Attention Deficit Disorder: A Neuropsychoanalytic Sketch

A neuropsychoanalytic sketch of attention deficit disorder (ADD) is presented. The syndrome is defined in terms of its core symptoms, and discussed from the perspective of etiology, pathogenesis, diagnosis, differential diagnosis, and treatment. Also unique is the effort to describe the patient's inner experiences and begin to map these onto the external perspective of what is happening psychologically and neurologically, that is, inside the patient's brain (chemically, anatomically, and neurophysiologically). A number of speculations are thus created regarding the role of the executive control network (ECN), particularly, that of the basal ganglia, cerebellum, anterior cingulate, and those parts of the ECN that are responsible for such things as cognitive shifting between low-level routine information processing modes and those used for high-level processing applicable for sensitive or complex analysis. The effects of trauma on the tagging of memories are also considered. In this manner the research of Shevrin et al., Posner and Raichle, Gedo, Levin, and a number of others integrating mind and brain is brought to bear on an illness with known cognitive and personality disordering. This paper complements a companion paper on the subject of learning disability (Orenstein and Levin, in press).