CHAPTER XIII- A WORD ON ADHD [Attention Deficit Hyperactivity Personality] &
Sympathetic Dominance Effects
In today’s world obsession about children who may not behave as expected is growing. This
is leading to confusion of many personality types with each other. Most importantly, attention
deficit and/or hyperactivity are frequently lumped within the autistic spectrum. This could not
be farther from the truth. There is no relationship between a sensitive autistic child who is
trying to decipher all the sources of stimulation and get used to them and between an
insensitive hyperactive child who cannot pay attention to any source of stimulation. In fact,
autism and ADH personality fall at opposite ends of the personality spectrum.
An autistic child is one who doesn’t throw stones at any one no matter how much he or she is
hurt. An attention deficit/hyperactivity (ADH) personality child may torture the neighbor’s un-
neutered dog for pleasure on any given afternoon. Most adults reading this can remember
from their childhood, that child in the neighborhood who seemed to be able to put his hand in
fire. That child who was constantly fighting and bullying or who finished a 2-hour exam in
fifteen minutes. ADH personality leads a child to grow up typically into excellent role player;
they can mold themselves usually into the role assigned to them with relative ease. Autistic
children on the other hand grow into adults who only thrive when they create and customize
their own environment.
ADH personality children are prone to harm themselves even early in life. They need watchful
eyes to protect them from themselves. In addition, as many parents agonizingly know, ADH
personality children are difficult to feed. They often refuse to eat. Their appetite is very
limited. The parents may have to come up with a multitude of tricks in order to feed them.
Later on as teenagers, once puberty sets in, these children are more likely to develop eating
disorders such as anorexia nervosa.
A consistent finding in ADH personality is relatively lower cortisol, a dysfunctional HPA axis
together with increased sympathetic system activity and high adrenaline and noradrenalin
compared to other children. This is a different dimension of sympathetic dominance. Usually
both adrenal cortisol and sympathetic adrenalin are simultaneously released in response to
strain. Sensitive people are more comfortable and resolute in the presence of adrenal
dominance. They favor their behavior during cortisol surges and may feel an out of body, out
of character experience with any sympathetic dominance. Some learn to accept it thinking it
must be how their body is changing with age, but it never really becomes part of their
constitution. On the other hand, ADH personality children and adults are very comfortable
with sympathetic dominance and would feel like an out of body, out of character experience if
cortisol took over the stress response.
This could be in large part responsible for the disruptive behavior ADH personality children
often instigate. Their behavior is usually a problem for the teacher in class, for their parents
who may need 5 quiet minutes to speak with a visiting old friend in crisis… In addition, these
children can be a danger to themselves in the sense that they may test the extent of their body’
s tolerance for endurance in an effort to stimulate themselves and keep their mood even. They
may also be too aggressive in play with other children. Their emotional arousability is usually
very low, so they don’t typically feel fear the way sensitive people do, and they feel all
possibilities are open for them. Moreover, they feel the need to challenge their body to the limit
in order to get their pleasure centers activated. We call them thrill seekers.
Some work has rightly focused on the degree of emotional arousability of ADH personality
during the resting state. The common observation is that many of these children have a
relatively low level of emotional arousability. Having lower arousal and being less arousable by
events leads them to constantly seek further stimulation and larger magnitudes of it.
Psychologically, these children have a free behavioral activation system, which is dominant
over the behavioral inhibitory system. Yet emotionally, they often have a danger model for
social interaction, the distant type. These children grow into the warriors in society. They
would get up and go to Vietnam without giving their mortality a single thought. They are the
firefighter who walks into a burning building at a moment’s notice. They are the spouse who
cheats on his or her spouse at the drop of a hat, and does not seem to regret it or give it a
second thought. Sadly, however, they may grow into the Enron and MCI executives who
have no problem ruining the pensions of a few hundred thousand innocent people. They do
not fear for their safety and they do not relate to other people. As a cautionary note, of course,
not every corrupted executive is an ADH personality and not every ADH personality grows to
become a corrupted person. However, it is easier to do it with this personality type when one
cannot relate to other people’s misery or remember it later for that matter.
There are very common characteristics shared by the average neurotypical person and the
ADH personality. In a way, ADH personality is neurotypical taken to an extreme or “gone
wild”. It certainly does not help to box the ADH personality within the notion of disorder. It
probably would be more helpful to help parents acknowledge the perks and risks of the ADH
personality, so they can raise their ADH child in a way to maximize its attributes and minimize
the untoward components.
To get into the mind of a person with an ADH personality, the closest way would be to drink
enough caffeine, ginseng and other stimulants until one feels:
- The thoughts racing unstoppably through their head
- Unable to sit down for longer than a second at any one point
- And trying to do a million things simultaneously
I am not advocating you drink a ridiculous amount of caffeine to experience how the ADH
personality feels like. However, for those who have had such accidents in their life may be
able to relate. Now imagine that one is on that stimulant-driven high 24 hours a day, 7 days a
week. May be then one can get a glimpse of the behavior of these poorly understood children.
Typically, when talking to someone with an ADH personality about a particular subject this
person sometimes seems to answer about another subject. In fact due to this constant thought
racing, when you get to ask the second question, the child has gone to the 8th or tenth
thought by then and he or she answers based on where they have reached in their thoughts.
These children do not realize that their racing thoughts are not something the average adult
understands. They genuinely believe they are on top of the conversation. In a way, the ADH
children are isolated too, in that they only recognize themselves and not their surroundings. A
loving and caring home environment can take this point into account and help the child rewind
her thoughts frequently until she realizes that conversing and learning is more about keeping
pace with the environment and interacting with it than it is about keeping pace with their
racing thoughts. Many ADH children can learn to use this property to their advantage as they
grow up. They can use it in academic work or excellence in business and so forth as long as
they learn to gain insight into their personality. This insight can help them control their pace
while in the company of others.
There is some emerging evidence of a family of neurohomrones known as hypocretins that
seem to provide some promise for these poor children. It appears that one of the functions of
the hypocretins is to act as a switch between the HPA axis and the central sympathetic system
handing the dominance to either system during a variety of circumstances. As more
convincing evidence emerges, it may become possible in the future to restrain the central
sympathetic system’s firing thus at least limiting the dysfunction the ADH personality brings.
In fact, it may turn out, that ADH persons growing up eventually learn to engage this chemical
switch through interaction and failure. However, it would be helpful to engage the switch at a
younger age in order to facilitate learning and orderly development.
The Heartmath institute is doing wonderful work on sympathetic to parasympathetic
balancing. They develop computer programs that administer exercises aimed at reducing
sympathetic dominance. These exercises can be done anywhere a desktop or a laptop is
found. The beauty of their program is that it can be done within the native environment where
a child is having difficulty, be it the home, a play date or the school. The program runs one
through a series of exercise aimed at producing harmony between sympathetic and
parasympathetic forces within. This is usually much more effective than taking someone out
of their environment in order to help them habituate.
Figure 8: Possible Stress System Switch that could be a target for optimizing ADH behavior –
color image http://bit.ly/psafig
Specific Case for Girls:
It may be worth noting that about 4-5% of all girls present since birth with a unique adrenal
functional combination consisting of limited capacity for cortisol production and increased
adrenal production of androstenedione and dehydroepiandrosterone (DHEA) since birth and
even starting in the womb. These girls tend to rely more on their sympathetic (adrenalin) in
handling stress. The result is a girl who is more interested in physical play, more aggressive
sports, may be frequently seen dominating older boys or tampering with school property.
Unfortunately, these girls may be looked at more as boys than girls in society and may suffer
from social isolation even early on. These girls may represent one sliver on the far right end of
the personality spectrum tending to show the ADH personality sometimes combined with
interest and attraction towards the same sex later in life. At this stage, the adaptive advantage
of this sliver on the personality spectrum is not completely clear but I suspect it may be
related to a protective role over other girls less equipped to protect themselves.
It is very important to recognize these qualities early on for validation purposes for the child
and to set the expectations of the parents early on. Many parents, to this day are conflicted by
a grown daughter who plays football and likes girls. Recognizing the personality
characteristics and the physiologic underpinnings gives parents time to accept their daughter’s
personality and to help her build her self-confidence and be herself when society takes on the
role of marginalizing her and driving her into guilt for no other reason but who she is.
Please note that the author does not claim to have found the genetic or physiologic basis for
homosexuality in women or men for that matter. The above section only describes one
documented and commonly observed possibility potentially associated with homosexuality.
Salivary cortisol and cardiovascular activity during stress in oppositional-defiant disorder boys
and normal controls
van Goozen SH, van Engeland H et al. Biol Psychiatry. 1998 Apr 1; 43(7):531-9.
BACKGROUND: Arousal-regulating mechanisms are important in explaining individual
differences in antisocial behavior. METHODS: Alterations in salivary cortisol concentration
and cardiovascular activity were studied in 21 boys with oppositional defiant disorder (ODD)
and 31 normal controls (NC) during a 2-hour stressful procedure involving frustration and
provocation. RESULTS: Baseline levels of heart rate (HR) were significantly lower in the ODD
group, but their HR levels were higher during provocation and frustration. Cortisol levels in the
ODD group were overall lower than those of the NC group, and the effect of stress seemed to
be minimal and similar for both groups; however, individual differences were large. Since
anxiety plays an important mediating role in cortisol response, subjects were divided into one
of four groups based on the intensity of their externalizing behavior and anxiousness. Cortisol
increase due to stress exposure was strongest in highly externalizing and highly anxious
subjects; cortisol decrease was strongest in those subjects who were high in externalizing
behavior and low in anxiousness. CONCLUSIONS: The results of the study support an
important role for hypothalamic-pituitary-adrenal axis sympathetic autonomic functioning in
persistent antisocial behavior in young boys.
Nurse evaluation of hyperactivity in anorexia nervosa: a comparative study.
van Elburg AA, Hoek HW, Kas MJ, van Engeland H. Eur Eat Disord Rev. 2007 Nov;15(6):425-
Department of Child and Adolescent Psychiatry, Utrecht, the Netherlands
Up to 80% of patients with anorexia nervosa (AN) manifest elevated levels of physical activity
or hyperactivity. A variety of methods have been used to evaluate activity levels, mostly
questionnaires but also expensive and invasive methods such as actometry or other
measurements of energy expenditure. Nurse observations have heretofore not been tested for
validity and reliability. In this study, 18 patients with AN under treatment in a specialized eating
disorder centre simultaneously rated their own physical activity levels, used an actometer, and
were observed for physical activity by trained nurses. We found that nurse ratings of activity
correlated significantly with the average actometer activity score (r = 0.61, p < 0.01). Patients
could not rate their own activity levels accurately. Nurse observation of activity levels of AN
patients during treatment is a reliable and useful monitoring tool.
Salivary testosterone and aggression, delinquency, and social dominance in a population-based
longitudinal study of adolescent males
van Bokhoven I, van Goozen SH, van Engeland H, Schaal B, Arseneault L, Séguin JR, Assaad
JM, Nagin DS, Vitaro F, Tremblay RE. Horm Behav. 2006 Jun; 50(1):118-25. Epub 2006 Apr
Testosterone (T) has been found to have a stimulating effect on aggressive
behavior in a wide range of vertebrate species. There is also some evidence of a positive
relationship in humans, albeit less consistently. In the present study we investigated the
relationship between T and aggression, dominance and delinquency over time, covering a
period from early adolescence to adulthood. From a large population-based sample (n = 1.161)
a subgroup of 96 boys was selected whose behavior had been assessed repeatedly by different
informants from age 12 to 21 years, and who had provided multiple T samples over these
years of assessment. On the whole, a decrease in aggressive and delinquent behavior was
observed in a period in which T rises dramatically. Boys who developed a criminal
record, had higher T levels at age 16. In addition, positive associations were
observed between T and proactive and reactive aggression and self-reported delinquent
behavior. Over the pubertal years different forms of aggressive and delinquent behavior were
positively related to T, which may indicate that specific positive links are dependent on the
social setting in which this relationship is assessed.
AUTHOR’S COMMENT: there is a good faith, yet misguided effort to explore the role of
excess “male” sex hormones in autism. In fact, most of the convincing evidence in the
literature points to increased testosterone in children with ADH personality fueling aggressive
and disruptive behavior. There is no room in this book for a more detailed description of the
role of sex hormones in childhood and puberty. It takes plenty away from the core focus of
the text in this first edition. However, Dr Bruce McEwen of Rockefeller University is an
author worth mentioning in this field. He has written volumes on the developmental effects of
sex hormones. Hopefully, if I live to finish a second edition of this book, the topic of sex
hormones and other relevant but more peripheral topics will be expanded upon.
CASE FOR GIRLS:
Prenatal androgenization affects gender-related behavior but not gender identity in 5-12-year-
old girls with congenital adrenal hyperplasia.
Meyer-Bahlburg HF, Obeid JS et al. Arch Sex Behav. 2004 Apr;33(2):97-104.
Department of Psychiatry, Columbia University, New York
Gender assignment of children with intersexuality and related conditions has recently become
highly controversial. On the basis of extensive animal research and a few human case reports,
some authors have proposed the putative masculinization of the brain by prenatal hormones-
indicated by the degree of genital masculinization-as the decisive criterion of gender
assignment and have derived the recommendation that 46,XX newborns with congenital
adrenal hyperplasia (CAH) and full genital masculinization should be assigned to the male
gender. The purpose of this study was to test in CAH girls of middle childhood the assumption
that prenatal androgens determine the development of gender identity. Fifteen girls with CAH
(range of genital Prader stage, 2-4/5), 30 control girls, and 16 control boys (age range, 5-12
years) underwent 2 gender-play observation sessions, and a gender identity interview yielding
scales of gender confusion/dysphoria. About half a year earlier, mothers had completed 2
questionnaires concerning their children's gender-related behavior. The results showed that, as
expected, CAH girls scored more masculine than control girls on all scales measuring gender-
related behavior, with robust effect sizes. By contrast, neither conventionally significant
differences nor trends were found on the 3 scales of the gender identity interview. We
conclude that prenatal
androgenization of 46,XX fetuses leads to marked masculinization of later gender-related
behavior, but the absence of any increased gender-identity confusion/dysphoria does not
indicate a direct determination of gender identity by prenatal androgens and does not,
therefore, support a male gender assignment at birth of the most markedly masculinized girls.
This is the official version so far of the medical establishment about one of the possible
genetic reasons for homosexuality in girls.
ADULT ADH REFERENCE:
Physiological and psychological stress responses in adults with attention-deficit/hyperactivity
Lackschewitz H, Hüther G, Kröner-Herwig B. Psychoneuroendocrinology. 2008 Jun; 33(5):
Georg-August University of Göttingen, Germany
According to self-report and unsystematic observational data adult patients with attention-
deficit/hyperactivity disorder suffer from increased vulnerability to daily life stressors. The
present study examined psychological and physiological stress responses in adult ADHD
subjects in comparison to healthy controls under laboratory conditions. Thirty-six subjects (18
patients with DSM-IV ADHD diagnosis, 18 sex- and age-matched healthy controls) underwent
the Trier Social Stress Test, a standardized psychosocial stress protocol which contains a
stress anticipation phase and a stress phase with a free speech assignment and subsequent
performance of a mental arithmetic. Physiological stress measures were salivary cortisol as an
indicator of the HPA axis, heart rate (HR), and time- and frequency-domain heart rate
variability (HRV) parameters. Subjective stress experience was measured via self-report
repeatedly throughout the experimental session. In line with previous theoretical and empirical
work in the field of childhood ADHD, it was hypothesized that the ADHD and control group
would exhibit comparable baseline levels in all dependent variables. For ADHD subjects, we
expected attenuated responses of the physiological parameters during anticipation and
presence of the standardized stressor, but elevated subjective stress ratings. Hypotheses were
confirmed for the baseline condition. Consistent with our assumptions in regard to the
psychological stress response, the ADHD group experienced significantly greater subjective
stress. The results for the physiological variables were mixed. While ADHD subjects revealed
an attenuated HR during the stress phase, no significant group differences were found for the
other parameters, although a trend was observed for both the low frequency/high frequency
(LF/HF) ratio of the HRV power spectral analysis and salivary cortisol (the latter possibly
indicating generally lower cortisol levels in ADHD subjects). In summary, the present findings
are the first to demonstrate a significant alteration of a specific physiological stress measure
(HR) and, more clearly, of psychological aspects of the stress response in adults suffering
from ADHD. In regard to the physiological stress response, it is recommended that future
studies employ larger sample sizes and a more comprehensive range of physiological stress
parameters. Additionally, the issue of transferability of laboratory results to real life stressors
needs to be addressed.
This is one of the rare studies detailing the response to stress in adults with the ADH
personality. As expected, the study results do not depart significantly from findings
documented in children. The HP-adrenal response is attenuated leaving the rest of the stress
response in the hands of the sympathetic system. Adrenaline is the main player here as it is in
children with the same personality.
This is an excerpt of the book Psyche-Smart Autism TM available on amazon and other book
Copyright 2011 Rami J Serhan, MD
Author: Rami Serhan, MD
(206) 659-1ASD (273)