Posts from — November 2004

ABC News Online (Australia) reports that diagnoses labeling children as AD/HD are wrong up to 75% of the time. A Western Australian parliamentary committee reported that misdiagnosis is commonly related to mistaking AD/HD to other conditions. This discrepancy was discovered after careful examination of labeled students by a team specializing in AD/HD. The study also indicated that Western Australia prescribes more dexamphetamines (speed) in the treatment of ADHD than anywhere else in that nation. Special thanks to blogger Dr. James Baker for bringing this story to my attention. It relates to several other stories making press at this time. His perspectives on AD/HD over-diagnosis are quite insightful.

But what if I really have a problem?

The International Herald Tribune (IHT Online) reports that children with true behavioral problems – including AD/HD – frequently are underdiagnosed in the UK because, as a parent in the article said: “I am at the end of my tether,” French said. “Hardly anyone at the National Health Service knows about it, and neither do the educational authorities. People here just don’t want to recognize it. They think ADHD is just an American version of being a naughty boy.”

As opposed to the 5% to 10% of American children diagnosed with AD/HD, the article states, In England, well under one percent carry the diagnosis, although recognition is growing. In countries like France and Italy, many if not most doctors do not believe the condition exists.

According the Dr. Russell Barkley , the average time to get a child diagnosed with ADHD is one to two years in the US. However, the IHT reports that, in Italy, where a recent study found that the lag time from referral to diagnosis was more than three years, medicines to treat ADD were not licensed until this year.

Furthermore, While many leading scientists believe there is excess diagnosis and overmedication in the United States, they concur that the condition has been seriously neglected in Europe – although that trend is changing. “The rate of the condition is probably the same everywhere, but there is big undertreatment here,” said Dr. Eric Taylor of the Institute of Psychiatry at Kings College in London. Gatekeeping in schools and by doctors filters out 90 percent of these children, and tells them they don’t have a disorder.

The article also says, People shy away from the diagnosis of ADD in Britain “because it feeds into panic about the traditional family breaking down,” Taylor said. “In Italy, with its family focus, it is blamed on the upbringing. French psychiatry is very Freudian, so it is all about psychoanalysis. Many doctors basically don’t recognize ADD. There are many very desperate families.”

Like the child mentioned in the ABC Online article, the IHT reports that This is a lesson that has been learned the hard way by some British parents. By the time Monica Harris’s son was diagnosed with ADD at age 12 and started on Ritalin, he had been suspended many times, sometimes for months on end. Teachers told Harris, who is black, that he was rebelling against his parents’ mixed-race marriage.ADHD and the Creative Child

In Understanding ADHD and the Creative Child, Colette Bouchez reports that ADHD students and gifted, creative children frequently share some traits.

People who don’t understand intelligence and giftedness and creativity think that if you’re smart you ought to know how to behave, and if you don’t behave you’re not smart – or you have something wrong with you – but that couldn’t be further from the truth,” says Minnesota child psychologist Deborah Ruf, PhD, National Gifted Children’s Coordinator for American Mensa and author of the book Losing Our Minds: Gifted Children Left Behind.”

Are they over diagnosed or not?

The answer is probably that children are over diagnosed. If we look at the diagnosis cycle, we find that parents commonly get their first recommendation from their child’s teacher. The parent then takes the child to the family practitioner or their pediatrician where diagnosis is made in short order – twenty minutes of interview time. Pediatricians and family practitioners are typically not specialists in ADHD, but they wield the authority to prescribe medication.

Since ADHD is now a common diagnosis, I suggest a battery of tests for both parent and child as standard practice. The battery should include behavioral ratings scales, computerized tests of attention (IVA, TOVA, etc.), a full physical, visual screening, auditory screening, a full parent and child interview, and a learning abilities inventory. This would provide an adequate picture of the child to determine whether he/she is gifted, has learning disabilities, is visually impaired, or is misbehaving because mother and father are in the middle of a divorce. Thoroughness should be the standard, not the exception.

The November 13, 2004 Boston Globe article, Playing their Way to Improved Concentration, refers to Play Attention, a feedback based learning system I created for persons with attention problems. It uses a video game format to teach cognitive skills typically deficit in children and adults with diffused attention.

I have always considered attention problems to be learning disabilities rather than brain damage (minimal brain dysfunction). In an evolutionary sense, people with diffused attention have always existed among us. In primitive times, they were likely the people standing or walking the perimeter of the camp fire while the rest of us ate our catch. Their orienting reflexes quickly triggered at the slightest sign of danger.

I synthesized my experience in education, computer education, and psychology to devise a system to optimize human potential. However, at the time I began this journey, my university training was of little help. None of my classes mentioned attention problems and therefore I received no training to assist my students.

The Globe cites that ‘…Peter Freer, who developed the product, used to teach school in West Virginia [actually Western Carolina] in the 1980s. Confronted with hyperactive students, Freer didn’t know how to help them. “At that point, at university level, they didn’t even teach anything about how to cope with these kids,” he said.’

I researched experimental data from NASA regarding astronaut performance and attention. I founded Unique Logic and Technology (ULT) in 1994 to provide technology to educators and the general public.

As the Globe points out,‘Freer was trained in computer programming, and he wondered whether technology might help his hyperactive students. While researching the matter, he found that the National Aeronautics and Space Administration had developed computer systems for improving the concentration skills of astronauts and test pilots. NASA scientists attached electrodes to pilots’ heads to capture their brain waves. They learned to identify the kind of brain activity that occurs when a person is concentrating on a task. Then they wrote software that lets pilots control images on a computer screen. The more they focused their minds, the better they performed. In the process, they learned how to how to set aside distractions and concentrate on the task at hand.’

I vastly altered and advanced NASA’s technology to make it appropriate for educational use. I did this by incorporating cognitive skill training and behavior shaping. ULT has been awarded three patents with others pending based on the advancements.

Everything we know about the brain indicates that it can restructure provided the right challenge is provided. The difficulty is that this process takes time. Play Attention takes time, too – perhaps forty to sixty hours of training to gain permanency. ‘Hours of practice can teach a child what it feels like – and looks like – to pay attention. As Joyce Bowen put it, “after you do it a couple of times, you develop muscle memory in your brain.”’

Joyce’s child has rewired his brain to perform quite well at school. He no longer strikes his sister impulsively. He’s a normal, might one say, average kid – bright and happy. Sometimes it’s great to be average.

ADHD Strategies for School & Work

Diffused attention during the learning process greatly decreases the amount of information that can be transferred from short-term memory to long-term. When questioning an ADHD student about the material just presented during a lesson, typically he’ll recall bits and pieces of the material presented, but seldom a holistic perspective. Other areas of life are affected including everything from personal interactions to work or school.

School

Diffused attention also makes reading a challenge as the student must read a passage two to four times before he can gain fundamental meaning from the text. Academic work becomes tiring and tedious. Children often claim homework is ‘boring’ after failing to be successful at simple assignments they are highly capable of accomplishing in short order if their attention were not diffused. Equating boredom with academic work is usually the result of lack of success and an assignment that is not highly stimulating.

Social Interactions

Socially, diffused attention causes an inability to perceive social cues. A look of disapproval, a simple shake of the head meaning NO, and other social cues are overlooked. For adults, this can cause conflict between workers or embarrassing situations at social gatherings. For a child, peers tend to shy away from kids who cannot recognize social cues. ADHD kids are labeled as nuisances and are often excluded from parties, etc. ADHD kids also discern themselves from their peer which results in reduced self-esteem.

Adults

 Typical symptoms of ADHD such as hyperactivity, poor organizational skills, distractibility, impulsivity, etc., often are challenges for the adult in the workplace. A recent article in WebMD.com reports that Joseph Biederman, MD, professor of psychiatry at Harvard Medical School, has surveyed ADHD adults and found that the incomes of households with an ADHD member are substantially lower than households without an ADHD member. Biederman calculates that households with an ADHD member have incomes that are $10,791 lower for high school graduates and $4,334 lower for college graduates. This extrapolates to an annual revenue loss of close to $77 billion in the US.

Biederman reports that an adult with ADHD has greater difficulty keeping a job due to lack of organizational and social skills. In fact, he thinks the disorder may actually make it more difficult to get an appropriate education to obtain a job that offers a higher pay scale. Lost days at work due to ADHD also provide a negative financial impact. “About 50% of the people with ADHD who had jobs in the survey said they lost work directly related to their ADHD symptoms,” says Biederman. “The symptoms of ADHD are very difficult for employers to deal with.”

However, there are strategies that can be employed to maximize function, skill, and satisfaction in the workplace.

Know your strengths and weaknesses

It is important to realize that many ADHD adults have successful careers. Edison, Mozart, and even Einstein may have had AD/HD.  Success seems to be linked to employing good coping strategies once you’ve discovered your strengths and know your weaknesses. Once you become aware of your specific set of challenges, it will become easier for you to plan a strategy. Therefore, consider your unique characteristics as you design your strategies. Below is a checklist describing many of the symptoms typically associated with ADHD. Strategies for coping are listed below each symptom.

Distractibility – people walking by your desk, or talking near you, distract you from your work

• Try to place yourself in the least distracting environment. This may be a private office or cubicle with little foot travel by other office workers. You may retreat to a conference room if possible.
• Maintain a memo pad to keep ideas and assignments from slipping away if you become distracted. Use the memo pad to jot down notes when you receive a phone call.
• Come in early or do your work when others are not in the office.
• Don’t multi-task. Set a goal to finish your current task before starting another.
• Background noise, sometimes known as “white noise” can be effective. Special white noise CDs, audio tapes, or earphones are available for this purpose. Simple classical or new age music may also help.

Poor Memory – you can’t recall dates, names, or appointments.

• First and foremost, buy a day planner and use it religiously to keep track of your schedule and upcoming tasks.
• Many freeware and commercial computer programs are available that automate scheduling and task reminders.
• Make use of pocket recorders. Current recorders no longer need audio tapes as they record on microchips. These are effective for personal reminders or note taking at meetings.
• Write checklists and set reasonable goals for projects.

Poor Organization – you can’t seem to finish projects on time or you fail to keep good records.

• If possible, find a job that does not require long-term task management.
• Set goals for your current task by breaking it into a series of manageable tasks. Mark the deadline for each mini-task with a timer. Computer programs are available for this or you may use a simple kitchen timer.
• Reward yourself when you reach a goal.
• Use an automated computer scheduler to set meeting times. These usually come with an alarm. Set it alert you five to ten minutes before each meeting.
• Allow adequate time between meetings or projects to you do not overload or overbook your schedule.
• Partner with a co-worker who has good organizational skills. This person may act as your coach. The coach will help set goals and reward you as you achieve your goals.

Impulsivity – you respond, at times, without thinking of consequences, sometimes your respond with outbursts

• Have a trusted co-worker provide constructive feedback about your interactions with other staff. This co-worker may also act as a personal coach to role-play appropriate responses to common office dynamics.
• From this feedback, develop strategies to be used when you become frustrated.
• Yoga and some martial arts classes may prove effective in teaching relaxation and concentration skills. A meditation class may be effective, too.

Procrastination – you put things off until the last minute sometimes frustrating or angering colleagues

• Set goals for your current task by breaking it into a series of manageable tasks. Mark the deadline for each mini-task with a timer. Computer programs are available for this or you may use a simple kitchen timer. Reward yourself when you reach a goal.
• Use an automated computer scheduler to set meeting times. These usually come with an alarm.
• Partner with a co-worker who has good organizational skills. This person may act as your coach. The coach will help set project goals and reward you as you achieve your goals.

Hyperactivity – you find it very difficult to sit still during meetings or at your desk o Maximize your personal time like breaks, lunch, etc. to exercise and burn off some energy. This can include walking around the block or trips up and down the stairwell.

• Break up your day to include trips to the mailroom, photocopier, fax, and restroom. o Bring a notepad to meetings and take copious notes.
• A rubber band or paperclip in your free hand can provide stimulation while you take notes.

Daydreaming – when you find something boring you block out the stimuli and think of something more fun.

• Remember, if you have a job you truly enjoy, you’ll find you’ll daydream less. o A job with challenging responsibilities will provide less opportunity for daydreaming than a job shuffling papers.
• Set goals for your current task by breaking it into a series of manageable tasks. Mark the deadline for each mini-task with a timer. Computer programs are available for this or you may use a simple kitchen timer.
• Reward yourself when you reach a goal.

Avoiding details – details like paperwork bore you and you find them virtually impossible to finish o Rule number one; if you can get someone else to do it properly (like an office assistant), let them handle paperwork.

• Make filing more fun by color coding folders and using catchy labels. o Personalize your filing (sensibly) by using fun labels and folders – possibly color coded.
• For paperwork that requires immediate attention have your filing system close at hand, perhaps directly on your desk

Poor social skills – your interactions with your colleagues are marked by your interruptions, blunt comments, or poor listening skills.

• Have a trusted co-worker provide constructive feedback about your interactions with other staff. This co-worker may also act as a personal coach to role-play appropriate responses to common office dynamics.
• Pay particular attention to social cues and work on them with a personal coach to develop awareness and appropriate response.
• From this feedback, develop strategies to be used when you become frustrated.
• Learn to pick up on social cues more readily. Some adults with ADHD have a hard time picking up nonverbal cues that they are angering a co-worker or supervisor.

Summary

A person with ADHD must develop skills and strategies that will enable him/her to function optimally in the workplace. Should skills and strategies fail, it may be necessary to switch careers after careful assessment of your work attributes and skills.

Do not confine your children to your own learning, for they were born in another time.
–Hebrew Proverb

Learning takes place by construction of neural networks. Neural networks are the “whispering” of neurons to each other. Neurons are brain cells that communicate with each other via an electrochemical process that carries neurotransmitters across the division between the neurons (the synapse). Our five senses process information (external stimuli) and then select certain neural connections to become active.

In the recent past, scientists believed this network building or neural activation to be deterministic – the genes you are born with would determine the networks that could develop. However, it has been proved that activation is a random selection among many possible neural connections that could occur. It is not something that happens by deterministic design.

The ADHD Connection

No one, that’s right, no one, knows why people have attention problems. Theories abound, but since there is no real pathology associated with attention problems (other than theoretical) it cannot be physically located to be surgically corrected. However, we do know that new information (sensory input) enters the brain through preexisting networks, which is why it is imperative to provide challenging stimulation in early childhood. If the input is not new, it can trigger memory. If it is new it can trigger learning. Cognitive psychology refers to this process as constructivism: The learner builds his or her own knowledge on his current knowledge base, but only in response to a challenge. It is evident that some persons are not born with the neural networks that facilitate focused attention.

Furthermore, the old notion that early childhood experiences have little impact on later development has been proven false. We now know that the brain is directly and decisively affected by early experiences. This includes the architecture of the brain and the nature and extent of adult capacities; the actual capacity to form new neural networks is directly affected by early childhood experiences.

It was also thought that brain development is linear: the brain’s capacity to learn and change grows steadily as an infant matures into adulthood. It is now known that brain development is non-linear: there are optimum times for acquiring different kinds of knowledge and skills. For example, it is often easier for a very young child to learn a new language than a person past the age of 25.

However, the brain can grow and continue development through death provided the right conditions are met. In light of this, a recent research study quoted by WebMD Medical News shows that fluency in two languages or more prevents some of the effects of aging on brain function. The study reports that bilingual people have a greater capacity to stay focused on a task than people who spoke only one language. Inability to stay focused on a task is a hallmark of the aging brain’s decline. Bilingual people also seemed more readily able to filter out distraction or irrelevant data. This suggests that the function, capacity, or neural network involved in bilingual language processing may be the same processing needed to stay attentive. The study appears in the June, 2004 issue of the Journal Psychology and Aging.

It’s essential that early stimulation be provided as it seems to lay the foundation for growth and capacity in later life. It appears that stimulation in utero may be a good beginning.

Until the recent past, the exact mechanism of the brain’s reorganization, learning, and memory was unknown.  With the advent of the human genome project and its subsequent research findings, we now have a greater understanding of how genetic factors contribute to human learning. The draft sequence of the human genome provides us a fundamental roadmap to understanding how the brain stores information beginning from at the genetic level which alters neural networking (our cognitive faculties), and culminates in behavioral change.  In upcoming articles, I’ll shine a light on various mechanisms of change beginning with neurogenesis.

Neurogenesis

In the past, it was thought that the brain did not create new brain cells after early childhood development.  Scientists were convinced that humans were born with a set of brain cells that steadily decrease as we age. Research at the Salk Institute found that patients as mature as 72 were actually creating new brain cells. The formation of new brain cells is termed neurogenesis.  Furthermore, the Salk Institute’s research revealed that mice that were stimulated environmentally – for instance made to run – produced more new cells than did their counterparts who were sedentary.  This growth was witnessed significantly in the hippocampus, the brain’s center for memory and learning.

While Dr. Fred Gage of the Salk Institute found neurogenesis commonplace, he did not know whether the new cells became functional neurons taking an active role in the brain to aid in learning or memory until it was revealed in later research that these cells do indeed become active neurons that grow axons for communication between other neurons and produce dendrites to receive more messages from other neurons.

Use it or lose it!

This finding presents possibility that the mature brain may be more flexible and dynamic than had previously been thought. Experience seems to shape this flexibility – we have a use it or lose it proposition.  This new growth may be due to the brain’s need to replace dying cells. However, Dr. Gage says, “Another possibility is that young neurons provide a greater degree of plasticity to the mature brain. This enhanced plasticity would become apparent from the integration of new functional units whose connectivity may be shaped by experience.”

Dr. Gage’s work coincides with our current understanding of neuroplasticity and is but one wonderful example of how the brain grows and adapts to environmental challenges.

To the man who only has a hammer in the toolkit, every problem looks like a nail.
–Abraham Maslow

As I’ve maintained for years, if we keep thinking of ADHD as unalterable brain damage, dysfunction, or dysregulation, it will be difficult to move forward with positive change. I contend that ADHD is a trait in the spectrum of human neurological variation. It is essentially no different that other genetic traits like intelligence, or eye and hair color, etc. Therefore, a new conceptualization of the basic nature and etiology of ADHD behaviors is necessary in which current known research about human potential and learning are incorporated to produce a scientific, systematic approach to teach sustained attention and improve subordinate deficits in related cognitive skills like short-term memory.

The problem is simply diffused attention. While this statement is quite simple, diffused attention greatly affects every aspect our one’s life. It makes the learning process much more difficult and therefore subsequently affects one academically, socially, and personally. However, having focused attention to a task, currently termed fluid intelligence, can be improved by providing correct challenges – both cognitive and behavioral. Therefore, one can learn to focus on any level of stimulation. The brain has a remarkable ability to compensate by either strengthening current neural networks.

In the very recent past, the brain was considered a gray lump that declined in function as it aged. We now know that this is entirely false. The brain is in a constant state of reorganization. This restructuring/reorganization of the brain is termed neuroplasticity. One of the root words is plastic. Its denotation is moldable or pliable like clay. It is not used in the sense of the hard plastic case covering a computer. Recent advances in brain scanning and analysis have revealed that the brain is plastic – always reorganizing not just in a sense of shuffling files, but architecturally as well. The wiring or neural circuitry is constantly changing depending on external challenges.

Children and adults with brain injury or developmental difficulties offer dramatic proof of the brain’s amazing capacity to compensate if provided a correct challenge that will stimulate the growth of a compensatory neural network or strengthen a previously existing one. Many neurological journals report cases where children who lose language due to a stroke at a young age often recover the ability to speak. This is due the fact that the brain is able to shift this function to another area (compensation through adaptive neural networks). According to UCLA pediatric neurologist Dr. Donald Shields, “if there’s a way to compensate, the developing brain will find it.”

Scientists apply the term neuroplasticity to the action of brain growth and adaptation in response to challenge. Provided the correct challenge and environment, children and adults frequently compensate (shift brain function from one area to another) when a certain area of the brain cannot function correctly. It is documented in many medical and neurological journals that the brain will increase activity in another region to overcome loss of another region.

Implications for ADHD

There is no question that the brain can compensate even if it has problems focusing attention. However, it has to be provided the correct environment prompting challenge. As recently as twenty years ago, scientists believed that the genes we were born with wholly determined the structure of our brains. However, current extensive research performed by scientists worldwide proves that how our brains develop, learn, and grow depends on the vital interaction between nature and nurture. Nature, or more accurately, genetic endowment, is directly affected by the environment, care, challenges, and teachings received (nurture).

As recently as twenty years ago, scientists believed that the genes we were born with wholly determined the structure of our brains. However, current extensive research performed by scientists worldwide proves that how our brains develop, learn, and grow depends on the vital interaction between nature and nurture. Nature, or more accurately, genetic endowment, is directly affected by the environment, care, challenges, and teachings received (nurture). Furthermore, the old notion that early childhood experiences have little impact on later development has been proven false. We now know that the brain is directly and decisively affected by early experiences. This includes the architecture of the brain and the nature and extent of adult capacities; the actual capacity to form new neural networks is directly affected by early childhood experiences.

It was also thought that brain development is linear: the brain’s capacity to learn and change grows steadily as an infant matures into adulthood. It is now known that brain development is non-linear: there are optimum times for acquiring different kinds of knowledge and skills. For example, it is often easier for a very young child to learn a new language than a person past the age of 25. However, the brain can grow and continue development through death provided the right conditions are met.

When I was training at university, psychologists contended that an infant’s brain was very inactive. However, scans now reveal an infant’s brain to be three times as active as that of a college student. Much has changed in the last ten years. In upcoming commentary, I’ll describe how learning takes place, its connection to neural networks and neuroplasticity, and site studies which support that brain development can be greatly enhanced via cognitive re-education.

In upcoming articles, I’ll discuss how we learn. We’ll look at this perspective from an external cognitive approach to learning and then proceed to an internal perspective involving the actual structural neural changes that occur when we learn. Finally, I’ll examine the molecular (DNA) changes that trigger the learning process and encode it to long-term memory.

One pound of learning requires ten pounds of common sense to apply it.
-Persion Proverb

If we take a cognitive view, from a purely external viewpoint, we can examine how we learn. Learning involves the teacher, the learner, the learning process, and the cognitive and behavioral changes associated with learning.

Flow Diagram

The teaching method is the series of actions that the teacher uses to present the lesson. The teacher could be a computer, but is ordinarily a human who includes both content and organization of teaching materials. The teaching method encompasses both how and what is learned, the teacher’s attributes (mood, knowledge base, etc.), and the learning environment. Examples may include use of preparatory sets, computerized instruction, repeating instructions, or providing an example, etc.

The learner’s attributes include the learner’s entire schema: all existing knowledge, metacognitive skills, disabilities, and memory capabilities. Picture this as everything the learner brings to class.

The learning process demands that the student pay as much attention to the teaching method as possible in order to assimilate the data provided. If this occurs, then cognitive processing of the data can occur which leads to integration and organization with prior information in the learner’s schema. A person with an diffused attention receives bit and pieces of the lesson information. This typically results in the transfer of bits and pieces of information being transferred to long term memory.

Cognitive outcomes are actual changes in the learner’s knowledge or memory system including acquisition of information, procedures, and strategies. This includes understanding of information. This is the result of developing neural networks. While educators do not explicitly state that their goal is to develop a new concept through neural networking, this is precisely what they are doing.

Outcome performance is the learner’s performance or actual behavioral changes including retention and transfer behaviors related to new tasks. This is quantified by a test of the cognitive outcomes or qualified by anecdotal records. In essence, the learner is transferring or generalizing what has been acquired cognitively.

When diffused attention allows only bits and pieces of information to be transferred to long-term memory, then cognitive outcomes are affected because both the meaning and significance of the presented information are altered. A good example is watching a person with diffused attention attempt to read. They scan the same page three or four times before they get the full meaning. Many college students reported to me that they read the text book four times! This obviously makes learning more difficult.

In the landscape of spring there is neither better nor worse.
The flowering branches grow; some short, some long.
– Zen saying

No Known Biological Marker For ADHD

Dr. Russell Barkley essentially has created an industry surrounding his name and ADHD. While saying little that’s new to the field, he regurgitates the repetitive paradigm that essentially places AD/HD children and adults into the minimal brain dysfunction category, i.e., ADHD people are brain damaged. He pathologizes ADHD even though no known biological marker exists; no certain neuropathology or brain abnormality exists that definitively establishes the presence or absence of the disorder. The NIH Consensus Statement – Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder, states: “Although research has suggested a central nervous system basis for ADHD, further research is necessary to firmly establish ADHD as a brain disorder.” In short, does anyone know the cause? No. Has it been identified with a biological marker? No. Has it been positively attributed to heredity? No. The NIH publication, A Look At Attention Deficit Hyperactivity Disorder  states, “The exact cause of ADHD has not yet been found.”

ADHD Is A Subjective Diagnosis

In other words, if one had a tumor, it could be located via scanning or possibly via X –ray and acted upon accordingly. Since AD/HD has no biological marker like a tumor, it is not identifiable as to physical location or magnitude. Simply stated, ADHD is a subjective diagnosis, an educated guess whose cause is unknown but is replete with theory.

 A Neuropsychological Paradigm

 While Barkley and others advocate the brain damage paradigm, this contradicts many psychologists’ current views that ADHD may naturally fall on the spectrum of genetic human traits like intelligence and hair color. Barkley’s neuropsychological paradigm predicts that ADHD will be found to have pathology, perhaps a single pathology. Proponents of this theory are looking for the Holy Grail of AD/HD – a single brain difference or dysfunction that will indicate the presence of ADHD. For many years researchers utilizing nascent technologies like SPECT, MRI, and QEEG etc., have produced reported structural and functional brain differences between subjects considered to be normal and those considered to have ADHD. Some research has demonstrated that ADHD people have brain sizes 2% – 5% smaller than their peers. Ridiculous as it may seem, this research, amounting to little more than a new phrenology, has contributed to a belief that these measurable differences establish a neurological basis for ADHD. This research has fundamental flaws and has greatly contributed to confusion regarding the cause of ADHD. Since no test exists to determine the presence of ADHD, and the diagnostic criteria are all subjective (and modified over the years), how does one select a group of normal subjects?

A Problem Of Antecedence

Assuming one could precisely find a normal group for comparative study, we still have the mystery analogous to the chicken and the egg – a problem of antecedence. Available research supports that any measurable differences in brain wave electroencephalography (EEG) or structural MRI (brain scanning) simply are the consequence of (and not the cause of) behaviors that define AD/HD or simply reflect personality differences.

Dr. Russell Barkley also proposes that ADHD is related more to lost interest and motivation rather than with an inability to pay attention or concentrate. He contends that students lose interest quickly because they are not motivated.

ADHD is Directly Related to the Level of Stimulation

If one has ever watched an ADHD child play commercial video games like Sony Play Station or Xbox, it becomes obvious that ADHD is not only a matter of motivation or interest, but is directly related to level of stimulation.  Video games are intrinsically motivating because they offer the viewer a heightened state of arousal, stimulation, and response. ADHD people do not have trouble maintaining focus on a three-ring circus. Motivation is a secondary consideration at best. It is a fact that persons with ADHD frequently cannot attend to low-level stimuli like homework or balancing a checkbook. ADHD people know that balancing a checkbook or doing well on homework are quite essential to their personal wellbeing. They are typically quite motivated to perform these tasks, but they cannot. Their diffused attention pulls them away from the task unless they are redirected by an outside stimulus/agency. People with ADD/HD can pay attention but usually shift attention from task to task, never staying with or completing a current task. It may also take a much higher level stimulation to shift out of inattentiveness or to maintain attention for longer periods.

Curriculum Modification Only A Short-term Intervention

Agreeing that ADHD is a misnomer, Barkley contends that curriculum should be made more motivating and interesting to students.  This is not only an over simplification of the problem, but also a fundamentally flawed perspective. Curriculum modification is a standard practice of teachers who encounter students with ADHD. It is a sensible short-term intervention just as are incorporating a behavioral shaping program, token reinforcement, and placing the student closer to the teacher. But these are only short-term solutions as they tend only to change the student’s environment.  They do not change the student.

ADHD Leads To A Negative Self-Image

This being so, when an ADHD student repeatedly fails to successfully perform homework, class assignments, or tests, their self-image declines. They perceive themselves as unable to control their behaviors and begin to believe they are victims of an unfair world. Because they believe that they cannot control their behaviors and thus are not personally responsible for negative behaviors, they deem other’s negative reactions as excessively harsh, discriminatory, or unfair.  Complaints of this nature are seldom assigned to just one person or group; they will be directed to everyone.  A natural reaction to the perception of victimization is anger.  Anger may cause outbursts, defiance, and even hitting as solutions to even the most minor conflicts. This type of behavior may cause the individual to become a social outcast.  This in turn serves to reinforce his perceptions of unfairness and rejection.  Sometimes, rather than fight or deny the negative responses to his behaviors, he may elect to agree with his critics.  He may label himself ’stupid,’ ‘lazy,’ ‘bad,’ etc.  This frequently leads to a feeling of worthlessness and may result in an I don’t care or I don’t care what you think attitude. 

ADHD and Learned Behaviors

All of the aforementioned perceptions and behaviors are learned. They are indeed compensations which produce a disastrous cycle that destroys self-esteem, decreases opportunities for friendships, and lowers academic performance.  It is quite evident that modifying the environment is only a short-term solution that must be tempered with cognitive skill building. 

ADHD And Cognitive Skill Building

Cognitive skill building includes increasing organizational skills, short-term memory skills, visual tracking, time on-task, and discriminatory processing (filtering) skills, all of which are loosely termed executive functions by psychologists and educationalists. Psychologists and research scientists have long known that executive functions can be improved through training. But the true question must be put: why do we consider ADHD a disorder that cannot be improved? Diffused attention can be improved thus improving subordinate deficits. Society will only become aware of this through a paradigm shift.

“Cognitive exercises, including computer-assisted strategies, have been used to improve neuropsychological processes, predominately attention, memory, and executive skills. Both randomized controlled studies and case reports have documented the success of these interventions using intermediate outcome measures.” –Rehabilitation of persons with traumatic brain injury, NIH Consensus Statement, 1998 Oct. 26-28;16(1):1-41.

Training Works For ADHD

It has been repeatedly demonstrated that provided the correct challenge, executive functions can be increased which would promote successes in the workplace and at school. It is founded in current cutting edge research in neuroplasticity and the human genome project. However, this is cutting edge, and the dinosaurs that rule the ADHD domain will not likely embrace it in their lifetimes.

One of the current gurus in the field of ADHD is Dr. Russell Barkley, a former Professor of Psychiatry and Neurology University of Massachusetts and currently Professor of Psychiatry at the Medical University of South Carolina. He is author of numerous books on ADHD and has performed research on ADHD, much of which has been sponsored by the pharmaceutical industry.

This includes his most recent survey, Without Boundaries – Challenges and Hopes for Living with ADHD: An International Survey, conducted for the World Federation for Mental Health. The focus of the survey was to determine the average length of time for diagnosis of ADHD and the family impact. The research was funded by Eli Lilly Pharmaceutical, and reveals that the average time to get a child diagnosed with AD/HD is one to two years. Not surprisingly, Dr. Barkley and Lilly think this is too long as children could be started on medication and behavior modification much sooner. While one must agree that a proper, quick diagnosis should be available to all children and adults, sponsorship of the survey is hardly altruistic of Lilly who makes millions of dollars, if not billions off of their ADHD meds. Are they requesting a quicker diagnosis to sell more medication quickly?