BRAINSTORMS

   "Attention Deficit Hyperactivity Disorder has become one of the fashionable psychiatric diagnoses of the 1990s. This book, authoritative, engaging, and often entertaining, explains the clinical presentation of ADHD and effortlessly guides readers to an understanding of their underlying neuroanatomy and rational pharmacology.

   Dr. Horacek's stated goal is to help us 'better understand the emotional storms that blow through the brains and souls of the people [we] love,' and he has succeeded admirably. His insights will serve as an invaluable resource for parents, teachers, educators, and psychotherapists."

             Anthony LaBruzza, MD
             Medical Director
             Community Services Division
             Greater Bridgeport CMHC
             Bridgeport, CT

   "Illuminating, comprehensive, and delightfully written, BRAINSTORMS offers a fresh perspective on ADHD and related Disorders. Dr. Horacek addresses their baffling emotional component, recognizing the need for paradigm shifts and an effective reframe for behavior. He simplifies brain chemistry and medication, and arms clinicians with the kinds of understanding that will help them solve the riddle of the complex neurology and psychology governing these syndromes."

             Eduardo M. Bustamante, Ph.D.
             Founder/Director,
             Family Team Development Center
             Amherst, MA

   For those who want to know more - "Brainstorms" is decidedly NOT a first book about ADD.

   After years in private practice, Dr. Horacek has developed a theory about ADD and Common Co-morid disorders, such as Depression, Obsessive-Compulsive and others. One of the few ADD books to give a comprehensive overview of life with these "differences".

   A LOT of medical information and some pretty heavy reading, but well worth the effort.

          Bob Seay
          The Mining Co.
         
NOTE: The full review is available at The Mining Co.

    Horacek begins "Brainstorms" by explaining the emotional storms associated with a myriad of diagnoses and syndromes. Though written with a clinical focus, Brainstorms explores both sides of the "brainstorm" coin - the side of creativity and the side of dysfunction.

   The "Dopamine-Serotonin-Noradreanaline (DSN)" System is based on diagnosis by Target Symptom. It defines domains of neurophysiological dysfunction instead of focusing on a specific diagnosis.

   The DSNQ questionnaire provides me with a tool for a more educated guess regarding selections of medications.Symptoms are grouped and scored according to neurotransmitter functioning. Medications can then be chosen to compliment the DSNQ profile.

   Clonicel, which needs to be compounded by a pharmacist, lessens the rebound effects sometimes experienced with Clonidine. (Interested pharmacists may obtain a free license to prepare Clonicel).

   We then move to the chapter "Beyond Medications" where Horacek, using personal histories, describes how families can be helped by multi-modal treatment plans and basic, old fashioned, paradigm shifts.

   You then revisit Thomas Edison and meet other equally interesting brainstormers of the past. Don't miss the "braintorm" about LifeSavers.

   Horacek follows by discussing Dysgraphia at length. "About 80 percent of the brainstormers that I treat have a significant degree of dysgraphia. Although it often appears to be part of the neurological complex of symptoms of ADHD, it is not listed as a diagnostic criterion and is seldom discussed. Yet I have found that this disability, though as plain to see as the nose on one's face, remains invisible and undetected far too often."

   You'll then revisit Emily, Julie, Jessie, and Ben in the final chapter to learn about their treatment plans and get an update on their lives.

   "Brainstorms" will stretch your brain and leave you standing with more questions in your mind about ADHD and related "Ds" than you began with. According to Horacek, "...this author will be more than satisfied if this effort serves to broaden the field of inquiry a little. As I conclude, if the reader is now as perplexed as I am by the complexities of the human condition, then "Brainstorms" has served its mission."

   But don't take my word for it. Read it yourself for a fresh and genuine ADD brainstorming experience.

(NOTE: To visit Dr. Horacek's personal Website, click on the photo to the left)

   H. Joseph Horacek, Jr., MD was born in Berkeley, California. He attended the University of California, at Berkeley, where he received the President's Research Award for his research and a Bachelor of Arts degree in Human Physiology in 1975. Dr. Horacek received his medical degree from the University of North Carolina, at Chapel Hill, in 1979.

   Upon completion of a residency in Neurology and Psychiatry at UNC, he moved to Duke University where he was a fellow in Child and Adolescent Neurology and Psychiatry.
He then returned to UNC, at Chapel Hill, NC, as a Robert Wood Johnson Clinical Scholar and a member of the faculty in the department of Psychiatry. During that time he was also a research fellow at the National Center for Clinical Infant Programs in Washington, D.C.

   Since 1987, Dr. Horacek has been in practice in Charlotte, NC where he is the founder and medical director for the Center for Neurological Health in Learning.

   Dr. Horacek is a published author, patented inventor and seasoned clinician.

"Children cannot be corrected with effect when their whole body is vibrating with anger and the motor impulses are necessarily too strong for resistance. That intensity of feeling must be given time to spend itself, and a normal functioning resumed, if reason and kindliness are to be substituted as motives"

The Normal Child and Primary Education.
Gesell, A.L. and Gesell, B.C. 1912 p.252 Boston: The Anthem Press. Ginn and Company, proprietors

   This turn-of-the century advice of Gesell and Gesell remains fresh and salient today, as if we were hearing it spoken for the first time this morning. Instead, we find this age-old wisdom in a book written at the turn of the century. Gesell and Gesell recognized then that such emotional episodes were to be found normally in children. The same insight can be applied to the children of today, and to adolescents and adults for that matter.

   Everyone has experienced emotional "storms" at times. Sometimes, stormy emotions can reach very high intensity. When their intensity, frequency, and duration become excessive, they may then be part of a cluster of symptoms that frequently occur together (a syndrome) and reflect an underlying neurobiological abnormality.

   In 1902 British pediatrician George Still (Still, 1902 p. 1077-1082) published an account in The Lancet of twenty children in his practice who were passionate, defiant, spiteful and lacking inhibitory volition, a syndrome he referred to as the "defective moral control. Of these characteristics, "an extreme degree of passionateness was the most constant feature." (p. 1080). Dr. Still made the then radical suggestion that bad parenting was not to blame; instead, he suspected a subtle brain injury, "the result of congenital limitation of the capacity of its development by some morbid condition of the brain dating from antenatal life, but also that it may be due to arrest or delay of its development by physical disease occurring in infancy, and, further, that after there has already been considerable progress in its development it may be lost to a greater or less degree as the result of physical disease, particularly lesions of the brain and certain febrile conditions" (p. 1079).

   In the 1970s Virginia Douglas noted a central feature of a group of children she was studying to be "a problem in regulating one's level of arousal" (p.149-168). The mood lability, hyperarousal and hyperreactivity symptoms are a familiar aspect of many neurobiological disorders. Yet Still's passion and Douglas's arousal dysregulation are still not currently recognized as core features of such disorders.

   Diagnoses often associated with such dysregulated, or "stormy", passion and arousal are included in the table below.

Attention deficit hyperactivity disorder (ADHD)
Impulse Disorder
Chemical dependency (alcohol, caffeine, marijuana, stimulants, cocaine)
Conduct disorder
Bipolar disorder
Anxiety and panic disorders
Dysthymia and depressive episodes
Learning disorder
Personality disorder
Oppositional defiant disorder
Post-traumatic stress disorder (PTSD)
Obsessive compulsive disorder (OCD)
Motor tics Tourette's syndrome
Autism and pervasive developmental disorders
Psychosis (more rarely)
Narcolepsy
Asthma and allergies
Coronary artery disease and hypertension
Irritable bowel syndrome (chronic diarrhea)
Sleep apnea
Vaso-vagal syncope (fainting spells)
Coronary artery disease and hypertension

   The word syndrome is defined in Dorland's Illustrated Medical Dictionary 27th Edition (1985 p. 1629) as: Syndrome [Gr. syndrome concurrence] a set of symptoms which occur together. Syndromes may cross diagnostic lines and span many diagnostic categories.

   We will examine, in this book, a syndrome that I have hypothesize accounts for many core aspects of a wide spectrum of disorders. This book has a clinical focus.

   I have tried to offer what I hope are useful and practical guidelines on how to understand and weather these storms. I hope that not only will physicians and therapists find useful strategies here, but also that teachers and "significant others" will learn from what was taught to me by hundreds who were in their shoes. I have tried to pass along what I have gleaned from my vantagepoint of working day to day in my office practice.

   This book is aimed toward the parents, teachers, scoutmasters, coaches, therapists, and physicians who care for those with the stormy brains. It is also aimed toward those adolescent and adult brainstormers who, though they find reading difficult, are willing to try to weather reading this text. I especially hope that their efforts are rewarded.

   Brainstorms is also written for the spouses, family members, coworkers and friends who struggle to better understand the emotional storms that "blow" through the brains and souls of the people they love. They are the ones who can most clearly see the treasures submerged and hidden beneath the noise.

CHAPTER 1. WHAT ARE BRAINSTORMS?

Johnny and the Case of Little Al:"Oppositional" or "Addled"?
The Brainstorm Self-Assessment-Questionnaire

CHAPTER 2. FOUR BRAINSTORMERS

Emily: The Child Who Would Not Play
Julie: The Explosive Preschooler
Jesse: The Juvenile Delinquent In Search of Self
Ben: Beam Me Up, Scottie!

CHAPTER 3. NEUROBIOLOGY AND BRAINSTORMS

Evidence for Neurobiological Underpinnings of
ADHD and Related Disorders

CHAPTER 4. BRAIN 101

A Very Basic Anatomy Of The Brain:
Introducing Bob
Neurons and Neural Circuits: The Brains' Wires
Dopamine, Serotonin, and Noradrenaline:
Selective Focus, Activation, and Arousal
Bob's Car: A Comedy of Errors?
Mind Versus Brain

CHAPTER 5. NORADRENERGIC REGULATION

Bob's "Mr. Arousal" Machine
Noradrenergic Dysregulation and Post-
Traumatic Stress Syndrome
The Goodness Of Fit Between State and
Context: Healthy verses Crazy

CHAPTER 6. DIAGNOSIS: THE CURRENT STATE OF THE ART

The Case of "Sparky": Syndromes that DefyDiagnosis
Diagnostic Manuals: Which One to Use?

CHAPTER 7. THE STATIC ENCEPHALOPATHIES

Making The Diagnosis of Static Encephalopathy
Medical Office Management of a Major Medical Disorder

CHAPTER 8. THE DOPAMINE-SEROTONIN-NORADRENALIN PROFILE:
DIAGNOSIS BY TARGET SYMPTOMS

Grouping Symptoms by Neurotransmitter Dysfunction
UsingTheDopamine-Serotonin-Norepinehrine profile(DSNP):Bob's Bad Brain Days

CHAPTER 9. THE MEDICAL MANAGEMENT OF THE
BRAINSTORM SYNDROME

The Mushroom Collectors
The Medicine Man: Scientist, Shaman or Sorcerer?
"Unlabeled" Uses of Approved Medications:Common Misconceptions
The Responsibility of the Physician to Treat
Effectively
Rational Complex Pharmacotherapy
Balancing Dopamine, Serotonin and
Noradrenaline Effects

CHAPTER 10. CLONIDINE: "TURNING DOWN THE STEAM"

A Brief History of Clonidine and Its Uses
The Rapid Emergence of Newer Off Label Uses
Mechanisms of Action
Basic Pharmacology
Extended-Release Oral Clonidine: Clonicel?

CHAPTER 11. BEYOND MEDICATIONS

Paradigm Shifts
Oppositional Defiance: Fighting the
Smokescreen or the Fire?
Working with Couples
Revising Personal and Collective Mythologies:
Using Brainstormers from History
Finding and Cultivating the Brainstormer's
Creativity

CHAPTER 12. DYSGRAPHIA AND THE
BRAINSTORM SYNDROME

What Is Dysgraphia?
A Brief History of Dysgraphia
Dysgraphia, the DSM, and the ICD
Emotional Problems Associated with
Dysgraphia
Accommodations for Dysgraphia

CHAPTER 13. DISABILITY AND RESPONSIBILITY: "EXCUSES" OR "REASONS?"

The Case of Bob and the $100 Coca Cola
The Case of Suzy: "Daddy, I Totaled the Car!"
The Case of Rebecca: "I Did Too Do My
Homework! I Just Forgot Where I Put It!"

CHAPTER 14. FOUR BRAINSTORMERS REVISITED

Emily
Julie
Jesse
Ben

CHAPTER 15. SUMMARY AND PARTING COMMENTS

REFERENCES
GLOSSARY
APPENDIX