What’s Better, ADHD Or Attention Priority Difference?

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

ADHD or Attention Priority Difference?

A few years ago I worked as a school psychologist. One day the mother of a 12-year old boy, who we’ll call Pete, explained to me that upon the urging of one of his teachers, she took him to his pediatrician to be evaluated for ADHD. The pediatrician asked this mother a few questions, diagnosed Pete as having ADHD, and then wrote him a prescription for Ritalin. After reading the possible side effects of the drug, the mother became concerned and spoke to Pete’s father.

Pete’s father and mother were divorced. Pete lived with his father on weekends, and the rest of the time he lived with his mother. Upon hearing about the prescription for Ritalin, Pete’s father was very much opposed to his son taking any drug for treating this concern. And so, now the mother wanted to know what I thought should be done.

I explained that before I could make any recommendations, I would have to carry out an evaluation. As a student in the district that I served, there would be no cost to the family. Pete’s mother agreed to the evaluation.

First, I requested that the mother, father and each of Pete’s teachers fill out standardized questionnaires. The results indicated that Pete’s physical education teacher, art teacher and his father viewed his activity level and ability to pay attention as falling within the average range. Pete’s mother and academic class teachers generally saw him as having some problems paying attention. His math teacher, who had been the one to urge Pete’s mother to take him to the pediatrician, rated Pete’s ability to attend to his assignments as being way below average.

After looking at the results of the standardized questionnaire, I spoke to Pete’s father. He confirmed that it was his impression that Pete had no difficulty with either his activity level or paying attention.

“Do you mind describing a typical day that you have with your son?” I asked.

“Well, let’s see. Last Saturday, when we woke up, we went to play golf.”

“Do you walk the course, or ride in a cart?”

“We walk.”

“Pete doesn’t mind?”

“Not at all. He loves doing physical stuff like that.”

“After golf, then what did you do?”

“We went back to my place, I made some sandwiches, and then I read the newspaper while Pete worked on his drawing. He loves to draw, and he’s pretty good. Then we went in the backyard. I have a basketball hoop set up there and we shot around for a while. Then we started to get supper together.”

“Does Pete help you with that?”

“Yes.”

“Does he get distracted in any way when you two work on supper?”

“Not at all. He’s very helpful. Then we ate supper, went down to the basement and played ping pong for maybe an hour. Then we went upstairs and watched a movie.”

“When he watches a movie with you, does he appear to have difficulty sitting through it?”

“Not usually. Occasionally, the movie strikes him as boring. After the movie, he went to bed.”

“Does he have any trouble sleeping when he stays with you?”

“No. We do a lot of physical stuff that tuckers him out, and he ends up sleeping soundly.”

I then spoke with Pete’s mom. Consistent with how she filled out the standardized questionnaire, she confirmed that it was her impression that Pete did have difficulty paying attention.

“Do you mind describing a typical day that you have with your son?” I asked her.

“Well, yesterday, I got him up at 7 so he could catch the school bus on time. He complained the whole time he got ready. He hates the ride to school.”

“How long a ride is it?”

“An hour, and he says he doesn’t get along with the kids he rides with.”

“I see. He has to sit on the bus for an hour with kids he doesn’t like, then he’s in school sitting most of the time doing school work. Then he takes the bus home, sitting for another hour with kids he doesn’t like. For a boy his age who loves to do physical activity stuff, I could see how this could be hard for him.”

“Yeah, but other kids do it.”

“Most do. Please tell me what happened when he got home.”

“Well, I got home a little after he did. I started preparing supper, and that’s when I have him doing his homework. I sit him at the kitchen table where I can keep an eye on him while I prepare the meal. And he gets very distracted. He starts an assignment one minute, and I look over and I catch him doodling. Over and over again he gets distracted.”

“I see. After sitting most of the day, you have him sit and do his homework?”

“Yes. That’s when I can best keep my eyes on him.”

“How about the rest of the evening?”

“He’s fine then. Besides doing his homework, the only other time I have trouble with him is when I try to get him to clean up his room. He starts to do it, but when I look in a few minutes later, he has become distracted with something else.”

Next, I interviewed Pete. After some pleasant discussion I said, “Your math teacher says you have trouble paying attention in class. What’s up with that?”

“Aaaaa, he makes us fill out these worksheets doing the same problems over and over again. If I know how to do it, why do I have to keep doing 20 more of them? It’s so boring.”

“I see. Say, I hear that you like to draw. Would you mind drawing something for me.?”

Pete’s eyes light up. “Sure. What do you want me to draw?”

“Anything you like.”

Pete begins, and I notice he appears to become completely absorbed in the task. I start to try to distract him by making some extraneous sounds. He glances up to see what the commotion is all about, sees it’s nothing serious, and resumes work on his drawing.

A half hour later, he shows me what he has created. It’s an imaginative otherworldly drawing with spaceships and fascinating creatures. There is an excellent sense of shadowing. It’s far superior to anything I can create in the drawing department.

When I finished my evaluation, I informed the parents that in my opinion it is not in Pete’s best interest to view the concern that has been expressed about his attention as due to ADHD. A more apt description is to view Pete as having an “Attention Priority Difference.” School work was not a huge priority for him. He much preferred to draw and do more physically active tasks than is currently provided at school. These preferences may turn out to be his greatest values. He may someday find work that he truly loves in a field where his artistic interest and talent are crucial. And his interest in physical activity may keep him far more healthier than the many sedentary Americans who are at an increased risk of a number of real illnesses.

“Well,” said the mother, “will Ritalin help Pete with his Attention Priority Difference?”

To which I replied, “Consider an analogous situation. Suppose we identified a group of children who are not doing as well as most kids in physical education. Would it make sense to make up a pathological sounding term for these low-performing students, such as “Muscular Deficit Disorder” and then have doctors prescribe steroids for them?

“In my view, people have different interests and talents. This is a wonderful thing, not something that should be pathologized. We don’t just need every person in America sitting in ivory towers. We need, as well, artists, computer experts, magnificent athletes, hairdressers, and on and on.

“When I hear of a child placed on Ritalin, I become concerned about the child’s stomach, nerves, and brain. Drugs that have been said to be safe have turned out to be far more toxic than anyone ever dreamed of. I become concerned about the social misery that goes along with being singled out as a child that must take a pill to fix him. More than a few kids have told me that this became a dreaded experience.

“I believe that teaching children to turn to drugs when they are dissatisfied with their behavior or mood runs counter to a healthy lifestyle.

“I prefer to put forth a view that encourages us to teach our youth about the blessings of keeping our bodies in lifelong possession of its full youthful state by keeping their blood free of stimulants and narcotics. I wish to teach our kids that it is possible that the morning sun, air and dew can be sufficient powerful intoxicants. Doing something that puts a smile on the lips of a loved one, accomplishing a valued challenging task, providing assistance to another human being—these are the directions I wish we would point to when we guide a child toward a more fulfilling life.”

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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 and social intelligence. To begin at the very first post you can click HERE.