Last week’s post, titled ADHD and Psychiatric Name Calling, criticized the prevalent practice of converting concerns about a person’s ability to pay attention into medical lingo. There was a great deal of interest in the post so I decided to present another for your consideration.

As I began to craft this, my thoughts went back to my most popular post, Teaching Children How to Deal with Criticism. Since the major reason for its great success is that its ideas largely relied on those of William James, I went back to the great philosopher’s writings to see what he had to say on the ADHD subject.

There is unquestionably a great native variety among individuals in the type of their attention. Some of us are naturally scatterbrained, and others follow easily a train of connected thoughts without temptation to swerve aside to other subjects. This seems to depend on a difference between individuals in the type of their field of consciousness. In some persons this is highly focalized and concentrated, and the focal ideas predominate in determining association. In others we must suppose the margin to be brighter, and to be filled with something like meteoric showers of images, which strike into it at random, displacing the focal ideas, and carrying association in their own direction. Persons of the latter type find their attention wandering every minute, and must bring it back by a voluntary pull. The others sink into a subject of meditation deeply, and, when interrupted, are ‘lost’ for a moment before they come back to the outer world.

The possession of such a steady faculty of attention is unquestionably a great boon. Those who have it can work more rapidly, and with less nervous wear and tear. I am inclined to think that no one who is without it naturally can by any amount of drill or discipline attain it in a very high degree. Its amount is probably a fixed characteristic of the individual. But I wish to make a remark here which I shall have occasion to make again in other connections. It is that no one need deplore unduly the inferiority in himself of any one elementary faculty. This concentrated type of attention is an elementary faculty: it is one of the things that might be ascertained and measured by exercises in the laboratory. But, having ascertained it in a number of persons, we could never rank them in a scale of actual and practical mental efficiency based on its degrees. The total mental efficiency of a man is the resultant of the working together of all his faculties. He is too complex a being for any one of them to have the casting vote. If any one of them do have a casting vote, it is more likely to be the strength of his desire and passion, the strength of interest he takes in what is proposed. Concentration, memory, reasoning power, inventiveness, excellence of the senses,–all are subsidiary to this. No matter how scatter-brained the type of a man’s successive fields of consciousness may be, if he really care for a subject, he will return to it incessantly from his incessant wanderings, and first and last do more with it, and get more results from it, than another person whose attention may be more continuous during a given interval, but whose passion for the subject is of a more languid and less permanent sort. Some of the most efficient workers I know are of the ultra-scatterbrained type. One friend, who does a prodigious quantity of work, has in fact confessed to me that, if he wants to get ideas on a subject, he sits down to work at something else, his best results coming through his mind-wanderings. This is perhaps an epigrammatic exaggeration on his part; but I seriously think that no one of us need be too much distressed at his own shortcomings in this regard. Our minds may enjoy but little comfort, may be restless and feel confused; but it may be extremely efficient all the same. (quote from William James’s Talks To Teachers)

Here we see a true master at work. His sublime summary of the concern, placed in the context of other faculties working together, always lead me to vivid images of the many students I worked with over the years who had little ability to sustain their attention on school work and yet far outperformed outstanding students in such areas as music, athletics, art, computer technology, business, etc. Rather than framing the concern as a disabling mental disorder, James paints a vision that inspires the hope of finding a way to create a life filled with substantial value.

The one assertion that I tentatively disagree with James is that a person’s attention span is probably a fixed characteristic of the individual.

I have regualarly seen children who had a below average ability to attend to school work who, as they grew older did much better. Some of them got over a particularly stressful period in their life. Others learned the value of more physical activity which tired them out, and they began to sleep more soundly. Others seemed to improve for no other apparent reason than becoming more mature.

From my own experience, I found that when I learned to meditate, my ability to sustain my attention on a number of subjects distinctly improved. There are some excellent research studies that back up my own personal experience. For an example, that also reviews several of the other available studies, check out “Intensive Meditation Training Improves Perceptual Discrimination and Sustained Attention” (Psychological Science, Jun 2010; 21(6): 829–839.) Readers of my blog can find a simple to learn, absolutely free, form of meditation in my post “Anger, Rumination and Meditation.”

Let me add here, that in our society there is a push by the pharmaceutical companies to get people viewed as having ADHD to take stimulant drugs like Ritalin or Adderall. These have a number of negative side effects, and in a fairly short period of about a month or two the initial positive effects wane, and those using these drugs are left with the illusion that the drug continues to be helpful. The illusion occurs because once the positive effects wane after a few month of regular use, when the stimulant users don’t take the drug, they begin to have a withdrawal reaction that is uncomfortable and reduces their ability to pay attention. When they then again take the drug, the relief they experience from the withdrawal reaction convinces them that the drug is helping them. Instead, they are left with no better ability to pay attention while experiencing the various side effects of the drug.

Okay, so there are a few more ideas about concerns that come up about someone’s attention. I hope you find them to be helpful.

As always, I encourage readers to join the conversation by making comments in the “Comment” box at the very bottom of this page.

My very best,

Jeff

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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.

Recently I published a post titled “Name Calling by Psychiatrists: Is it Time to Put a Stop to it?” Among the points that I had tried to make is that psychiatrists falsely claim that the names they use to describe patients are “diagnoses.” In actuality, all that they do is convert someone’s expressed concerns into medical jargon.

I soon followed with a post titled “Psychiatric Name Calling: Is it Helpful?” Having thus raised some questions concerning the whole range of psychiatric labeling practices, today I’ve decided to focus in on just one of its most popular so called diagnosis–ADHD.

ADHD: A Huge Loss to Society

Gambling institutions well know that it is not hard to disguise losses as wins. For example, it is common in modern video slot machines that players are encouraged to bet on multiple play lines and follow any winning combination with flashing lights and high-fidelity audio, even when the amount won is less than the amount wagered. There are, of course, some who catch on to this gimmick. As one man noted, “I eventually realized that if I kept on winning, I was going to go broke.” A similar disguise is occurring with the ADHD situation.

In the spring issue of The Journal of Mind and Behavior, I found a relevant article by Lincoln Stoller titled “ADHD as Emergent Institutional Exploitation.” It documents that an estimated $3.6 billion was spent annually on ADHD drug treatements with the hope that this would help those students with an ADHD label do better in school. The drugs do create some flashing lights and audio sounds of delight from short-term effects of the drugs. And yet in terms of real life important outcomes for the students who are being placed at risk of a number of serious side effects, in the long term the drugs lead to more losses than gains. I well understand that many fine, well-meaning and intelligent people strongly disagree with me on this. Let’s look at the research.

The NIMH Multimodel ADHD Treatment Study (see HERE) is the largest study ever carried out, involving 6 study sites, millions of dollars, nearly 600 elementary school children, ages 7-9, randomly assigned to one of four treatment modes: (1) medication alone; (2) psychosocial/behavioral treatment alone; (3) a combination of both; or (4) routine community care. The results were initially written up as a big success for the ADHD drugs because in the short term, those taking the drugs did appear to do somewhat better on some outcome measures. But by the end of 14 months of treatment, no significant differences were found between those who had taken the drugs and a similar group who did not take them in terms of improved behavior and academic achievement.

In a recent Canadian study, those who took the drugs actually did significantly worse than those who didn’t. And other studies (see this article for review) indicate that by the time ADHD-labelled students reach the age that most students graduate high school, they do no better if they had taken ADHD drugs than a similar set of students who had not taken the drugs. High school average, high school graduation rates and performance on achievement tests were the same for both groups. But for each student taking the drugs, side-effects were endured and thousands of dollars spent on prescriptions.

And so, at some point it makes sense to start asking if a temporary improvement in school, which washes away by 14 months, is worth $3.6 billion? The pharmaceutical industry, like gambling institutions, well know that it is not hard to disguise losses as wins.

A Recent New York Times Article

Not long ago in the New York Times an article by Dr. Richard A. Friedman appeared titled “A Natural Fix for A.D.H.D.” There, the author states, “people with A.D.H.D. may not have a disease, so much as a set of behavioral traits that don’t match the expectations of our contemporary culture.” To defend his position, Dr. Friedman points to the fact that in schools, which tend to be regimented, require a great deal of sitting time, and lack much choice at what someone wants to be doing at any given time, the attention problems are far more prevalent than with adults who often have some choice at what career they go into.

For example, a patient of his, a 28-year-old man,

was having a lot of trouble at his desk job in an advertising firm. Having to sit at a desk for long hours and focus his attention on one task was nearly impossible. He would multitask, listening to music and texting, while “working” to prevent activities from becoming routine.

Eventually he quit his job and threw himself into a start-up company, which has him on the road in constantly changing environments. He is much happier and — little surprise — has lost his symptoms of A.D.H.D.

My patient “treated” his A.D.H.D simply by changing the conditions of his work environment from one that was highly routine to one that was varied and unpredictable. All of a sudden, his greatest liabilities — his impatience, short attention span and restlessness — became assets. And this, I think, gets to the heart of what is happening in A.D.H.D.

Although Dr. Friedman does a good job questioning the value of viewing ADHD as a mental disorder, he does throw in a plug for using ADHD drugs on children. Thus he says:

What are the implications of this new research for how we think about and treat kids with A.D.H.D.? Of course, I am not suggesting that we take our kids out of school and head for the savanna. Nor am I saying that we should not use stimulant medications like Adderall and Ritalin, which are safe and effective and very helpful to many kids with A.D.H.D.

In actuality, the effectiveness of these types of medications are very much in question because, as I have already pointed out, their effects soon wash away as tolerance to them develops. Meanwhile a great deal of money has been wasted.

As far as his statement that these drugs are safe, among the common side effects are high blood pressure, chronic trouble sleeping, feelings like throwing up, upper abdominal pain, and head pain. Moreover, there are a number of far more serious problems that, although rare for any individual child, nevertheless, because of the current policies that lead to several million children being placed on these drugs, thousands of our youth end up experiencing awful tragedies.

The world benefits from having people with a variety of interests, skills and talents. Schools tend to push people into too limited an environment despite the diversity of people who come through its doors.

Additional Research

There is research that demonstrates that many students who are given the ADHD label do far better if they are given opportunities to run around a few extra times during the school day, but most schools are cutting out more and more recess time to squeeze in more seat time for learning. Many kids given the ADHD label tend to be the youngest in their class. Because everyone in a class is expected to do the same level of school work in any given class, the youngest begin to stand out, and are identified more as “ADHD” kids.

Other research indicates a strong association between an ADHD label and sleep problems. These problems occur in part because some people are not morning people and like it or not, school begins early.

Should being a person who doesn’t function as well in the morning be considered a disease? In some settings, the fact that there are people who would prefer to work a later shift is an enormous plus, but for those in school, name calling and drugging is viewed by the authorities as making sense.

Some people who have sleeping problems have other real problems that contribute to their sleeping woes such as parents fighting, stress from community violence, bullying, serious financial problems, and on and on. In such cases, doesn’t it make sense to view the students as having difficulty coping with difficult environmental conditions rather than having a mental disorder?

Are Genetics the Cause?

The pharmaceutical companies love to promote genetic studies that appear to demonstrate that ADHD is a real disease. Since they fund so much of the media’s advertisement business they greatly influence what gets coverage in newspapers, TV and internet stories. Results are initially exaggerated and splashed all over the headlines. Then, when the real facts start to appear, you have to dig into the bowels of research libraries to find them.

A great example of this occurred when a 2010 study was heralded as being the first to find direct evidence that ADHD is a genetic disorder. As Lincoln Stoller tells the story:

Thapar, who is one of the authors, is cited in a press release preceding publication of the article as saying: “Now we can say with confidence that ADHD is a genetic disease and that the brains of children with this condition develop differently to those of other children” (Walsh, 2010)…. Thapar implies that those who differ from the norm are necessarily inferior.

Once the study was actually published it showed that 85 percent of those labelled as having ADHD had no discernible genetic difference from those without ADHD. Shortly after the study was published, it was found that it did not control for differences in IQ. By removing from the study students who had IQs below 70, the results indicated that about 90 percent of students with ADHD in the study had no discernible genetic difference. Finally, in a subsequent paper, two of the original authors of the study stated, “gene variants still explain only a small percentage of the inherited component of ADHD.”

Although the original press released got a great deal of attention in the media, the press was silent as the more accurate information surfaced.

Conclusion

Because people have differences, whether genetic or otherwise, this does not mean they have a disease. For example, if great singers have a genetic difference than the rest of us, this doesn’t mean they have some sort of disease. And for those of us who perhaps have some genetics that has led us to sing less than average, we need not view ourselves as diseased. We can, instead, seek to find other situations in which we can make ourselves useful. The same holds true for those who find that in some situations their minds wander more than others.

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