds that there is a Universal Intelligence that created and maintains everything in the Universe.  A specific portion of this Universal Intelligence is localized in a portion of matter (the body) to keep it actively organized.  This is called Innate Intelligence, whose function is to constructively adapt some of the forces and matter of the universe as needed, for the construction and maintenance of the body.  Innate Intelligence works through the brain, sending and receiving messages through the spinal cord, nerve trunks, and their branches, extending to and from the various tissues of the body.  The nerve trunks pass through the intervertebral foramina, where they are vulnerable to pressures or tension from spinal misalignments changing the size and shape of the intervertebral foramina.  Vertebral subluxations result because this interferes with the transmission of Innate Intelligence’s workings, either directly or indirectly.  The actions of Innate Intelligence are always perfect within the limitations of matter, specifically the interference with the transmission of these nerve impulses.  Innate Intelligence works to adapt the universal forces and matter for the body’s benefit.  Perfect adaptation results in health; imperfect adaptation results in dis-ease.  All dis-ease can thus be traced back to interference with the proper transmission of the nerve impulses.  The Chiropractor uses his science, art, and philosophy to locate, adjust, and correct this interference so that the Innate Intelligence can restore health to the body.  [Stephenson 1927, 1-2]

The vertebral subluxation also interferes with the function of the dopamine receptors in the nervous system, particularly in the dorsal roots of the spinal nerves and the dorsal horn of the spinal cord.  This will lead to further altered function and incoordination.  This is often seen when obsessive/compulsive or addictive behaviors are used by Educated Brain in response to Innate Intelligence’s messages to increase the release of dopamine in the limbic system (including the dorsal roots of the spinal nerves and the dorsal horn of the spinal cord) until the vertebral subluxation can be reduced or corrected.

 

THE BRAIN REWARD CASCADE

 

            The Deoxyribonucleic Acid (DNA) molecule is made up of pairs of four bases.  Guanine always pairs with Cytosine while Thymine always pairs with Adenine.  These construct the approximately 3 billion base pairs that make up each DNA molecule in the chromosome.  Each parent contributes half of each base pair in the gene.  According to the best current estimates from the human genome project, there are approximately 30,000 genes on the 23 pairs of chromosomes in the human cell.  The production of all of the proteins and enzymes necessary for life is controlled by the genes as mediated by the nervous system.  If there is a defective gene, either the structure or the function of the body will be disrupted.

The proper functioning of the dopaminergic and opioidergic reward pathways of the nervous system are critical in providing the pleasure drives for eating, love, and reproduction that are elemental in the survival of vertebrates.  The “natural reward” of pleasurable sensations involves the release of dopamine, the primary neurotransmitter in the brain reward pathway, in the nucleus accumbens, the frontal lobes of the brain, and the dorsal roots of the spinal nerves and the dorsal horn of the spinal cord.  These pleasurable sensations can also be mimicked with “unnatural rewards” such as alcohol, nicotine, amphetamines, marijuana, cocaine, and heroin; and by such stimulating behaviors as gambling, carbohydrate bingeing, compulsive sex, and high-risk activities that produce this same release of dopamine.  The proper functioning of the brain reward pathway and its proper sensations of pleasure are dependent on the genes that regulate the dopamine receptors and the synthesis, degradation, and transportation of dopamine.  [Blum et al. 2000, 21]

While studying the alerting process in rats’ brains, Olds discovered the vital importance of the brain reward pathway in producing pleasure.  Electrodes were placed in part of the limbic system, which the rats were allowed to excite by pressing on a lever.  The rats would stimulate this area as often as 5000 times per hour, ignoring everything except sleep, even enduring severe pain to receive this stimulation.  In humans, electrical stimulation of the medial hypothalamus would generate a feeling of quasi-orgasmic sexual arousal.  [Olds and Olds 1969]  Further research demonstrated that stimulation to other areas in the limbic system would produce a light-headedness that eradicated negative thoughts.  From this it was concluded that pleasure must be a distinct neurological function linked to a complex reward and reinforcement system.  [Hall et al. 1977]

Nicotine, opiates, cocaine, and ethanol enhance the release or block the re-uptake of dopamine, in one or more of the primary terminal sites of the nucleus accumbens.  The glucocorticoid receptors in the hypothalamus have been found to connect with the serotonergic system by opioid peptides which also cause the release of dopamine in the nucleus accumbens.  [Koob and Bloom 1988; Gessa et al. 1985]   Alcohol activates the norepinephrine receptors of the mesolimbic system by interacting with serotonin, opioid peptides, and dopamine.  It also forms neuroamine condensation products (TIQ’s) that interact with opioid receptors or directly with the dopaminergic systems.  [Airaksinen et al. 1984]

To explain the neuropharmacology involved in substance use disorders, Blum and associates have developed the neurotransmitter model which they named the Brain Reward Cascade.  [Blum and Kozlowski 1990; Blum, Briggs and Trachtenberg 1989]  Their research demonstrates that the neurotransmitters in normal people work together in patterns of stimulation or inhibition.  These patterns of stimulation and inhibition spread downward from complex stimuli to complex patterns of response resembling a cascade, with the ultimate reward of feelings of pleasure and well-being.  [Stein and Belluzzi 1986; Cloninger 1983]  Even though this neurotransmitter system is not totally understood because of its complexity, we do know that the primary reward centers are in the mesolimbic system and frontal lobes of the brain, the dorsal roots of the spinal nerves and the dorsal horn of the spinal cord.

 

FIGURE 1

 

The neurochemicals in the limbic system mediate all of one’s feelings and emotions.  These neurochemicals include numerous neuropeptides, the very basis of the emotions.  They are responsible for a person’s sense of well-being.  The neuropeptides suffuse the body.  From a biochemical viewpoint, if someone feels overcome by a particular feeling, they are overcome by the neuropeptide that mediates that feeling.  Even though science has traditionally separated the brain from the body, when we consider the neuropeptides, there is virtually no distinction between the two.

The neuropeptides form a virtual network, integrating the whole organism by carrying information throughout the brain and body.  All parts are equal in this system as a network has no hierarchy.  Pert and Dienstrey’s research has shown that the limbic system, which is the neurosubstrate of the emotions, is made up of not only the amygdala and hypothalamus, but also the dorsal roots of the spinal nerves and the dorsal horn of the spinal cord.  Using radioactive tracing, they found that the dorsal roots and the dorsal horn are almost as richly endowed with neuropeptide receptors as the amygdala and hypothalamus are.  [Pert and Dienstrey 1988]  A direct connection exists between the nocioceptive reflexes at every level of the spine and the limbic system.  Every spinal level has an intimate relationship with the proper functioning of the limbic system.  [Blum and Holder 1997]

Figure 2 demonstrates how the following interactions take place in the reward centers as researched by Blum and by Stein and Belluzzi [Blum 1989; Stein and Belluzzi 1986]:

 

·        Serotonin (1) in the hypothalamus (I) indirectly activates opiate receptors (2) and causes a release of enkephalins in the ventral tegmental region A10 (II).  The enkephalins inhibit the firing of GABA (3) which originates in the substantia nigra A9 region (III).

·        GABA’s normal role, acting through GABAB receptors (4), is to inhibit and control the amount of dopamine (5) released at the ventral tegmental regions (II) for action at the

nucleus accumbens (IV).  When the dopamine is released in the nucleus accumbens, it activates dopamine D2 receptors (6), a key reward site.  Activation of the dopamine D1 receptor results in stimulation, but leaves the brain in a jittery state.  However, activation of the dopamine D2 receptor results in a calming, pleasurable effect.  This release is also regulated by enkephalins (7) acting through GABA (8).  The supply of enkephalins is controlled by the amount of the neuropeptidases (9) which destroy them.

·        Dopamine may also be released into the amygdala (V).  From the amygdala, dopamine (10) reaches the hippocampus (VI) and in the CA1 cluster cells (VII), stimulates dopamine D2 receptors (11), another reward site.

·        An alternate pathway involves norepinephrine (12) in the locus ceruleus A6 (VIII), whose fibers project into the hippocampus at a reward area centering around cluster cells which have not all been precisely identified, but which have been designated as CAx (IX).  When GABAA receptors (13) in the hippocampus are stimulated, they cause the release of norepinephrine (14) at the CAx site.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FIGURE 2

 

 

The interactions of activities in the separate subsystems above merge together into the much larger global system.  These activities take place simultaneously and in a specific sequence, merging like a cascade.  The end result is a sense of peace, pleasure, and well-being when these systems work normally.  If there is a deficiency or imbalance, the system will work abnormally, causing the sense of well-being to be displaced by feelings of anxiety, anger, low self-esteem, or other “bad feelings”.  This can lead to the craving for a substance that masks or relieves those bad feelings such as carbohydrate bingeing, alcohol, or cocaine; or to other addictive behaviors such as compulsive gambling, compulsive sex, workaholism, or engaging in high risk activities.

According to the Cascade Reward Theory, genetic defects or variations, prolonged stress, or long-term alcohol or drug abuse can lead to a self-sustaining pattern of abnormal craving behavior.  [Blum et al. 2000, 10-11]

 

REWARD DEFICIENCY SYNDROME

 

Genetic variations can lead to the disruption of normal physiology, to the detriment of the body such as the mental retardation and other health problems seen in Down’s Syndrome.  Sometimes, these variations are not necessarily a disadvantage.  A so-called genetic “disease” may in reality be an evolutionary survival adaptation for a particular time, place or set of circumstances.  In sickle-cell anemia, the red blood cells are misshaped and are impeded from moving freely through the capillaries after they release oxygen to the cells.  This can lead to frequent and severe infections, an enlarged heart and abdomen, brain damage and impairment of the major organs.  However, in areas where malaria is rampant, there is a survival advantage, since carriers of the sickle-cell gene are less susceptible to the Plasmodium parasite that causes malaria.  Tay-Sachs disease seen in descendants of Eastern European Jews, makes the carrier less susceptible to tuberculosis.  While inheriting the gene from both parents is fatal within a few years, the inheritance of only one cystic fibrosis gene appears to protect its young bearers from diarrheal diseases such as cholera.  [Hartmann 1993, 13]

The DRD2 gene is responsible for the body’s production of dopamine receptors.  The A1 allele variation causes a reduction in expression of the DRD2 gene compared to the more common A2 allele.  Those people with the A1 allele have approximately 30 percent fewer D2 dopamine receptors than those with the more common A2 allele.  [Noble et al. 1991]  The lower number of dopamine D2 receptors causes a hypodopaminergic function.  [Gardner et al. 1997a; Gardner et al. 1997b; Gardner et al. 1998]  Recent research has shown that those with ADHD have more dopamine reuptake transporters than the normal population.  The dopamine molecules are reabsorbed by the presynaptic terminal before they have enough time to reach the postsynaptic terminal.  The decreased amount of dopamine does not allow the neuron to send its reinforcing signals.  [Dougherty et al. 1999]

These factors in turn cause these people to receive less of an emotional reward from activities that the majority of people find satisfying.  When measuring the quantity of dopamine D2 receptors with positron emission tomography, it was observed that people with normal D2 receptor levels had feelings of anxiety, restlessness, and dissatisfaction when using psychostimulants.  Those with low D2 receptor levels using psychostimulants, described feelings varying from pleasure to euphoria.  [Volkow et al. 1999a; Volkow et al. 1999b]  A high correlation has been found between pathological schizoid/avoidant cluster and the presence of the A1 allele of the DRD2 gene.  In the early stages, these individuals are languid, remote, lacking passion, depersonalized, conflicted, hypersensitive, phobic, and self-deserting.  With the passage of time, they attempt to alleviate their symptoms of dysphoria by carrying out outrageous acts of violence, followed by comorbid substance use disorders.  [Blum et al. 1997a; Blum et al. 1997b]

Those with the A1 allele often have difficulty coping with the stresses of life since dopamine helps reduce stress.  In an attempt at self-healing, they often search for temporary relief by seeking out those substances or behaviors that will stimulate the release of additional dopamine in the reward areas of the brain.  Many turn to alcoholism, substance dependence/abuse [Uhl et al. 1992], carbohydrate bingeing, nicotine abuse [Spitz et al. 1998; Comings et al. 1996a], pathological gambling, compulsive sex, compulsive work, conduct disorder, and other behavioral abnormalities.  [Blum et al. 1996a; Blum et al. 1996b; Nakajima 1989]  Research has shown that many of these disorders have the A1 allele of the DRD2 gene in common.  [Blum et al. 1990; Blum et al. 1995a; Blum et al. 1995b; Blum et al. 1996a; Blum et al. 1996b; Blum et al. 1996c]

To a certain extent, the substances and behaviors noted above are interchangeable in their results.  Often, a person with the A1 allele variation will jump from one substance or behavior to another, or even use them in combination with each other, in their attempt to “feel normal”.

The dopamine D2 gene could be called the “reward gene” because of its effect in controlling or modifying aberrant craving behavior and giving a sense of well-being when functioning normally.  Blum has given the name Reward Deficiency Syndrome to the group of disorders resulting from the abnormal functioning of the dopamine D2 gene.  To summarize Blum et al. in the November 2000 issue of the Journal of Psychoactive Drugs:  “We have not been able to determine if there are any advantages to this genetic vulnerability to addiction and/or obsessive/compulsive behavior.  But we do know that some people’s physiology is different, this physiology is genetically inherited, and some of these physiological changes can be induced by heavy exposure to alcohol and some other drugs by setting in motion perturbators of the neuro-chemistry and receptors.” [Blum et al. 2000, 2]

Figure 3 displays a whole spectrum of these interrelated disorders, from the level of the genes, to the areas affected by these genes, to the resulting disorders.

 

FIGURE 3

 

 

 

Disruption of the Brain Reward Cascade noted above (refer back to figure 2) results in the Reward Deficiency Syndrome.  The mild variety may be seen in the chain smoker while the severe variety is seen in the chemical addict.  These vast extremes in behavior are linked by their genetically-based biochemical inability to be rewarded by their daily activities. 

The addictions to alcohol, nicotine, or cocaine; the obesity due to carbohydrate bingeing; ADD and ADHD, Tourette’s syndrome, and Post-Traumatic Stress Disorder are all centrally mediated Reward Deficiency Syndrome disorders.  There is a heightened predisposition for these disorders because of the decreased quantity of dopamine receptors and increased reuptake transporters, and consequently an inability to cope with stress.  This results in the craving for those substances or activities that cause the increased release of dopamine in the reward centers to temporarily relieve the stress and craving.  The consumption of carbohydrates, alcohol, nicotine, marijuana, cocaine, or the stimulation of gambling, compulsive sex, compulsive work and high-risk activities can be used individually or in combination, and to a certain extent, interchangeably.  Even though each substance and activity affects a different step in the Brain Reward Cascade, the results are the same:  dopamine is released at the reward sites in the nucleus accumbens, the hippocampus, [Koob and Bloom 1988; Cloninger 1987] the dorsal roots of the spinal nerves and the dorsal horn of the spinal cord.  [Pert and Dienstrey 1988; Blum and Holder 1997.]

When there is a predetermined tendency toward these disorders due to a lack of adjustment to the underlying genetic variation, then one really cannot blame the carbohydrates, alcohol, nicotine, drugs, the orgasmic experience of sex, or the euphoria of gambling for their problems.  This genetic variation would appear to be an evolutionary blunder where one would be cursed with these problems since one’s conception.  But, could this possibly be nature’s protection against some hidden or unknown danger that we are not yet aware of?  Could this be an evolutionary development for the progression of mankind?  After all, many of those with the A1 allele variation score higher on IQ tests.  Processing information and stimuli more quickly, their brains have tendencies toward hyperactivity as seen in ADD and ADHD.  This genetic variation with its underlying susceptibility to feeling unfulfilled by the normal activities in life, may also allow increased intelligence, quicker processing of information, and an increased drive for accomplishment.  Because they have a greater tendency to turn to one of the obsessive/compulsive or addictive behaviors in an attempt to find a feeling of fulfillment, they need to find other approaches for coping and finding satisfaction in their personal relationships and daily activities.

That is why it is crucial that the spine be subluxation-free.  Only then can the limbic system, particularly that part in the dorsal horn of the spinal cord and the dorsal nerve roots, be able to function normally.  Without the interference from spinal subluxations, the individual will finally be able to attain a feeling of satisfaction and well-being, and achieve his or her greatest potential.

 

IMPLICATIONS OF REWARD DEFICIENCY SYNDROME

 

Many different processes can interfere with the Brain Reward Cascade and cause Reward Deficiency Syndrome.  These include not only the genetic variation of the A1 allele of the DRD2 dopamine receptor, but also decreased neurologic function due to physical, chemical, or emotional traumas, illness, nutritional deficiencies, and drug or medication interactions.  Those suffering from Reward Deficiency Syndrome attempt to compensate or “self-medicate” through using addictive chemicals or behaviors in order to feel good about themselves.  Their survival instincts direct them to seek whatever will give them feelings of self-peace, self-satisfaction, self-fulfillment, and well-being, even though only temporarily.  They crave the release of dopamine in the Brain Reward Cascade to achieve a false sense of well-being through their addictive or obsessive/compulsive behaviors.  Eventually, addictive or compulsive behaviors result in the over-utilization of chemical substances and/or mind-altering events.  Long term, these behaviors result in a further downward spiral and dependency because they create a further breakdown in this cascade of neurotransmitters.

Researchers of addiction recognize five categories of addictions:  1) compulsive use of drugs/chemicals (including alcohol), 2) compulsive eating (particularly carbohydrate bingeing), 3) compulsive gambling, 4) compulsive sex (ranging from promiscuity to nymphomania or satyriasis), and 5) compulsive work (the only socially accepted, and even admired, addiction in Western society).  The research of Kenneth Blum, Ph.D., at the University of Texas Health Science Center in San Antonio, Texas ties together these 5 categories of symptoms as just one disease—addiction.  All involve the same breakdown of the Brain Reward Cascade pathways in the limbic system of the brain, dorsal horn of the spinal cord, and dorsal nerve roots of the spinal nerves.

            The first recognized cause of these addictive and compulsive behaviors is the genetic variation or flaw seen with the A1 allele of the DRD2 dopamine receptor.  Blum that found 69% of severe alcoholics had this genetic variation present, while only 20% of the non-alcoholic population had it.  This research led to the Brain Reward Cascade theory, where the proper release and utilization of dopamine in the nucleus accumbens area of the brain leads to a linear sequence of neurochemical events resulting in the ultimate feeling of well-being, satisfaction and peace.  Any interference in this cascade of neurotransmitters does not allow the potentially addicted person to be able to achieve the normal feeling of well-being.  Complicating matters is the fact that they are already deficient in dopamine utilization because of the genetic deficiency in the number of dopamine D2 receptors and increased reuptake transporters.

            Jay Holder, D.C., M.D., Ph.D., states that his research has shown that of those babies delivered with forceps or suction cups, approximately 90% have a subluxated cervical spine.  The spinal cord is dangerously stretched and the vertebrae become misaligned because of the tremendous forces used during delivery.  In turn, these children have a greatly increased risk of becoming addicted as adults because of their nervous system dysfunction, particularly in the limbic system found in the dorsal horn of the spinal cord and the dorsal roots of the spinal nerves.  This risk is even more frequent if the child already has the genetic variation involving the A1 allele of the DRD2 dopamine receptor.

This same genetic DRD2 dopamine receptor variation has been found by Blum and Holder in those children afflicted with Attention Deficit Hyperactivity Disorder and Tourette’s Syndrome.  It is estimated that these compulsive disorders affect approximately 10 percent to as high as 20 percent of the children in the United States.  [Richard Leviton 1995, 17-18]

           

EDUCATED BRAIN AND EDUCATED MIND

 

            From the perspective of Chiropractic Philosophy, the question arises:  How are Innate Intelligence, Educated Brain, and Educated Mind involved in obsessive/compulsive and addictive behaviors?  Let’s take a look again at the Chiropractic Textbook written in 1927 by R. W. Stephenson.

            EDUCATED BRAIN.  That part of the brain used by Innate as an organ for reason, memory, education, and the so-called voluntary functions.  The seat of Educated Mind.

It is supplied with mental impulses over nerves, as any other tissue.  It is liable to incoordination as any other tissue; . . . It is the chief organ of adaptation to environmental conditions.

            Innate Intelligence uses the Educated Brain as the organ to direct voluntary functions.  Information about the external environment is dispatched by the Five Senses to the Educated Brain.  The Educated Brain constantly compares this information with past impressions so that the body can profit by avoiding actual or threatened dangers.  Educated Brain also stores information about what has worked or not worked for the benefit of the body for future use by Innate Intelligence.  [Stephenson 1927, 13-14]

            EDUCATED MIND.  Educated Mind is the activity of Innate Intelligence in the Educated Brain as an organ.  The product of this activity is Educated Thoughts; such as,

reasoning, will, memory, etc.  Innate controls the functions of the “voluntary” organs via the Educated Brain.  Educated thoughts are mostly for adaptation to things external to the body.

            Educated thoughts such as learning, will, memory, and reasoning are used to adapt to the external environment.  They are used for the welfare, comfort, betterment, and safety of the body.  Successful adaptations always give pleasure.  Unsuccessful adaptations will cause harm to the body, and can even be fatal.  [Stephenson 1927, 242-243]

            If Innate Intelligence is infinite in her wisdom, how can she allow the body to become addicted?  Stephenson says the following:      

Innate Intelligence, the builder and warden of the body, with her infinite knowledge knows her own mind; knows what should be introduced into the body, both immaterial and material.

Educated Brain is finite and must work within the limitations of matter, therefore it cannot decide for Innate Intelligence what forces or matter are good for the body.  Innate Intelligence will proclaim her material needs through normal hunger and thirst.  The purpose of Educated Brain is to deliver whatever Innate Intelligence determines is needed.  The Educated Mind should cooperate, not hinder, Innate Intelligence’s workings through Innate Mind in its choice of nourishment for the body.  When Educated Mind interferes with Innate Mind, it is because it is abnormal.  Interference with transmission because of vertebral subluxation(s) causes this abnormality.  Instead of working with Innate Intelligence in harmony, Educated Brain begins to work against the best interests of the body.  [Stephenson 1927, 129-130]

When a poison such as an addictive drug is first ingested in the body, Innate Intelligence responds with great energy to eliminate and excrete the poison with any method at its disposal.  When there is a strong dose of poison, Innate Intelligence responds immediately with the quickest method at its disposal, a mechanical reaction, which may result in a vertebral subluxation.  Innate Intelligence next initiates the proper preparation of an antidote for the poison.  When the poison is repeatedly ingested, Innate Intelligence continues to rebel, but also adapts by continuing to manufacture the antidote to keep the body chemically balanced, until it is manufactured continuously.  Then if the ingestion of the poison is stopped, the body becomes unbalanced again.  The antidote causes stress, since it is now a poison in the body.  Innate Intelligence now craves the original poison to offset the poison of the antidote.  The body will go into the withdrawal process if the poison is not provided.  Eventually, Innate Intelligence will destroy the antidote and stop manufacturing it.  In the words of R. W. Stephenson, “Subluxations play their part in all this, in the matter of incoordinated educated mind, poor elimination, and inadequate adaptation in the matter of balancing drug and antidote for every day’s struggle.”  [Stephenson 1927, 153-154]

When Educate Brain receives inaccurate information because of the presence of a vertebral subluxation, it may respond with a faulty adaptation.  The person with a decreased number of dopamine receptors in the nucleus accumbens, the dorsal horn of the spinal cord, and the dorsal nerve roots of the spinal nerves that make up the limbic system, will have an impediment to achieving a sense of well-being.  Innate Intelligence orders Educated Brain to compensate for the lack of dopamine.  Educated Brain may respond imperfectly in its choices due to vertebral subluxations and the limitations of matter.  It may turn to mind-altering addictive chemicals, obsessive/compulsive behaviors, or mind-altering events to temporarily increase the dopamine levels, rather than having the vertebral subluxations adjusted and searching for the balanced nutrition that is needed.  This may offer temporary relief from the immediate symptoms of discomfort, anxiety, and distress.  This is very destructive to the body in the long term.

It is vital in the care of obsessive/compulsive and addictive behaviors to include vertebral subluxation reduction and correction.  Only then can the dysfunction be identified, the messages from Innate Intelligence be properly responded to, and the body begin to heal and function naturally.

 

CHOICE OF ADDICTION

 

One may wonder if obsessive/compulsive or addictive behaviors are the fault of a person’s heredity and genetic variations, or if the environment and influences of society are more to blame.  There is a greater tendency to develop these behaviors when one inherits the A1 allele variation of the dopamine DRD2 receptor gene.  But not everyone develops the same disorders, a few people even find ways to cope and live fairly normal lives.  Casey did extensive research to answer the question of heredity or environment, but came to no absolute conclusion.  [Casey 1960]  It appears that people do have some freedom in their choice of obsessive/compulsive and/or addictive behaviors from what are available to them environmentally, financially, and within their moral values.

Alcoholism, carbohydrate bingeing, drug abuse, and compulsive gambling do not always have a genetic basis.  Research has demonstrated that a considerable number of severely addicted people begin their substance dependence and abuse because of the DRD2 genetic variation affecting the limbic system’s reward center.  [Chipkin 1994]  The picture is further complicated by such environmental factors as social structure, economic status, family, occupation, and substance availability.

The somatopsychological responses may be the mind’s way of coping with or adapting to this genetic variation.  The real origin of all behavior, whether the socially accepted “normal” or the socially unacceptable or “abnormal”, is determined at conception by one’s genes.  While the multiple combinations and variations of these genes will predispose these people to these behaviors, these will also be shaped by the environmental influences of their family, friends, their level of education, their economic and social status, various environmental pollutants, and the availability of psychoactive drugs.  [Blum et al. 2000, 64]  Due to the decreased levels of dopamine released in the nucleus accumbens, they cannot achieve a sense of well-being.  Therefore they search for outside stimulation; whether chemical or behavioral, to temporarily attain this feeling artificially.  [Blum et al. 2000, 3]

Even after prolonged abstinence, the craving persists once they become addicted to psychoactive drugs.  They may then use other behaviors, ranging from the socially positive (compulsive workaholism) to the socially negative (compulsive sex or gambling) to satisfy their craving.  Their choice of stimulant, either chemical or behavioral, then depends on the availability and accessibility along with the perceived costs and risks.  [Blum et al. 2000, 2]

The American Indians are a prime example of the availability and/or accessibility in their choice of stimulant.  The Indian cultures used various stimulants and hallucinogens such as tobacco, hemp, peyote, and psychogenic mushrooms.  With the arrival of the Europeans, they began using alcohol, causing a total disruption of their society.  Among the more affluent, such as professional athletes and the Hollywood movie industry, cocaine is often the drug of choice.  (As Robin Williams said, “Cocaine may be God’s way of telling you that you have too much money.)  Alcohol, nicotine, and marijuana are often the choices of the lower end of the economic scale.  As an example of looking at the cost versus risk factor, a person may select a high nicotine brand of cigarettes rather than risking problems from the illegal use of marijuana.  Compulsive gambling behavior can even be replaced by less risky behaviors such as the compulsive playing of bingo, video and computer games, or virtual reality games. 

Personal choice has a large influence on the choice of one addiction or behavior over another due to life experiences, personal values, and societal mores.  A young female may have inherited the same Reward Deficiency Syndrome as her alcoholic mother and drug abusing father.  She may have so much pent up rage toward her parents that she vows to never use alcohol or drugs.  She will search for another method to achieve a feeling of well-being.  Starving for male attention and affection, but having a poor relationship with her father, she turns to other males.  Sexual intercourse temporarily satisfies her need for male attention and affection, while also releasing enough dopamine for a temporary sense of well-being.  This behavior becomes addictive as she needs a continual “fix”, eventually leading to promiscuity or nymphomania.

A young male on the other hand may grow up in a family in which it is considered a sign of manliness and virility to have sex with as many females as possible.  Often, heavy use of alcohol and mind-altering drugs goes along with this type of behavior.

Carbohydrate bingeing may be the outlet for another family with a cultural or religious aversion to drugs, alcohol, and illicit sex.  Wheeling and dealing in the world of business may be a more acceptable outlet than casino gambling.  A person may become a world-class chef, getting his excitement from creating and cooking, and the enthusiastic praise of others, rather than from overeating.  The potential alcoholic may sublimate his craving by becoming a connoisseur of wine, deriving his sense of satisfaction and excitement from pursuing the new taste experience rather than the actual drinking. 

            Being passionate about a goal or pursuit can compensate and give one that sense of well-being as the Brain Reward Cascade of neurotransmitters ultimately releases more dopamine in the reward centers of the limbic system.  Each person chooses their own personal method of compensation.

ADD/ADHD OVERVIEW

 

Between three and four million children, and probably even more adults, are afflicted with what is currently referred to as Attention Deficit Hyperactivity Disorder (ADHD) (with or without hyperactivity) or sometimes as Attention Deficit Disorder (ADD).  ADD/ADHD is the most frequently observed of the obsessive/compulsive disorders.  Some researchers use the term ADHD when the symptoms of hyperactivity are present, and ADD when no hyperactivity is present.  The ADD/ADHD child demonstrates a group of maladaptive or disorganized behaviors which put him or her out of sync with the surrounding adults.  It is a variation of normal behaviors that appear more frequently, more obviously, and more intensely than is seen in other children of the same age.  While all children are impulsive, distractible, and inattentive some of the time, ADD/ADHD children are impulsive, distractible, and inattentive most of the time.  [Sears and Thompson 1998, 6]  There is a continuum of behaviors that range from the young girl who is “spacey” and always daydreaming to the young boy referred to as “hell on wheels” and “the human tornado” as he runs continually at top speed, knocking everything and everyone over, rarely stopping to rest.

For the purposes of this paper, we can think of ADD as the person who “fogs out” which results in a deficit to attention, while the person with ADHD “acts out” with hyperactivity resulting in a deficit to attention.  ADD is characterized by the anxious, preoccupied, and dreamy child who is often described as apathetic, lazy, unmotivated, and not very smart.  ADHD is characterized by the child with a hyperactive brain, which is also often expressed with hyperactive movements.  Their thoughts appear to be disjointed to an observer as their brain races from one thought to another.  They are easily distracted and/or have difficulty focusing on only one thing at a time.

It was formerly thought that three to four times more boys than girls are afflicted.  It has since been realized that girls more often display the ADD form without hyperactivity.  Consequently the diagnosis is often missed as they are written off as being “spacey”, “ditzy”, or just always “daydreaming”.  Boys tend to more often display a physically active and aggressive form of ADHD, irritating their peers and the adults around them.  Adjusting for these differences, the incidence is approximately equal in both sexes.

The names ADD and ADHD imply that the diagnostician actually understands the neuropsychological processes involved.  But the reality is that ADD/ADHD cannot be measured in precise scientific terms.  The diagnosis is made from the list of symptoms published in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

            In 1902, pediatrician George Still was the first to describe a group of hyperactive, impulsive, and inattentive children, though he labeled them as being “morally defective”.  Before Dr. Still, ADD/ADHD was not recognized, even though the temperament or biological predisposition was present.  More alternatives existed for the child who could not sit quietly in school.  He or she could help out on the farm, work in the family’s store, or help care for their younger siblings.  With compulsory education in the twentieth century, children had to function in this environment.  In the bad old days, children who misbehaved in school were beaten into submission.  Today, that option is rightly rejected; however, while we are no longer willing to intimidate children into compliance, we seem to be willing to drug them into it.  [Diller 1998, 89-90]

 

CAUSES OF ADD/ADHD

 

            There appears to be a genetic basis as ADD/ADHD often runs in families.  Between 10 and 35 percent of ADD/ADHD children have an ADD/ADHD parent.  If one parent has ADD/ADHD, approximately 60 percent of their children will also have ADD/ADHD.  This rises to 85 to 90 percent if both parents have ADD/ADHD.  [Amen 2001, 22-31]  ADD/ADHD is seen more often in identical than in fraternal twins.

            Current research implicates the A1 allele variation of the dopamine D2 receptor as the most frequent cause of ADD/ADHD symptoms.  This gene also predisposes the bearer to other addictive behaviors, especially when a conduct disorder is present.  [Disney 1999; Comings 1991; Blum et al. 1990]  As previously seen with the Reward Deficiency Syndrome, these compulsive disorders are the end result of the neurotransmitter imbalance in the Brain Reward Cascade.

            Researchers have correlated ADD/ADHD symptoms with not only the DRD2 dopamine receptor gene on chromosome 11, but also aberrations of the DRD4 dopamine receptor gene on chromosome 11, the DAT1 dopamine transporter gene on chromosome 5, the HLA gene on chromosome 6, p21.3 on chromosome 6 affecting production of fatty acid-CoA transferase, q11.1-q13 on chromosome 16 and p11-p12 on chromosome 20 which both affect the production of phospholipase C.  [Amen 2001, 22-31; Stordy 2000, 16-17]  Fatty acid-CoA transferase is associated with the conversion of short chain essential fatty acids into long chain polyunsaturated acids and their incorporation into nerve cell membranes.  Phospholipase C is associated with the breakdown of phospholipid membranes in brain cells.  It is critical that both of these processes are in balance for the normal, rapid fire communication between neurons.  [Stordy 2000, 8, 16-17]

To a lesser extent, ADD/ADHD symptoms are seen as the result of head injuries (especially the left temporal region), lack of oxygen (e.g. cord wrapped around the neck during delivery or drowning accidents), meningitis and encephalitis, toxic substances (fetal exposure to drugs, alcohol, cigarettes, lead), and thyroid conditions.  [Amen 2001, 22-31]  In each of these situations, there is an adverse affect on the dopamine rich areas in the limbic system.

 

SYMPTOMS AND CONSEQUENCES OF ADD/ADHD

 

            Many children are hyperactive even in the womb.  Many are challenging from birth:  sensitive to noise and touch, difficulty in being comforted, cautious and fearful, fussy eaters, colicky, and/or difficulties with sleeping.  As a toddler, the child is often excessively active, fidgeting, squirming, running around, high-strung, making excessive noise, impulsive, mischievous, demanding, noncompliant with parental requests, difficult to toilet train, disorganized, and more reckless and accident-prone than his or her peers.  Though not intentionally defiant, the child frequently breaks rules, interrupts others’ activities, and refuses to wait for his or her turn.  The child does not grasp the consequences of his or her actions, but rather blames everyone else for his difficulties.  Lacking normal caution and reserve, these children lack the tact expected for their age, impulsively finishing others’ sentences, giving answers before the question is finished, and blurting out whatever comes to mind.  Many isolate themselves because these actions make them unpopular with their peers.

            Entering school only makes the problems worse as they are easily distracted by everything going on around them.  They have difficulty with organization and paying attention to details.  Consequently, they make many careless mistakes, lose their schoolbooks and assignments, procrastinate, and fail to complete their schoolwork.  Often they talk excessively and at inappropriate times, are disruptive in class, and appear to not listen when spoken too.  Their behavior is often uninhibited and inappropriate.  They have difficulty playing quietly and waiting their turn becomes an even bigger struggle.  Often they are described as very intelligent but socially immature.  They have poor peer relations and are often labeled as underachievers, willful, defiant, or oppositional.

The symptoms of impulsive behavior and motor hyperactivity usually decrease during adolescence.  However, the impulsive behavior, restlessness, boredom with anything that is not highly stimulating, and lack of tact persists.  [Amen 2001, 36; Web site of the U. S. Surgeon General, 2001]  Moods and behaviors can change suddenly, for no apparent reason.  A five-year-old may have the vocabulary of an eight-year-old while displaying the self-control of a three-year-old.  A seemingly independent child may become clingy and demanding later in the day, wanting a pacifier at night.  The ADD/ADHD child usually remains 30 percent behind his peers in maturity.  The ten-year-old child will act more like a typical seven-year-old, while the twenty-five-year-old adult may still have the maturity we would expect of an eighteen-year-old.  [Turecki 2000, 14-15; Bissen Neuville 1995, 32-33]

The minds of those with ADHD are always racing.  The rest of the world just moves too slowly for them as others cannot keep up with their tempo. They view others as boring, preoccupied with irrelevant details, or even lacking in intelligence because others cannot keep up with the speed of their thoughts and actions.  In their view, they do not suffer from hyperactivity, rather the world suffers from AEHD—Attention Excess Hypoactivity Disorder.  Oftentimes focus becomes a problem because of the racing of their minds.  They compensate for a maddeningly slow world by multi-tasking:  reading a book while carrying on a conversation or doing the homework for one class while taking notes during the lecture in another class.  (You know you have ADHD when you read the paper, put on your makeup, and talk on the phone, all at the same time—while driving.)

When the ADHD person is bored, motor activities spill over such as drumming the fingers, tapping the feet, whistling, looking around, scratching, stretching, and doodling.  By absorbing part of the brain with motor activities, the rest is able to focus on the task at hand.  When something interesting or exciting engages the brain, the non-productive motor activities decrease.  Those with ADD/ADHD often become incapacitated when they have to write because of difficulties with fine motor skills.  They go into overload when required to copy from the blackboard, fill in blanks that are too small in their workbooks, write complete sentences, or make legible handwritten notes.  [Garber 1996, 68]

People with ADD/ADHD are unable to filter out the background noise in the neighboring environment because of the overload and discord in their nervous systems.  Concentration is obstructed by the increased awareness of every sight, sound, and sensation constantly bombarding them.  Not able to focus their attention, they are always in a hurry, have trouble setting goals, forget appointments, miss deadlines, forget to pay their bills, and have frequent legal problems because they fail to take care of problems when they occur.  While often very intelligent people, they have difficulty adjusting to change.  In a world that is too bright, too loud, too abrasive, and changing too rapidly, they are in constant overload.  Nonessential stimuli cannot be differentiated from essential stimuli, as it all merges into a disorganized, unbearable bedlam.  There is so much tumult in life that even the most minor change in routine is very distressing.  The stress of being in overload is so severe that frustration cannot be tolerated—leading to sudden, explosive anger, temper tantrums, and harsh language.  The extreme frustration leads to impatience.  Often there are also problems with orientation in time and space, causing difficulty with following instructions, reading maps, or telling time.  [Blum and Holder 1994; Blum et al., 2000, 28]

            The seriousness of this problem in society is seen in that those with ADD/ADHD:

 

 

Those with ADD/ADHD are two to three times more likely to fail their classes than their peers.  They score lower on achievement tests for math and reading, are often one to two years behind their peers in math, reading, spelling, and language.  Weiss and Hechtman found that as adults, one third had failed to graduate from high school.  [Garber 1996, 104-105]  Complicating this is the fact that the harder many ADD/ADHD people try, the worse things get.  Brain imaging studies demonstrate that when they try to concentrate, the part of the brain affecting concentration, focus, and follow-through shuts down—just when they most need it to turn on.  [Amen 2001, xvi-xvii]

           

DIAGNOSING ADD/ADHD

 

According to the Diagnostic and Statistical Manual for Children and Adolescents for Primary Care, 4th edition (DSM-IV), ADHD can be diagnosed from the following:

 

Diagnostic Criteria for Attention Deficit Hyperactivity Disorder

TYPES:

  1. Attention Deficit Hyperactivity Disorder Predominantly Inattentive

Must have at least six items from criteria one for six or more months.

  1. Attention Deficit Hyperactivity Disorder Hyperactive-Impulsive

Must have at least six items from criteria two for at least six or more months.

  1. Attention Deficit Hyperactivity Disorder Combined

Must have at least six items from criteria one plus six items from criteria two for at least six months.

CRITERIA ONE: INATTENTION

The following items must be to a degree that is maladaptive and inconsistent with an individual's developmental level.

A.     Often fails to give close attention to details, makes careless mistakes in school, work, or other activities.

B.     Often has trouble sustaining attention in tasks or at play.

C.    Often doesn't listen when spoken to directly.

D.    Often doesn't follow through on instructions.  Fails to finish work in school, chores, or duties in the workplace.  (Not due to oppositional behavior or failure to understand instructions.)

E.     Often has trouble organizing tasks and activities.

F.     Often avoids, dislikes, or is reluctant to engage in tasks that require sustained effort.

G.    Often loses things necessary for tasks and activities.

H.     Often distracted by extraneous material.

I.         Often forgetful in daily activities.

CRITERIA TWO: HYPERACTIVE-IMPULSIVE

The following must be to a degree that is maladaptive and inconsistent with an individual's developmental level.

Hyperactive:

A.     Often fidgets with hands and feet or squirms and seat.

B.     Often leaves seat when remain