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ADHD ADHD medication ADHD Research Attention Priority Difference

What’s Better, ADHD Or Attention Priority Difference?

Welcome to From Insults to Respect.

Recently, I came upon an article in The New York Times by Ellen Barry titled, “Autism, A.D.H.D., Anxiety: Can a Diagnosis Make You Better?” She begins by telling us about a woman in her early 50s who, upon getting a diagnosis of attention deficit hyperactivity disorder, “described it as a profound relief, releasing her from years of self-blame — about missed deadlines and lost receipts, but also things that were deeper and more complicated, like her sensitivity to injustice.” Other people Ms. Barry met who were given a “diagnosis” of autism spectrum disorder also experienced it as relief. Simply putting a name to it seemed to help.

Negative Effects Emerging

However, Ms. Barry notes that evidence is emerging that over the long term, diagnosing these conditions doesn’t help. “Yes,” she says, “there is a positive effect of lowered self-blame. But there is a negative effect as well–a greater pessimism about recovery.”

Defending her position, Ms. Barry describes a study that looked into this negative effect. The study identified no significant differences in the demographic characteristics or socio-emotional wellbeing of 9-year-olds with hyperactivity/inattention who had and who had not received a diagnosis of ADHD. However, by age 13, those who had a diagnosis at age 9 showed more emotional and peer relationship problems, worse prosocial behaviour, and poorer self-concept.

Other research found that those who were treated with A.D.H.D. medication, in the long run, did no better academically while suffering a variety of negative effects from the prescribed drugs such as becoming addicted to the drug, along with head and stomach aches,

Last year, a study found that even a medium strength daily dose of Adderall, the most commonly prescribed drug to treat A.D.H.D., more than tripled a patient’s likelihood of developing psychosis or mania. A high dose increased the risk by a factor of five. And yet, another study found that the height suppression found in earlier studies, which were thought to be temporary, found that nine years after treatment, the height gap remained. The subjects’ A.D.H.D. symptoms, meanwhile, were no better than those who had stopped taking the medication or who had never started.

Benefits To Realizing The Characteristics That Lead To An A.D.H.D. Diagnosis Are Often Not Permanent

Recent researchers have been discovering that A.D.H.D. behavior characteristics can be highly responsive to the environment. When the surroundings of a person with an A.D.H.D. diagnosis better matches the person’s interests and talents or home life improves, the behavior pattern that led to the “diagnosis” often improves as well.

We need people with different interests and talents to fill the various roles society values. Someone who enjoys painting houses might find sitting all day in front of a computer screen very boring, while others enjoy a job that has them engaging for hours on a computer. Fortunately, we have a need for both types, and conceptualizing one or the other as having a pathological condition does not appear to be helpful in the long run. Much better is to provide narratives that demonstrate people who find they are inattentive in certain settings, such as the typical school classroom, may very well do much better in some other environments better suited to them. More and more, research is demonstrating this is true.

In 2016, Arielle Lasky and other members of her research team published a paper that describes their discussions with subjects who had been given a diagnosis of A.D.H.D. as children, but were now in their mid-20s. Subject after subject spontaneously brought up the importance of finding their “niche,” or the right “fit,” in school or in the workplace. As adults, they had more freedom than they did as children to control the parameters of their lives — whether to go to college, what to study, what kind of career to pursue. Many of them had sensibly chosen contexts that were a better match for their personalities than what they experienced in school, and as a result, they reported that their A.D.H.D. symptoms had disappeared. In fact, some of them were questioning whether they had ever had a disorder at all — or if they had just been in the wrong environment as children.

The work environments where the subjects were thriving varied. For some, the appeal of their new jobs was that they were busy and cognitively demanding, requiring constant multitasking. For others, the right context was physical, hands-on labor. For all of them, what made a difference was having work that to them felt “intrinsically interesting.”

One subject, who was studying film in college, said that his ability to thrive in his chosen field made him question the years he spent being treated for A.D.H.D. “Originally, when I was first diagnosed with it, it was explained to me as attention deficit, just a lack of attention,” he said. “An ability not to have an attention span for very long. But I can have an attention span for extremely long for the things that I care about.”

A hairstylist told the researchers that her inability to concentrate in school vanished when she began studying hair. “If you sit up there and give me a lecture on a haircut, I will remember everything you said, word for word,” she said. “Stuff that I’m into, I am so immersed in it. But in school, it was awful.”

A young man who was training to be an auto technician said that in his new career, his A.D.H.D. was no longer an issue. “It’s just that I had to figure out what I wanted to do,” he explained. “I want to work with cars. I don’t get bored doing that. If people with A.D.H.D. are directed into areas where their strengths and interests lie, I’m pretty sure that they can naturally just go about dealing with it, instead of having to give people medications.”

Instead of characterizing A.D.H.D. as a  medical disorder, which tends to lead people to believe they are defective, perhaps suggesting to them that they may have an “Attention Priority Difference” might be better. For some children, a different school, or a different kind of school, might produce the same profound shift that we are finding in recent research studies.

In a 2021 review paper, researchers found 14 studies in which receiving an A.D.H.D. diagnosis seemed to create a sense of “empowerment” by “supporting a sense of legitimacy accompanied by understanding and sympathy as well as decreased guilt, blame and anger.” In 22 other studies this team found, “a biomedical view of difficulties was shown to be associated with disempowerment. By providing an excuse for problems, a decrease in responsibility by all involved can occur, often followed by inaction and stagnation.” An additional 14 studies found that the diagnosis increased feelings of stigmatization. “The diagnosis can create an identity that enhances prejudice and judgment, which are associated with even greater feelings of isolation, exclusion and shame.”

Conclusion

Admittedly, the  A.D.H.D.medical model provides parents and students a simple explanation for their children’s problems that can bring about relief and reduce blame, at least in the short term. However, the Attention Priority Difference model can do this as well and more accurately reflects the latest scientific understanding that a student’s environmental context can dramatically alter the concerning behavior. Rather than our society spending millions of dollars on drugs that people have become convinced is a quick fix to these problems, the Attention Priority Difference idea can offer for many a valuable alternative. It can motivate schools to provide more varied classroom activities that are designed to better match the various interests and talents of their students who are bored with the traditional approach that has students sitting at their desks doing seat work for unbearably long hours.  And it can give these children a vision of their future in which things might actually improve — not because their brains are chemically refashioned in a way that makes them better able to fit into the world, but because they find a way to make the world fit better with whom they are.

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE

Categories
ADHD ADHD medication ADHD Research conflict resolution

ADHD: The Latest 2017 Research

Currently, in many countries a wide variety of children are being classified as having ADHD and placed on a regimen of consuming psychiatric drugs. Supporters of this trend often cast a disrespectful eye toward their critics while arguing that scientific research supports their position. Meanwhile, equally scientific minded individuals who have looked at the same research come up with a completely different set of conclusions. So, about once a year I take a look at the most current research to see if I can throw some light on this topic.

Last year, for example (see HERE), I reported on a study that suggested that:

Children and adolescents who take medication for attention-deficit hyperactivity disorder (ADHD) show decreased bone density, according to a large cross-sectional study that appeared in the Journal of Pediatric Orthopaedics.

I also reported last year on another study that provided the latest replication of other studies indicating that drug treatment provides no lasting benefits for students classified as having ADHD.

Factors looked at were academic achievement and social functioning. Although the medicated ADHD students didn’t do any better or worse on these measures then the unmedicated ADHD students, they did endure many uncomfortable side effects while they were on the ADHD drugs, such as sleep problems, headaches, stomach aches, and feelings of depression each evening when the drug wore off. Thousands of dollars per child were consumed on purchasing the medications that achieved some modest short term gains but had no lasting positive effects.

How about this year? Are there any new studies that throw light on the ADHD controversy?

The Latest Study

The April 2017 issue of Lancet Psychiatry contains a write-up of a study that looked at the largest data set to date to see if people who have been labelled as having ADHD had some difference in certain regions of their brains than people who were not labelled (the control group). The sample comprised 1713 participants labelled as having ADHD and 1529 controls from 23 sites with a median age of 14 years (range 4–63 years).

Of the 8 areas of the brain that they looked at using MRI scans, 6 were statistically smaller for the group of ADHD labelled people when compared to the control group, but this statistical difference was only found for the group of children younger than 15. When the study looked at these regions of the brains of adults, there were no statistically significant differences.

The authors claimed that their analysis supports the theory that ADHD is due to a delay in the brain maturing. Finally, they concluded that their study contained important messages for clinicians: “The data from our highly powered analysis confirm that patients with ADHD do have altered brains and therefore that ADHD is a disorder of the brain. This message is clear for clinicians to convey to parents and patients, which can help to reduce the stigma that ADHD is just a label for difficult children and caused by incompetent parenting. We hope this work will contribute to a better understanding of ADHD in the general public” (p. 7).   

Media Coverage of the Latest Study

Even before the study was published in the April 2017 issue, media outlets rushed to cover the story. Here is a sampling of headlines:

Critical Analysis

Dr. Corrigan
Robert Whitaker

Shortly after the publication of this study, two people with impressive scientific credentials, Michael W. Corrigan, Ed.D. and Robert Whitaker, thoroughly analyzed it, and concluded that the study is very misleading and they are calling for it to be retracted. Their entire analysis, which I highly recommend, is available for free HERE. For my readers, I will summarize a few of its key points.

The authors refute the study’s conclusion that it found that people labelled as having ADHD have smaller brain volumes. Thus they state:

“In this study, the authors pooled together MRI brain-scan data for the 3,242 participants in the study (which had been collected and archived at the 23 sites), and then calculated, for each cohort, mean intracranial volumes and mean volumes of specific brain regions. They reported the differences for each of these comparisons and the “effect size” of the differences. This is the critical aspect of the results to consider and understand: effect sizes reveal the true strength of the findings and how much overlap there is between the individual brain volumes in both groups, and thus establish the likelihood that an individual in the ADHD group has a smaller brain volume than an individual in the control group.

The biggest effect size that was found was .19. This was for differences in the mean volume of a region known as the accumbens for ADHD labelled children under 15 years of age. An effect size of 3, which is the largest effect size one can obtain using this type of statistic, would have suggested that pretty much all of the children in the study that were labelled as having ADHD had a distinctly smaller volume in that region than controls. An effect size of 2 would have suggested a distinctly weaker relationship and that some of the children in the ADHD group did not have smaller volumes than the control group, some in the ADHD group had larger volumes than the control group, and some of the control group had smaller than average volumes in that region and yet showed no signs of ADHD. An effect size of 1 would have indicated even a weaker relationship. The effect size of .19 is less than a fifth the size of 1, that is, about a small an effect size as you can imagine. (To learn more about what an effect size is, access this article by Robert Coe: It’s the effect size, stupid.) The critique summarizes this issue as follows:

“In short, if you just flipped a coin to guess which of the two cohorts the child belonged to, your odds of being right would be nearly the same. The diagnostic value of an MRI brain scan, based on the findings in this study, would be of little more predictive value than the toss of a coin.”

Perhaps the best way to understand this is to look at the individual site data. Thus, the study’s authors reported that the “volumes of the accumbens, amygdala, caudate, hippocampus, putamen, and intracranial volume were smaller in individuals with ADHD compared with controls in the mega-analysis” (p. 1). If this is true, then smaller brain volumes should show up in the data from most, if not all, of the 21 sites that had a control group. But that was not the case.

Here are summaries of individual site results:

  • Mean accumbens volumes: At 4 sites, the volume for the ADHD cohort was actually larger than for the control, and at another 6 sites, the mean volumes were basically of equal size.
  • Mean amygdala volumes: At 5 sites, the mean volume for the ADHD cohort was larger than for the controls, and of equal size at 4 others.
  • Mean caudate volumes: At 5 sites, the mean volume for the ADHD cohort was larger than for the controls, and of equal size at 2 others
  • Mean hippocampus volumes: At 7 sites, the volume for the ADHD cohort was larger than for the controls, and of equal size at 4 others.
  • Mean putamen volumes: At 5 sites, the volume for the ADHD cohort was larger than for the controls, and of equal size at 1 other.
  • Mean intracranial volumes: At 5 sites, the volume for the ADHD cohort was larger than for the controls.

“The problem here is obvious,” says the writers of this critique. “If the authors are claiming that smaller brain regions are a defining ‘abnormality’ of ADHD, then such differences should be consistently found in mean volumes of ADHD cohorts at all sites. The fact that there was such variation in mean volume data is one more reason to see the authors’ conclusions—that smaller brain volumes are a defining characteristic of ADHD—as unsupported by the data.”

The critique goes on to mention a number of other serious problems with this study. For example, in a scientific study we look for possible sources of bias. The critique correctly points out that this study was written by an authors’ group that included many who had close ties to pharmaceutical companies that sell ADHD medications. We can also surmise that some, if not all, of the authors who do not currently have ties to these pharmaceutical companies may hope to land in the future financially rewarding speaking fees sponsored by these companies.

There are many other serious weaknesses with this study that the critique points out, but since it is readily available for free, I’ll end my summary here. My own conclusion is this. The study’s results are highly questionable. Particularly troubling is the suggestion by the study’s authors that their findings will help to reduce stigma. How in the world does telling people that ADHD people have smaller brains help to reduce stigma for that group of people? Moreover, even if we found enough evidence to conclude that there are some differences in the brains of people being labelled ADHD, this would still not lead us to conclude they have a brain disorder. A difference is not automatically a disorder. Having people with different brains can be a wonderful thing. For example, it can mean that some people will prefer to work sitting all day, while others prefer to do work requiring lots of activity. We need both types of people, and other types as well, to enrich our lives.

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.