It’s All in Your Head: Treating Attention Disorders

by Lisa Watts

Pediatrician Skip Baker ’64 likes to tell the story about how his grade point average went up a point and a half during his sophomore year at Wooster.

"I thought maybe I had figured out how to study, finally," jokes Baker. "But I realized later that it was the same year I started smoking."

Research is beginning to show how stimulants such as nicotine and caffeine raise dopamine levels in the brain in the same way as Ritalin and Adderal, two common medications for attention disorders. But Baker has long suspected the connection.

"We’ve been self-treating ourselves since before Columbus discovered America – stimulating our brains with chocolate, coffee, tea, tobacco, heavy exercise. Montezuma drank forty cups of chocolate a day. The French philosopher Voltaire drank sixty cups of coffee a day."

As a founder of the Descanso Medical Center for Development and Learning in La Canada, California, Baker treats children and adolescents who have learning or behavioral problems related to attention deficit disorders. Business is booming. Attention disorders affect from 10 to 15 percent of the population nationally, he says. This past winter his center couldn’t book new patients until July.

To Baker, ADD or its hyperactive version, ADHD, are matters of brain chemistry. Researchers have identified the prefrontal cortex, above the eyes, as the part of the brain that handles short-term memory, impulsivity, and reading comprehension, among other tasks. As early as 1989, brain scans showed lower levels of glucose utilization in that area of the brain in people with attention disorders.

"This is a neurobiological issue – not an emotional or environmental one," says Baker, also a clinical professor of pediatrics at University of Southern California School of Medicine. "When you help that biological difference in the brain, a lot of things get better."

Baker was featured in a 2002 documentary, Misunderstood Minds, produced by the Public Broadcasting System. In the video, he works with Lauren, an eleven-year-old who was having trouble making friends and keeping up with her schoolwork. Clinical tests reveal classic indicators of attention deficit disorder. Baker recommends medication, which Lauren’s family resists.

Parents often are reluctant to medicate their child, Baker says. They can try behavioral changes and other strategies, he says, but medication can fix imbalances more simply. He offers an analogy. "Let’s say you can’t see the blackboard in school. There are lots of strategies you could employ. You could always sit up closer, you could have someone take notes for you, you could tape-record the lesson. But you could also put on eyeglasses."

In the documentary, Lauren’s family moves her to a different school, but her problems return. Finally, when Baker tells the parents that Lauren is statistically twice as likely to be drawn to cigarettes and alcohol for the chemical stimulation, the parents decide to try medication. Her improvement, academically and socially, is remarkable.

Physicians should monitor and adjust a child’s medication as closely as they would with insulin or thyroid medicine, he says.

Attention problems continue into adulthood, but "most adults can adjust their lifestyles to fit their needs," Baker says. Youth with ADD or ADHD, however, can run smack into a brick wall: school.

The issue hit home when the Bakers’ oldest son, who had struggled through high school, came home from community college drinking up to a dozen Diet Cokes a day. Seeing an obvious attempt to self-medicate, Baker had his son diagnosed and evaluated for medication. The young man has responded well to the change.

Baker has another son attending medical school. Faculty members there, perhaps closer to the cutting edge of neuroscience, offer students options beyond the standard lecture format, including tapes for auditory learners and study guides for more visual learners. Baker hopes research on learning styles will keep trickling down to eventually reach public elementary schools.

"We are expecting our kids to do things in third and fourth grade that we weren’t doing until junior high," Baker says. "Our brains all work differently. My brain, for example, works best by listening and talking. I have a good friend who’s a movie director. He never went to lectures in grad school. He gets his information best by reading and writing. Yet we’ve created schools as if our brains all work the same."