Adults with ADD (often coupled with ADHD, representing the related attention-deficit hyperactivity disorder) have to cope with the three-ring circus performing in their heads: They are paying attention to the sound of the other person's voice, experiencing past and future fears, becoming aware of the freedom to say or the fear of saying what they are feeling - all while concentrating on getting the meaning from the other person's words.

Ordinary brains seem to "run on batteries", automatically doing what they are supposed to without giving organization a thought. But ADD/ADHD brains are like a wind-up watch that requires constant attention by being wound up periodically. While the peaks of activity can provide stimulation and be a wonderful source of creativity, they can also create communication problems.

These three imaginative similes are used by Ronald Weinstein, director of the ADD Centre currently located in England, to describe what goes on inside the heads of ADD/ADHD sufferers. And he ought to know: Although middle-aged, he himself was diagnosed only 10 years ago as having ADD/ADHD, and one of his three children has also been identified as having it. His training in neurobiology and behavior and child growth and development laid the foundation for his specialty in ADD/ADHD.

And there's no shame in it. After his child was diagnosed, Weinstein raised the suggestion that he was suffering from the condition that he had been diagnosing and treating in others for many years. He is in good company. Studying their reputed behavior, Weinstein believes that King David, Maimonides, Thomas Edison, Winston Churchill, John Kennedy and Bill Clinton may also included in the ranks of ADD/ADHD sufferers.

"I couldn't do that!" Weinstein exclaimed admiringly during a two-hour interview with this reporter, who was asking questions, writing down his answers word by word and thinking of more questions simultaneously. "I can't write or type and listen at the same time. My brain doesn't organize things well." 

The American psychologist ⁽¹⁾-  a leading international expert in ADD/ADHD --  was in Israel for the first time to address the International Congress on ADHD/LD in the Jewish World: Character Education as the Foundation of Achievement.. 

Held at the Renaissance Hotel in Jerusalem, the conference was organized by the non-profit Jacob's Ladder Center for Character Education in the capital's Kiryat Hayovel quarter that is affiliated to the city's private Matara Institute for diagnosis and treatment of behavior and learning problems (especially ADD/ADHD). Both are headed by American-born clinical psychologist Dr. Stewart (Simcha) Chesner, who organized the congress. 

"Our Jacob's Ladder Center has been recognized by the Education Minister as a training institute for professionals in the field," Chesner said. The syndrome is believed to affect an estimated three to five percent of schoolchildren; the symptoms In some, symptoms --  trouble focusing attention and completing tasks; excessive activity, difficulty sitting still; impulsiveness, including a tendency to blurt out comments or to act without considering risks --  may persist through adolescence and adulthood.

Chesner suggests that observant Jews with ADD/ADHD suffer more socially than others because book learning and concentration are accepted values in their setting, while children with the syndrome have difficulty sitting in one place and may be regarded as "bad". 

He and educational expert Cissie Chalkowsky founded Jerusalem's Neve Ruchama Academy for teenage girls and the Yeshivat Bnei Chayil for teenage boys with the disorder.  The boys' school, while having many successes, has been forced by the Jerusalem Municipality to wander from building to building each year, and the current location is shared with another school and lacks the outdoor space that the boys need.

Studies show that two to three times more boys are affected than girls, but Weinstein believes there is more balance between the sexes. "Girls tend to control their symptoms and keep them hidden more than boys,"  he suggested. 

Although no objective physiological tests had been known to diagnose the condition, psychologists at Stanford University have used a non-invasive technique called functional magnetic resonance imaging to show that specific areas of the brain called the basal ganglia are less active in ADD/ADHD children than in healthy ones. They also found the first evidence that Ritalin works differently in children with ADD/ADHD, a finding that may lead to the first explanation of why a stimulant seems to have calming properties. Ritalin apparently increases brain activity in the basal ganglia in hyperactive children, but decreases basal ganglia activity in healthy children.

The cause is unknown, but the syndrome tends to run in families, and certain genes may increase susceptibility. Researchers are investigating possible differences in brain function in people with ADD/ADHD. 

Experts agree that it is not usually caused by too much TV, food allergies, excess sugar or inadequate schools, but it may be connected to physical trauma at birth or psychological trauma later in life. Teachers can often help with treatment by changing a child's seat in class, shortening assignments and using behavior-modification techniques. At least half of children with the condition also have specific learning disabilities, so most children in whom it is suspected should undergo psycho-educational testing to identify such problems. 

ADD/ADHD can sometimes be confused with other developmental disorders. In addition, studies have shown that ADD/ADHD sufferers are significantly more likely than others to abuse drugs  including tobacco, alcohol, marijuana, cocaine and stimulants  than those without the condition.

The Bronx-born psychologist ⁽¹⁾ remembers always getting into trouble in Hebrew school. "I was constantly being thrown out of class for 'making trouble' and I blamed myself. I always thought there was something wrong with me. At parent-teachers meetings, my mother and father were always told that 'I could do better' if only I'd sit still." Although he has been able to obtain numerous advanced degrees, Weinstein recalls that pursuing his doctorate at Cornell University was very difficult. 

When his son was eight, he was always coming home from school crying and complaining that other kids didn't like him. Although he was gifted, he would say and do things without thinking of the consequences. He was diagnosed with ADD/ADHD and put on Ritalin, a stimulant often given for the syndrome. Later, as new medications were developed, he was switched to dexedrine and then to Adderall, an amphetamine (approved three years ago by the US Food and Drug Administration, but not yet okayed in Israel) originally meant for weight reduction. 

Ritalin and other stimulants exert their paradoxical calming effects on sufferers by boosting levels of the brain chemical serotonin; this seems to restore the delicate balance between serotonin and dopamine, another neurotransmitter, and controls hyperactivity.  "Ritalin is a safe medication, but it's short acting, so there are peaks and valleys. It's often not prescribed properly," Weinstein said. "But Adderall keeps things level for a much longer time."

His wife at that time, who was then working in the Psychiatry Department of the University of Connecticut Health Center, went to a support group for parents of ADD/ADHD children, and upon returning, she told her husband: "You know -- you have it too." It seemed to make sense. He has trouble explaining why he -- an expert in the syndrome --  had not diagnosed himself. He was then officially diagnosed. "I suppose it's a matter of the cobbler's children going barefoot, and the fact that one can't really be objective about oneself,." he stated. "The diagnosis explained a great deal for me. My life was turned around and I felt like a new man." Weinstein, too, advanced from Ritalin to Adderall.

Weinstein has written about the difficulties faced by couples in which one member has ADD/ADHD and the other does not. "Ron's ADD/ADHD was undiagnosed during the first half of our marriage, and there most likely would not have been a second half had it remained undiagnosed," she wrote with him in Attention! magazine for ADD/ADHD children and adults. Adults with the condition have suffered a great deal of pain and had to developing coping mechanisms to help them survive. This, in turn, can cause great stress. 

An affected person may often make statements they didn't mean, walk past a bag of garbage without picking it up, drive past the library with overdue books and think "it's no big deal", since they think these will get done eventually. They may be sloppy, release frequent outbursts of anger and have trouble holding down a job. Thus going for counseling after diagnosis can ease the tensions in living together, they advise.

Ron Weinstein can be reached at DrRon@addcenter.co.uk or through his website at http://www.addcenter.co.uk

Judy Siegel-Itzkovich
Health, Science, Computers and Telecommunications Reporter
The Jerusalem Post
Jerusalem, ISRAEL

^{(1) Please note than I was incorrectly identified as a psychologist. (back)}

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