Dear Sir,

It was with some interest that I read the article What You Should Know About Attention Deficit Disorder by Edward W. after having it handed to me by a member of our church. There were elements of the article that were insightful, helpful, and needed to be said in a public forum, especially the discussion of the moral and spiritual dimensions of behavior. For this part of the article I applaud Mr. W.

However, Mr. W's discussion on the physiological/biological aspects of ADD ADHD was lacking to the point of being misleading to the readers. I am sure that Mr. Welch had no intention of misleading any readers, as that would hardly reflect the "biblical guidelines with which to understand ADD" that he seeks to communicate. Therefore, for the sake of clarifying some details, may I present the following evidence. Perhaps in the near future you would run an article that would present some of this information to your readers, so that they have an accurate understanding of the disorder.

We continue the dialogue here in part four. Mr. W writes,

"The popular assumption is that there is an underlying biological cause for the behaviors, but the assumption is unfounded. Although there are dozens of biological theories to explain ADD, there are presently no physical markers for it; there are no medical tests that detect its presence. Food additives, birth and delivery problems, inner ear problems, and brain differences are only a few of the theories that are? unsupported by evidence."

". . . there are presently no physical markers for it;"

This is not supported by research. There are many physical markers for it. One just needs a fMRI, SPECT scan, QEEG, or PET scan, to see them. I have personally performed hundreds of EEGs and some QEEGs, and can attest first hand to the differences in brainwave patterns of ADHD individuals vs. non-ADHD subjects.

". . . there are no medical tests that detect its presence."

This is also misleading to the readers. Many, if not most, biologically based medical conditions are diagnosed by the observation and experience of a trained clinician or physician. Many medical conditions have no "medical tests" that detect its presence.

For example, I am presently house-bound recovering from pneumonia. Did you know that until July, 2000, there were no "medical tests" that detect the presence of pneumonia? Just last summer a urine test was approved by the FDA which is between 75% and 80% accurate in diagnosing pneumonia. There are no blood tests, or other forms of "medical tests" to diagnose it.

My pneumonia was diagnosed solely on the observation and experience of the physician. He listened to my breathing and coughing. He observed and interpreted a chest x-ray. Then he made a judgment, a diagnosis, based on observation and experience (not on empirical, objective results from any medical tests), and began treatment. The x-ray, my coughing, etc., gave him evidence of a condition only. He had no "medical tests" (he did not try the new urine test) to tell him if I had viral pneumonia, bacterial pneumonia, or mycoplasmic pneumonia. Yet based on observation and experience he started a course of treatment. The treatment involved the use of powerful medications, and the treatment has so far been beneficial.

The fact that there are no blood tests - "medical tests" - to diagnose pneumonia is hardly evidence that I am not suffering from a medical condition.

ADHD is also diagnosed by clinicians through observation and experience. The clinician would rely on developmental, family, academic, and genetic histories, behavioral rating scales, and objective testing. There are tests, psychological and neurocognitive tests, that are extremely helpful in making a diagnosis, such as continuous performance tests and other tests of executive functions. There aren't any blood or urine tests - "medical tests" - as Mr. Welch would say. But that does not invalidate the biological basis for the condition.

Mr. Welch further writes: "There are some medical problems that can provoke ADD symptoms. For example, thyroid problems can affect energy level, and hearing or visual impairments can make paying attention difficult."

Yes, these are true. But they describe thyroid problems, and hearing or visual problems, completely separate medical conditions which happen to share some symptoms with ADHD. They do not cause Attention Deficit Hyperactivity Disorder. Depression and anxiety can cause symptoms that look like ADD, but they are not ADD. A head injury can cause symptoms that look like ADD, but a head injury is not ADD.

The neurological problems that cause ADD are the causes of ADD. Mr. Welch is simply unwilling to admit that there is a neurological, biological, physiological basis for a very real condition called ADHD. His position, however, is not supported by the reality presented in the research.

This is the end to part four of this discussion. You can learn more about Attention Deficit Hyperactivity Disorder by visiting the ADHD Information Library's family of web sites.

Douglas Cowan, Psy.D., is a family therapist who has been working with ADHD children and their families since 1986. He is the clinical director of the ADHD Information Library's family of seven web sites, including http://www.newideas.net, helping over 350,000 parents and teachers learn more about ADHD each year. Dr. Cowan also serves on the Medical Advisory Board of VAXA International of Tampa, FL., is President of the Board of Directors for KAXL 88.3 FM in central California, and is President of NewIdeas.net Incorporated.