ADD Overlooked: Cognitive Anxiety

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ADD, as the single cause of cognitive anxiety, is often overlooked: generally speaking ADD/ADHD is one of the most frequently overlooked diagnoses seen everyday in the office. Missed in children, most often missed in adolescents and adults.

At this moment in time no one asks about cognitive anxiety.

Even today few grasp the evidence that ADD is genetically inherited, can have a high .25 heritability index [25% have it] in children with an ADD parent, and .82 heritability index in identical twins. While those rates are high, some say the incidence of heritability is higher than these numbers. ADD is biological, not character malformation. But what and where with the biology: What part of the brain?

In an earlier comment here an interesting and experienced coaching consultant Lyle Lachmuth, “The Unsticking Coach” over at Creative Careers Unleashed, sees these problems often with some of his most interesting clients. But Lyle is caught like many of us waiting for the right test results to proceed.

So just what is this odd thing called Cognitive Anxiety?

Friends, we won't be able to cover this complex question in one post. It is so interesting and so pervasive, and, the good news, so very treatable. When I get started on this subject I can go on for hours, so let's keep Monday simple:

Cognitive anxiety is: unmanageable, or barely manageable, cognitive abundance. Thinking too much, worrying, fretting, indecision, paralysis of analysis… ever seen any of that? Somewhere in my machine is my paper on this very subject – you will get a kick out of the title: “Multivariant Thinking: The Clinical Implications of Unmanageable Cognitive Abundance.” A bit over the top for Monday, but you catch my drift.

Said another way, cognitive anxiety is mental anxiety, affective anxiety is felt somatically, in the body.

The new title for that paper: “Racing Thoughts…” – but what quickly comes to your mind with “racing thoughts?” Let's see… bipolar?

Remember this: cognitive anxiety is cognitive, can be associated with bipolar, but not with your successful exec who has struggled for years with board meetings, or the car salesman who cannot stand his promotion to manager. In this subset of ADD too many variables at once decreases executive function unless it is life and death.

Have a surgeon patient with ADD who is totally on when the blood flows, is totally off with financial reports.

The brain biology of thinking too much we can see on SPECT scans. We can demonstrate what everyone already knows, slowing in the prefrontal cortex with diminished executive function. This slowing can be demonstrated in qEEG's for neurofeedback evaluation, and with a variety of other tools. Evidence is there, the person is suffering, and we are wondering: does this disorder count? Am I being scammed? If I give meds will that make him medication dependent? What do we do in the office?

The most frequent ADD presentation in the office: Cognitive anxiety, period. More about what we do next post.

9 Comments

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  5. Chuck Parker says:
    December 31, 2006 at 2:10 PM

    Thank you Dr Hal, hope you won’t be too snowed in up there!
    Best in 07!
    Chuck

  6. Chuck Parker says:
    December 23, 2006 at 1:18 PM

    Dr Hal,
    Thanks for your thoughts, shared by many, and right to the point. First of all, I jumped on the original blog text to make sure that I really didn’t say “ADD as the single cause of cognitive anxiety” Said it right there in the first sentence, -got me! Ouch!

    Thought I didn’t say it that way because I am so much against categorical thinking: “Only, single, always.” etc.

    I did go on to say that ADD is the “most [frequently] overlooked cause of cognitive anxiety in the office,”-is most frequently overlooked as the primary [main, “single”] biologically treatable cause of cognitive anxiety. This is my experience, I overlooked it for years.

    Most do think of cognitive anxiety as having a depressive, or bipolar origin. The result is often the wrong meds. Neither of those two med subsets completely turns the cognitive anxiety around, and both often amplify cognitive anxiety of ADD origin.

    Totally agree that cognitive anxiety is “almost always”associated with psychological variables.

    Yes, can see the ADD changes and the cognitive stuckness on SPECT, and SPECT will help affirm the ADD clinical origin.

    Will be sending more posts on the SPECT/ADD subject,

    Thanks Hal for bringing this excellent point of clarification, appreciate it!

    Cheers for the season.
    Chuck

  7. Dr. Hal says:
    December 22, 2006 at 11:39 PM

    Chuck,

    “ADD, as the single cause of cognitive anxiety” is a very bold and powerful statement. Are you stating that ADD is the only cause of cognitive anxiety?

    I have always looked at cogntive anxiety as being of psychological origin. It sure make sense that ADD is a cause of cognitive anxiety and may account for some patients who fail to respond to traditional medications for cognitive anxiety.

    Are there different findings in SPECT scans for cognitive anxiety caused by ADD and psychological dynamics?

  8. Chuck Parker says:
    December 12, 2006 at 8:36 AM

    Hey Lyle,
    Please call me Chuck, since we’re now working together! Hard to speculate exactly what your waves were, can get anxiety [more affect with some cognitive from Beta], and with the Delta a person suffer cognitive anxiety because they aren’t sorting material as well as they would like.

    Yeah, for us in the inside I use the tech term “cognitive anxiety.” But when I talk to patients I make it even simpler: Thinking too much. Unable to make decisions.

    And easier yet, I break anxiety into: Feeling Anxiety and Thinking Anxiety, and score them out on both carefully at the outset.

    Have asked these questions on thousands of visits over the last 12 years, and am confident understanding these matters will help change our approach to the way we use meds.

    Thanks again, have a great Holiday!
    Chuck

  9. Lyle Lachmuth - The Unsticking Coach says:
    December 12, 2006 at 7:42 AM

    Thanks Charles!

    Ok, so I was treated for Fibormyalgia with Neurotherapy – FNS and biofeedback.

    Learned through biofeedback how to shift Alpha waves.

    So, I was working on my Cognitive Anxiety?

    Hey, I love that term!!

    Thanks again, LL