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Life

My ADD: Curse or Gift?

SECOND OF TWO PARTS: Scientists now think ADD helped propel human culture. But that was before desks, schedules, and Ritalin.

By Dee Hon 14 Dec 2004 | TheTyee.ca
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[Second of two parts. Read part one here.]

At age 30, I have finally come to understand that I have Attention Deficit Disorder, and am starting to experiment with drugs to calm my racing mind, the better to fit in with the demands of today's society. When I tell people this, they tend to react with the kind of pity reserved for people with an illness, as if I am somehow broken, rather than merely different.

But scientists are finding reason to stop thinking about ADD as a genetic "disease." Indeed, a strong case can be made that my modern "affliction" was, many thousands of years ago, the very adaptation that allowed human culture to make a great leap and flourish.

Crash course in gene science

To understand why, bear with me for a bit of biology course. Human behaviour is a complex web, but numerous researchers have found strong associations between ADD and a gene on the 11th chromosome called DRD4.

The 'DR' in the name of the gene refers to its role in the formation of receptors for the neurotransmitter dopamine. People with ADD are thought to have less active dopamine receptors in the prefrontal cortex of the brain - a result of having a different variant of the DRD4 gene.

DRD4 exists in numerous different variations, or alleles; it has more variations than is found in most other genes. Most people - about 65 per cent - carry a version called 4R. The allele contains a nucleotide sequence that repeats itself four times. The 7R allele (seven repeats) is most strongly associated with people with ADD. 7R is rare in Asians, some of whom carry the 2R allele. 2R is thought to have derived from 7R. It also produces a blunted dopamine response, but appears to have less pronounced effects than 7R.

When researchers in the late 1990s surveyed genes  from a worldwide population, they found a surprising result. Almost 20 per cent of people in the world carry the 7R or ADD allele. Another 9 per cent - mostly Asians - have the 2R allele. The other alleles, which range from 3R to 11R, are poorly studied. They make up the remaining five per cent. The path from genes to gene expression is twisted and fraught with dead ends. Environmental factors and a person's biological development help determine whether a gene's effects - the phenotype - are seen. But even estimates based on diagnostic criteria indicate between three and nine per cent of people in western countries have ADD.

Disease, disorder, gift?

Those numbers and the genetic data challenge the idea that ADD is, from an evolutionary standpoint, a disease. Genetic diseases are typically rare, and found in genetically isolated pockets of the population. Compare ADD with the rates of even the most common genetic diseases. Cystic fibrosis affects one baby in every 2,000. Tay-Sachs disease hits in one in 30 American Jews. Hemophilia affects one in 1,000 males, though its prevalence amongst members of the German, Russian, and English royal families made it a model for genetics textbooks everywhere.

But people with ADD come in all humanity's colours. What's different about ADD that has made it spread across the earth? Why hasn't nature sequestered 7R to a few small, inbreeding populations? Maybe ADD is more than an ancient curse. Perhaps it's a gift as well.

"Men's evil manners live in brass, their virtues we write in water," Shakespeare wrote in Henry VIII. Could this also be true of how our society looks at those with ADD? What virtues have we overlooked that could make 7R so successful?

Wild ride

On Alberta's upper Red Deer River, annual springtime melts bring the water to a raging froth through six sets of rapids, each of them natural drowning machines. My job for two summers was to navigate these rapids in an inflatable raft powered by a dozen screaming customers. I was good at my job. I could pilot the boat within a margin of inches, where mistakes might have spelled disaster. I liked fishing petrified people from the water when they became too scared to swim. Keeping focus was never an issue, despite my ADD. I got bored and missed being on the river while on my days off.  

When I started looking into my life with ADD, I knew there were things I wasn't good at - things I wanted to fix. I was a poor fit for my last job tethered to a cubicle. I was the first laid from off in an office purge because my poor focus and persistent tardiness made me most expendable. But there are many tasks I excel at too; challenges where I am both capable and eager. I've just begun to see I may owe some of my strengths in part to my ADD.

I always hated school. But that doesn't mean I wasn't learning. My grade three psychological evaluation noted my only wish in life was for "no homework." Yet when asked what I did for fun, the psychologist's notes say "read books: encyclopedias, history." I left high school without graduating and rode the rails in Europe when I was 17. I had never felt so at home in my life.

Tribe of dreamers

People with ADD are often dreamers - explorers in mind, if not also in body. They hyperfocus and excel at activities that engage them. That they're easily bored can also be seen as a constant ache for challenges to excite them. Their distractedness makes them observant of details others miss. It's natural for them to be inventive and think outside the box. They never fit inside the box to begin with.

The list of famous people with scattered minds is long, and includes Leonardo da Vinci, Albert Einstein, and Winston Churchill. Da Vinci admitted the classic ADD problem with finishing projects because his interests were "so many and so diverse."

Thomas Edison - who later claimed more than 1,000 patents - so infuriated his schoolteacher with his daydreaming and self-centered behaviour his mother withdrew him from class.

"I heard the teacher tell the visiting school inspector that I was addled and it would not be worthwhile keeping me in school any longer," Edison later recalled. His mother told the teacher her son had "more brains" than him, and schooled the youngster at home.

Many people with ADD find success in jobs that require creativity or have lots of action. They can make good musicians, artists, emergency room nurses, or as in my case, whitewater raft guides.

ADD and the great leap

Somewhere on our road from cave to condo, we stopped living like mere animals. Archaeologists and geneticists agree our climb from beast to force of geological power was quick and dramatic. Some 50,000 years ago, we left Africa's Garden of Eden, became artists, explorers, and deadly hunters. Genetic evidence indicates a great population explosion and the start of human expansion across the globe.

This great leap forward was by far the most important event in our species' history. Only the advent of agriculture some 40,000 years later approaches this dawn of culture in significance.

But why did it happen then? Homo sapiens appeared in Africa 150,000 years ago. These first humans had the same brain size and similar anatomy to us. And yet a hundred millennia passed before any of them made art, learned to fish, or left the continent. Why did we wait so long?

Prominent researchers believe the simplest answer lies in our genes. Some unknown change in our DNA made us smarter and more adaptable. Now fresh research, including a paper published this spring, indicates a new gene emerged during this cultural awakening. The first person on the planet with the DRD4 7R allele - the ADD gene - may have appeared 50,000 years ago.

'Ah ha!'

A leading proponent of this theory is Dr. Robert Moyzis who, with a team of researchers at University of California Irvine, collected genetic samples from around the world and sequenced the DNA. One day, as Moyzis sat on a plane examining the data, he was struck by what he saw.

The frequency of both the 4R ("normal") and 7R (ADD) alleles of the DRD4 gene suggests these alleles are more than 300,000 years old - older than our species and presumably passed down from our proto-human ancestors. But Moyzis' sequencing data indicate 7R is in fact much younger - about 50,000 years old.

"It was one of those all too infrequent 'Aha!' moments in science," Dr. Moyzis recalls. "My reaction was 'my goodness, where did this come from?' It looked like it got dropped from Mars."

7R couldn't have become so prevalent in the human population within that time frame by mere chance alone - it could only mean positive selection, concluded Moyzis and other experts. In other words, those with ADD thrived in the world they inhabited.

Moyzis had seen a similar pattern before. Genes for pathogen resistance spread quickly through humanity after the birth of agriculture some 10,000 years ago.

'Response-ready' migrants

The question arises: If the ADD gene has been so beneficial, why isn't nearly everyone ADD today? The likely reason, say experts, is balanced selection, where any particular allele's dominance relative to the others is held in check by a kind of evolutionary rock-paper-scissors game. It may be good to have a few people with ADD in a society, but too many might spoil the mix.

Researchers call the typical 7R behaviours "response-ready." People with the allele scan the environment without paying undue attention to minor details, but hyperfocus on more significant stimuli. 

And that's just what the doctor ordered, so to speak, if you were a human being 50,000 years ago, embarking upon the great exodus from Africa - attempting to migrate and survive throughout a much harsher world than the one we inhabit today. It's likely people had long been pushing unsuccessfully at our species' bounds. But suddenly we learned to adapt to the new challenges we faced.

A different intelligence

Humans faced more than just new environments during that migration. The world's climate fluctuated wildly throughout the exodus. Human genes would not have been able to react to speed at which the challenges came. Only our intelligence would have allowed us to survive. Famed psychologist Jean Piaget defined intelligence as what you do when you don't know what to do - when nothing you've encountered has prepared you for the situation you face. A varied environment promotes intelligence over rote repetitions of patterns.

Our species now occupies every continent on earth, in all its varied ecosystems. The long journey would have favoured people who sought out and could adapt to new challenges. People with 7R were just such individuals.

In fact, in South America - the last major leg of humanity's 40,000 year journey - natives have the highest frequencies of the 7R allele found anywhere in the world. The Ticuna of Colombia have a 7R frequency of 78 per cent and other South American native groups average 63 per cent. Mayans from Mexico's Yucatan region have a 7R frequency of 39 per cent. North Americans like the Cheyenne and the Jemez Pueblo average 26 per cent. 7R frequency is correlated to migratory distance. Similar patterns exist throughout the world.

ADD elsewhere

If the 7R allele (and its Asian derivative 2R) was once a great asset to our species, today our formalized schools - which have only existed for a minute fraction of human history - have no room for kids who don't fit the mould. We're shoehorning them in with drugs.

Is this the wisest course of action? It's not the only one. Dr. Moyzis points out that in South American countries like Chile, tolerance for what we would call ADD behaviours is much different than in ours. Students there for example, are heavily graded on their classroom participation - encouraging them to be more actively engaged.

"Rather than saying this is a disorder, we should nurture what these kids have," Dr. Moyzis suggests.

As an adult, I can make an informed choice for myself whether to take drugs or not. I can hunt for a niche in society where my ADD doesn't hinder me. But how much should we be medicating our kids so they can fit our classroom ideals? And how much should we instead be trying to build a place where they can realize their strengths?

My daily dose

I've been taking Ritalin now for 2 weeks, and I can't call it a complete success. I'm more productive when I'm on it. I take fewer breaks and am less distracted. But I don't feel as creative. My muse seems more distant and ideas don't come as easily to me.

I tell my psychiatrist my dilemma. I'm reluctant to toss away the hand dealt to me from all those years ago. If I lived as a prehistoric nomad, would I even bother to treat my so-called ADD? He looks at me over his glasses and gives me a smile.

"Probably not," he says with a shrug. "But in our society, we all have to work." He hands me my prescription and walks me to the door.

Go here for the first part of this story, 'Attention Deficit Disorder: A Personal Investigation'.

Vancouver-based Dee Hon is news editor for Terminal City weekly and occasional contributor to The Tyee.  [Tyee]

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