Attention Deficit Hyperactivity Disorder: Minimal Brain Dysfunction - Attention Deficit Hyperactivity Disorder

Written by Dr. W.J. Levin

FOURTHLY, the adult who still has a problem and has never had treatment, had inadequate treatment, or had treatment prematurely stopped, should not be over looked. They are entitled to treatment. And what is more, it is just as successful as in the child if correctly used.

FIFTHLY, many a parent cannot come to terms with the idea of medication, despite the American Surgeon- General's investigation a few years ago, indicating not only the need to medicate, but also the safety of psychostimulants. In South Africa the Health Department has come to the same conclusion. The same health department has more recently published their definite condemning of smoking as a major health hazard. Under these circumstances, it is difficult to understand the parents' reaction to medicating their children, when some of these parents condemn medication while being smokers themselves. Nevertheless a non-condemning, sympathetic attitude must be adopted towards these parents until they come to terms with their own anxieties and their children's problems.

Any attempt to explain the intricacies of the human brain to people is like a poorly sighted observer looking at a piece of complicated machinery in a darkened room through a non-strategically placed peephole, and describing it to a hard of hearing audience.

Despite this we do know that we have a right and a left cerebral hemisphere connected to each other by the corpus callosum. Each side has four lobes, each with a specific function. The "cross over" function allows the left hemisphere to team up with the right side of the body and the right hemisphere to team up with the left side of the body. The speech center is usually situated on the left side of the brain even in most left-handed people. Speech and thought are our most highly developed functions and are found only in man. The left brain is the dominant hemisphere in most people (93%) and therefore we are predominantly right handed and become aware of the "right" early on in life. There is also no confusion created by the opposition side, unless the left hemisphere is less effective or immature.

The higher cortical functions that are acquired offshoots of speech, namely reading, writing and spelling and logical maths are mainly in the left hemisphere, and they are the talents most sought after in school.

The verbal input (listening to words) and output (speech) on the left side of the brain are focally concentrated and a conscious processes, executed in an orderly, logical and sequential manner. The right brain, on the other hand, which functions in a less dominant capacity, is visio-spatially orientated. It processes information more vaguely than the left brain. It processes information simultaneously and holistically and is far more mechanically orientated than the left brain.

The left brain is clearly the thinking (inhibitory) side while the right brain is the doing (activating) side. It stands to reason, and happily so, that the dominant left-brain "thinks" first, and then allows the right brain to "do" thereafter. This maturation process occurs in a predetermined developmental pattern. This arrangement in no way implies that the right brain is inferior to the left in any way. Both sides of the brain have their own, but very different talents.

There is a maturational difference between boys and girls in that boys' right brain is often dominant and thus they tend to "do" rather than "think" while maturing. This tendency to right brain dominance is a disadvantage in boys at the age of 6 years, when we tap mainly the left brain for school readiness. Consequently six year old girls are more mature than boys are and boys have far more and behavior and learning problems than girls.

Clearly there is a maturing process that allows the left brain to become the dominant side, by the time the child has to go to school. Each side specializes in certain functions that are suited to our developmental needs.

Our genetic talents are only molded by our environment. A talent in the wrong place, such as temperament on the right side, and developing at the wrong time could well be a disadvantage. A prerequisite to understanding unusual dominance or late developing dominance is the knowledge of the developmental norms of the child.

If the left brain is more highly developed, it is also more likely to be more susceptible to insult from any cause, be it genetic inherited immaturity, trauma, anoxia (lack of oxygen) or inflammation. Any insult to the left hemisphere resulting in failure to mature, thus allowing the right hemisphere to dominate will disrupt functions.

With Cerebral Dysfunctions the tendency is for some or all of the right brain functions to gain the upper hand. This clearly explains so much of the unusual patterns of behavior (due to right brain excess) and lack of learning (due to left brain immaturity) in A.D.H.D. children. It is sometimes difficult to decide whether a particular pattern of behavior is due to increased right-sided function or decreased left-sided function or equal ability causing left-right confusion. There can be no doubt however that loss of left brain dominance is a disadvantage to learning. Equally, right brain dominance for doing first and thinking later is a built-in troublemaker, with a tendency to be left-handed.

There are a number of interesting superficial anatomical deviations (dysmorphic features) that can be seen more often in A.D.H.D. children. I refer to:

• Epicanthic folds of the eye
• Ocular hyperteleorsism (widely spaced eyes giving the appearance of a wide nasal bridge)
• Curved little finger
• Simian palmer fold (a single palmer fold)
• Webbed toes (between 2nd and 3rd toe)
• Unusually large 1st toe space
• Absent or non-dependant ear lobes
• High palate
• Facial asymmetry
• F.L.K. (Funny looking kid)