Attention Deficit Disorder (ADD) – or is it? by Dr Robin Pauc

It is my personal belief that the learning and behavioural conditions of childhood do not exist. That is, they are not conditions in their own right but no more than symptoms, and symptoms that always appear in patterns of comorbidity (together). The patterns of presentation are therefore as unique as the individual child and, in part, colour what we call the personality. However, my research has led me to discover that some of the “conditions” so often seen are also often misdiagnosed and the underlying cause missed completely.

Many children are inattentive and appear to be drawn to any movement in their immediate vicinity. No problem when at home playing in their room with their Lego, but in the busy classroom setting this can be such a distraction as to hinder learning. If the inattention is moderate to severe, and particularly when it is coupled with learning difficulties, it may alert the teaching staff to the possibility of Attention Deficit Disorder (ADD). However, suppose it is not ADD but a retained visual defensive reflex that makes it impossible not to look at any movement in the peripheral visual fields.

It would appear that shortly after birth we develop a visual defensive reflex that causes us to make rapid saccadic movements of the eyes to bring our central vision to bear on any movement detected in our periphery. If we look back to humans’ early days on the planet, it would be vital to the infant or young child’s survival to detect the presence or approach of a potential predator and, by screaming, alert an adult to the possible danger. This primitive defensive reflex should be replaced by the more discriminating adult reflex at around five years of age, but often it remains firmly in place, causing the child to be unable to focus on the task before them.

The human visual system is often depicted rather simplistically as the two eyes being connected to the thalami via the optic nerves and tracts and from there to the visual cortex in the back of the brain. However, in reality it is not that straightforward and is divided into various sub-tracts that connect with various other parts of the brain and brainstem. One such area is the magnocellular area of the parietal cortex (roughly above the ears). A prime function of this particular area is to monitor what is happening in our peripheral visual fields, an essential function in survival if you are a hunter but also potential prey to a larger predator.

We have a magnocellular area in each parietal cortex, each monitoring what is happening in the opposite peripheral visual field. However, recent research would suggest that it is the right magnocellular area that has executive control and decides if the stimulus in either visual field warrants our attention. We have all come across people who, when you are talking to them, have the habit of looking away and thereby breaking the all-important eye contact that we expect during an important conversation. In this situation you are either boring them to death or perhaps they have a retained defensive visual reflex.

In the clinical situation we rely upon the case history as provided by the parents, but also a simple test which, although designed to check that the peripheral visual fields are functioning correctly, also serves as a very good indicator that the child has the retained visual reflex. The test involves the child sitting directly in front of the practitioner and staring at their nose while covering firstly the right eye and then the left. An isopter (i.e. an inverted cocktail stick) is then introduced slowly into the peripheral visual fields of each eye in turn from above, below, left and right. The child with a retained visual reflex finds it impossible to keep looking at the practitioner’s nose and looks at the isopter as soon as it become visible.

Many practitioners from various disciplines believe that retained reflexes should be treated by the provision of specific exercises often termed the ‘bottom-up’ approach. However, it is my personal belief that all retained reflexes are better treated by getting the brain to do what it should do naturally in a top-down approach. The treatment of this retained visual reflex could not be easier and works by getting the right magnocellular area to do its job properly in an adult discriminatory manner. To do this, all that is required is a Where’s Wally book and a simple computer-generated program.

The Where’s Wally book is placed upright immediately to the right of a computer screen and the child sits in front of the book and has six minutes to find as many of the characters and objects as possible. The computer program generates patterns on the screen the colours, size and frequency of which are specifically designed to stimulate the magnocellular cells of the right parietal cortex. The treatment is carried out at home on a daily basis for a period of eight weeks, after which the child is reassessed in clinic. Generally speaking a significant improvement in the child’s ability to fixate on the practitioner’s nose is seen in eight to twelve weeks.

When treating children with any learning or behavioural issues it is essential to provide dietary advice, suggest supplementation with quality omega 3- & omega-6, together with vitamins and minerals at age appropriate doses and provide a treatment regime specifically tailored to the child’s unique needs.

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Dr Robin Pauc

About Dr Robin Pauc

Robin Pauc is a Past Assistant Professor of Clinical Neurology. He has been in clinical practice for over 30 years and now has a special interest in developmental disorders in children. Robin is the author of a number of books covering a variety of genres – anatomy, poetry, a user’s guide to spinal problems and learning and behavioural issues of childhood. Robin is the founder of The Tinsley House Clinic, which is situated in the New Forest National Park and provides an ideal setting for both research and treatment. Robin has a particular interest in the treatment of children who have previously been diagnosed with Dyslexia, Dyspraxia, ADD, ADHD, OCD and Tourette’s syndrome of childhood. For more information you can visit