In reading a recent article in the New York Times by L. Alan Sroufe of Minnesota’s Institute of Child Development, I had a strong sense of deja vu. Based on his literature reviews of treatment programs for ADHD symptoms, along with 30 years’ experience conducting his own longitudinal studies, Dr. Sroufe concludes that there is no evidence to support the “inborn defect” theory of attention deficit disorder and no lasting benefit to be had from taking Ritalin, Adderall and other drugs commonly prescribed for attention deficit disorder. It so reminds me of the scientific controversy around the chemical imbalance theory of depression, detailed by Robert Whitaker in his book The Anatomy of an Epidemic, and his conclusion that there is no evidence to support it, and no lasting benefit from the long-term use of anti-depressants.
Ritalin and Adderall are central nervous symptom stimulants. For many years, it has been widely believed that they have a “paradoxical effect” on children who suffer from ADHD symptoms because those children have an “inborn defect”, as a result of which the stimulants calm them down and help them to focus rather than exciting them. Dr. Sroufe debunks this myth and shows that these drugs had exactly the same effect on radar operators during World War II; he also found that “all children, whether they had attention problems or not, responded to stimulant drugs the same way.” No inborn defect, no paradoxical effect. Ritalin and Adderall are amphetamines — “uppers”, as we used to call them when I was young — and anyone who has used them during exams week understands their short-term benefits. They help you focus your attention and engage in “boring” tasks (like studying for your chemistry final) for an extended period of time.
As the body habituates to these drugs, the short-term benefits eventually fade (just as the short-term benefits of taking anti-depressants fade after 6-8 weeks). They also have unpleasant side effects such as sleeplessness and loss of appetite; if you’ve read Whitaker’s book, you have to wonder whether there may also be long-term neurological damage if these drugs are taken continuously for years.
I found this portion of the article especially relevant: “Many parents who take their children off the drugs find that behavior worsens, which most likely confirms their belief that the drugs work. But the behavior worsens because the children’s bodies have become adapted to the drug. Adults may have similar reactions if they suddenly cut back on coffee, or stop smoking.” For similar reasons, the worsening of depression symptoms after discontinuing SSRIs often persuades patients that the drugs were “working”. In interactions with site visitors here, I find it almost impossible to dissuade people from this belief.
Dr. Sroufe does not target aggressive marketing by the APA and the pharmaceutical industry, as Whitaker does in his explanation of the widespread usage of psychiatric medications; instead, Sroufe faults the common belief/wish that psychiatric illness and societal ills might be cured by taking a pill. He also looks at the science on brain anomalies, used to support the theory that ADHD symptoms result from inborn defects, and makes the following important point: “Overlooked is the very real possibility that both the brain anomalies and the A.D.D. result from experience.”
Sroufe cites the recent neurological studies showing that early brain development is influenced by experience — “trauma, chronic stress or other early-childhood experiences.” (I discussed this issue in my series of posts about attachment theory). Since 1975, he and his colleagues have been conducting a longitudinal study of 200 children born into poverty and therefore more vulnerable to behavioral problems. What his and other epidemiological studies have found is that the “environment of the child predicted development of A.D.D. problems. In stark contrast, measures of neurological anomalies at birth, I.Q. and infant temperament — including infant activity level — did not predict A.D.D.” What happens to you during infancy and early childhood will shape you for life.
I have very close friends with a son who suffers from ADHD symptoms. His was a premature birth and that experience colors his academic, peer and family relationships to this day. I’ve known others who suffer from attention deficit disorder and you don’t have to look far into their backgrounds to find the chaos and instability that likely influenced the development of their symptoms. Sroufe says there are many experiences in early childhood that my lead to behavioral problems such as attention deficit disorder: “domestic violence, lack of social support from friends or relatives, chaotic living situations, including frequent moves, and, especially, patterns of parental intrusiveness that involve stimulation for which the baby is not prepared.” This point of view is a refreshing alternative to the simplistic “inborn defect” theory.
Of course, Sroufe’s view means there are no simple answers, no “magic bullet” that will fix it all, and for this reason I’m sure it will be unpopular. It’s much easier and deceptively comforting to think you can prescribe your way out of the problem, rather than attempting to address the highly complex interaction between societal ills, family dysfunction and brain development. Likewise, it’s much easier to believe an anti-depressant will cure your depression than to accept the need for long-term psychotherapy — difficult and often costly — in order to make any kind of meaningful different.
I am the mother of three children ages 12, 10 and 8. My two older children, a boy and girl respectively have both been diagnosed with attention deficit disorder-inattentive type. I am also a teacher. I did not work when my children were young, we did not move excessively, there was no violence or lack of support ect. I am willing however to consider that ADD is a function of experience, I just don’t know what experiences that may encompass and by the sounds of it neither do you. We as parents are so often told what not to do in regards to treating ADD (i.e., don’t take medication) but what frustrates me is that there are never any concrete or even alternative suggestions of how to treat or deal with ADD.
One of the possible influences that Sroufe discusses is an intrusive, insensitive parenting style — where the parent abruptly interacts with a child when the child is unprepared for it or deeply involved with something else. I believe the example he gives is of a parent disrupting a child’s play and abruptly putting him or her into the bath. I also think that over-exposure to television has bad effects; watching TV, with all its brief scenes, abrupt changes, commercial interruptions, etc. affects long-term concentration in a way that’s very different from, say, reading a book.
This is a grossly over-used diagnosis, as well. Behavior that used to be considered with the norm (esp. with boys) has now become pathologized. So many more children seem to suffer from it than before.
True and important. And sometimes the short-term is very important.
As long as we remember it IS short-term, I agree. I was listening to NPR the other day and heard about some very dramatic improvement (like almost instantaneous) using Ketamine for suicidally depressed patients. I thought to myself, “Now there’s the perfect use for medication — provide immediate relief, remove the suicide threat and get them going in therapy.” I did some more research and, of course, they’re now trying to find ways around the nasty side effects so they can put people on these drugs long-term.
My brother, my father, and my mother are categorized as having ADD. The doctors were amazed I was not hyper all the time. I have had a long harsh life, but my brother had a hard childhood he quickly grew out of. Once my parents took him off Ritalen, he got worse, but after a few months, began acting normal as he didn’t remember his years in pre-school. He is now 19 and living with us still with an ontario honors. He is frequently acting ADHD shown from his singing at the top of his lungs, jumping about, and easily distracted and irritated such as petting the dog and talking babyish while serious discussions are underway that very much need to be taken seriously such as selling the farm or deciding what college he should go to, but during shows or playing his xbox, he is very calm and relaxed. Why is this? He also burps and farts obnoxiously as possible and barely ever wears pants. My mother says its his ADD, but that’s why I’m posting this.
When he comes home from work as a baker at Timmies, he plays his xbox till he falls asleep, leaving for either family tv, food, or bathroom. He is, as I find this incredibly odd, easily persuaded by his parents. Whatever my mum says, he takes her side. Whatever my dad says, he takes his side. When I was telling my mum that there is no scientific evidence for chemical imbalance and that most disorders spawn from nurture rather than nature, she denied and stated that if that were true, than whats the point of having hormones? My brother saw and immediately took her side. Why? I took my Playbook and showed them the evidence, your blog posts, and the book, plus google scholar. But after all of it, my brother and my mother refused to believe. My father, who spent 9 years in university and on the constant lookout for new info on science and tech, agreed with what I was saying. His room has a minimum of 8 shrines to certain video games and is inconceivably messy. No, I’m serious, inconceivable; like stuff you see on cartoons that you think can’t possible occur from real people. He also has a low libido and barely ever makes sex jokes, which I think is fairly unhealthy for a growing teen, and never talks about girls and such, which makes me feel a bit odd whenever i am going to say something that deals with sex such as funny joke or comment, but curb my tongue when he’s around.
Why is my brother ADHD only when he is only around others? Again, everyone blames his actions on his “ADHD”, but is it really?
Your description gets at the problem: ADHD is not a collection of consistent symptoms and behaviors can vary dramatically. I’d be wondering what your brother is anxious about and what he’s trying to avoid. He probably becomes very anxious when he comes into contact with people he doesn’t know well and then acts “ADHD” as you call it. He’s probably frightened about sexual contact and struggles with feelings that he’s still a child inside, not really a teenager on his way to adulthood. It sounds as if he also has some more autism-like symptoms.
Its not autism as, when I gave him a micro-expression pre-test and landed par with society at 50%. I was mis-diagnosed with autism once and tried the pre-test on autistic adolescents when I got sent to a camp. They were below the par at around 10-30%.
I have been looking at Maslow’s motivation levels and I feel that he has a low esteem. He has fulfilled the third one (social), but I’m not sure about the fourth (esteem). I think his obnoxious attitudes and the video games are a way for his to get into control of things. His siding with his parents is, I believe, caused from the loss of not being able to get to the fifth level (self-actualization) because he feels hindered at the forth.
Is this right? I do think this explains his motives to act autistic/ADHD are well explained. So, for him to get better, would he need more esteem? I’m learning about this in English and I think this is a good explanation.
I don’t mean autism as a diagnostic category; I mean there are types of defense mechanisms that I would call “autistic” — their aim is generally to shut out the threatening world and defuse the impact of external stimuli. Having more self-esteem might help, but the only way to get that is for him to get to know himself better and confront the experiences that terrify him.
It pleases me to read a validation of my long-held belief around the origins of ADHD. I have symptoms, as do both of my sons. Many clinicians like to declare ADHD as “hereditary”. It is inherited only to the extent that unstable living patterns persist across generations. Thanks for putting this out there. I am going to share it. A lot.
I was so pleased to read about Dr. Sroufe’s studies and findings. I’m glad there are professionals like him out there, providing an alternative view to the drug-industry and medical establishment POV.
My dad was on powerful psychological prescriptions for decades, as “treatment” for his diagnoses of schizophrenia and manic-depression.
Tomorrow is the anniversary of his 1998 death at age 60. He died after his organs had begun failing over a period of a few years. I’m pretty sure Dad would have lived longer if not for the long, steady diet of pharmaceuticals his psychiatrists had fed him through the 1970s, 1980s and 1990s.
And what those medications never seemed to do was deliver a consistent quality of life… Dad was never a happy man, and he seemed to endure more psychological suffering as the years went by.
For me, there’s a clear lesson from this experience, as well as from what I’ve learned of the mental health field’s history of sanitariums and lobotomies: be very, very wary of psychiatrists.
I agree, though I think most of them are just practicing the way they were taught and don’t know any better. It has been accepted dogma.
You’re usually right-on J, & this time, not. S’s opinion piece is Bad science . Please consider S’s beliefs & biases, & how he’s misrepresenting the study he evidently didn’t understand. These links shd help clarify what Ed Hallowell, MD[one of the most experienced & expert researchers/writers/clinicians about ADHD] wrote in response to S’s opinion piece & S’s perspective has been unnecessarily distressing & condescendingly insulting to the innocent. My beliefs/biases will also be clear in the following E I’ve circulated to interested colleagues. Warmly, b
The psychology & neurology of ” Which came first, the belief or the reasoning?” are sure fascinating. It all seems a whole lot like religion/politics to me, and I know what I choose to believe, dispite it’s arbitrary nature. If you’re deeply interested in this perspective, consider “On Being Certain [Believing You are Right Even When You’re Not” by a neurologist, Robert A. Burton, MD. Be aware, it may not be a perspective most folks would want to know about, cz it’s rather distressing. I DK how to activate these 2 links directly from this Comment — perhaps you can ?
http://www.drhallowell.com/blog/dr-hallowells-response-to-ny-times-piece-ritalin-gone-wrong/
https://mail-attachment.googleusercontent.com/attachment?ui=2&ik=0da0039c01&view=att&th=13534333d0b9bd84&attid=0.1.1&disp=vah&safe=1&zw&saduie=AG9B_P9ROWJu_IA3eIyDjLfOm6Kh&sadet=1328066499731&sads=FizO6czlFbHDjjdCCrZJIS72JT0
http://WWW.DRBOBDICK.COM (919) 215-4703
Thanks for your comment and your links, Bob. I think this is such a complex issue that I can’t really address the points you (and AKM) raise, so I’m going to write a follow-up piece later this week in response.
These issues are So complex & ideosyncratic.
The different views of the issur & resolutions all have good intentions & good points to make.
I wish we could just have it clear & simple, & we can’t. bd
I wonder if Dr. Bob has any thoughts on Dr. Hallowell’s recent about-face on ADHD prescriptions… he now says he regrets analogy of “ritalin as safe as aspirin” and has acknowledged over-prescription of ADHD drugs.
1 in 5 American boys diagnosed ADHD? $9 billion spent on ADHD drugs in 2012? An epidemic, indeed…
Nice piece.
I disagree with many statements in this post, but not because I find them contrary to popular belief or inconvenient.
First of all, I do not understand what the “inborn defect†theory is. When we talk about genetic vulnerability or a genetic factor this does not imply a birth defect in the brain. The heritability factor is around .77 ( twin studies). When a condition is all genetics the number would be 1. This number is rather high for ADHD, higher than for intelligence which is around .52 and in fact most psychological conditions are around .5 to maybe .6. But just as all one’s intelligence isn’t apparent at birth simply because the brain isn’t fully formed, one’s ADHD will not be apparent. That doesn’t mean anything except, well “duhâ€.
Denying the genetic factor is not possible unless one denies the validity of mathematics.
So, does that mean the U.S really has a disproportionate number of people with a genetic vulnerability for ADHD compared to the rest of the world? Of course not. So there is much truth in saying that it is over-diagnosed and often the default diagnosis for any problems during childhood. That still doesn’t mean it’s either fake or trauma, this statement in the linked article is a false dichotomy because the author does not seem to understand the meaning of heritability. It does mean that many people who shouldn’t do diagnose ADHD and worse yet, prescribe medication for it. I am referring to pediatricians and general practitioners.
Dr Sroufe does not debunk any myth because it has been long known that the paradoxical effect is not paradoxical at all , he is merely stating the obvious. And why would medication help with broader learning capabilities? It’s not meant to do that. He mentions brain imaging, what he didn’t mention is measurement of brainwaves, the qEEG, which can be used as an aid to diagnose ADHD in difficult to diagnose cases. The qEEG is always done the same without the performance of tasks or activities and clearly shows a difference in the brains of people with ADHD and those without. After all it is true, many conditions show overlap with ADHD symptoms.
As for the personal anecdote, obviously there are cases where the environment is such a clear major factor it would be silly to argue that. But there are also examples where you’d be hard pressed to find the environmental factor. For example Dr. Hallowel, a psychiatrist who has written a lot about ADHD, has ADHD himself and two children with ADHD. Must we assume he and his wife somehow failed their children? I do not think so. In other words, you can be the better than good enough parent and still have a child with ADHD because the genetic factor is not in doubt.
You make so many good and important points, I feel I can’t respond to you here in the comment section. I’m going to write a follow-up piece later this week, and also address some of the points raised by Dr. Bob Dick. I will say that part of the problem was my overly sensational language — “debunking a myth”, and I apologize for taking that tone. But you bring up the key issues and I’d like to discuss them in detail. Thanks so much for your very cogent critique.
Joseph, what is your take on the usefulness of dietary approaches, such as the Feingold Diet, to ADHD? I have friends who have had very good results with eliminating food additives and preservatives, as well as reducing sugar, in their children’s diets.
It just stands to reason that reducing sugar and the related metabolic spikes will help. Most parents have seen what happens to their kids when they eat too much sugar, and some children are far more sensitive than others. I think there needs to be a comprehensive approach; there isn’t one single answer.
My daughter was diagnosed with ADHD at the of 6 and she’s been on Ritalin ever since…she’s now 9. But now what do I do from here onwards (alternative to medicating her). She can’t concentrate in class if she misses her daily doze of Ritalin..
There are professionals who believe in types of treatment other than medication. You’ll need to find someone who will help you and your daughter, but I don’t think I can offer any useful advice in this venue.
No responsible, experienced ADHD expert ever said meds are the only or exclusive way to go,
nor that environmental/other psychological problems don’t/can’t appear along with ADHD. Those are urban myths &/or Straw Men.
T he question isn’t “either /or”, but rather how do nature & nurture interact in this particular
person. Traditional talk therapy alone is not usually helpful with adult ADHD. Effective & efficient psychological approaches to adult ADHD syndrome are usually more like coaching, & the therapist must be expert with the necessary differences & variations on psychotherapy
with this population.
therapy
The problem, as you know, is not “ADHD experts”; the problem is that GPs and other inexperienced medical professionals are making this diagnosis and writing script. This is the problem with psychiatric medications in general; they are being prescribed by non-psychiatrists, or psychiatrists who run drug mills, with little follow-up or monitoring.
Darn, I just lost further commentary on how therapy w/ adults’ ADHD [other psychological issues are nearly always present – it’s hard to imagine imagine living for decades with this syndrome un-diagnosed & not developing emotional problems.] is more like coaching, because traditional talk therapy can’t much help the neurologically-related focus & organizational issues. The most useful psychological approach book I know for that is
ADD Friendly Ways to Organize Your Life -K Nadeau, PhD & J Kolberg. Dr Bob
Hi Dr. Burgo,
the other day, I saw a documentary on TV that introduced neurofeedback as a new method (free of side effects) to deal with ADHD. Also found this info on Wikipedia:
“Neuroimaging studies have correlated ADHD with abnormal functioning in the anterior cingulate cortex (ACC) during tasks involving selective attention. In 2006, Johanne Levesque et al. published results from their fMRI study showing normalization of ACC activation during a selective-attention task in ADHD subjects who had undergone neurofeedback training. Subjects in the study were randomly assigned to either the neurofeedback treatment group or a no-treatment control group, and subjects from the latter showed no difference in ACC activation compared to their baseline.”
http://en.wikipedia.org/wiki/Neurofeedback
What do you think of this approach?
I think it’s fascinating. I believe that those who suffer from ADHD symptoms have “abnormal” brain activity, as do people who struggle with depression and anxiety. If you can help people to respond differently, you will alter their brain scans. I think the same thing occurs over time in therapy, where people learn to cope differently with their emotional struggles, thus altering the way their brain functions.
Some of the critics miss the biggest point here, and on this blog in general. I’d just like to readdress the beginning point of the argument. Any talk about “what is ADHD” misses the point because ADHD is not a thing. It’s not a disease condition. As defined by APA, it’s a set of behavioral markers that are hypothesized to indicate a disease state, but in actuality could be produced by any number of different conditions, including genetic brain abnormalities, early insults, trauma, etc. People are remarkably complex but when something goes wrong the manifestations are remarkably stereotypical. Knowing why one person exhibits the behavior may not say much about why another does.
Thanks, Steven. Much better said and more accurate than my post (or the article).
Hi, I’ve been diagnosed with adult ADHD last week – I am 29 – The doctor, who is a specialist in this area, was very kind and spent lots of time with me, looking at my school reports etc. – The thought that I might have ADHD has been around since I was a child. But I do agree that I think environmental factors play a role – although not in every case. My parents split up early in my life and we moved a lot before I was 5. My dad beat my mum, my mum was very chaotic and our life was unstable. My parents were both neglective and unreasonable and agressive with us to this day – I kept moving from my mums house to my dads and back. I also suffer from depression and anxiety since I had a burn-out 6 years ago. I tick all the boxes for ADHD. But: I don’t care what the cause of my problems is – I just want a solution. ADHD is more than just hyperactivity. We can’t just “pull ourselves together” – it seems impossible to not get distracted and to get on with stuff we don’t enjoy. People without ADHD will just never get it. And it hurts me that so many conditions are classed as real but ADHD isn’t. I don’t care what it’s called and I don’t care where it comes from. Funnily enough, my sister who grew up with me doesn’t have ADHD but she seems to show signs of Aspergers or narcisstic personality disorder, just like my dad. It is such a complex area and on one hand it’s nice to have an explanation for your problems but on the other hand it feels like an excuse. Is it really a condition or just your personality which you and your environment have to accept and shouldn’t try to alter? What if it makes your life a misery because you just don’t fit in and can’t do what everyone else is doing? Just try to do your best and don’t care what other think? I tried that and boy, just trying to get average results in work, life or other areas (compared to a normal person) seems to be so draining and exhausting..It’s true, my parents never taught me how to sit down and concentrate on learning material or how to deal money – they just thought the solution to everything is to shout at their children. And that makes me think it’s the main reason why I am the way I am. Maybe I’ll never find an answer but I still need help. Unfortunately people only accept one excuse and that is a visible impairment. Everybody else should just try a little bit harder…I am sick of it. I tried therapies and they don’t help now I just try to change my job and do something that I like and I think I can concentrate on and stay away from computers!
Maybe you just had the wrong type of therapy. Given the other issues in your family, I’m confident there are psychological factors in what you call your ADHD. “Just pull yourself together” isn’t helpful, but that doesn’t mean there aren’t issues that can be addressed and struggled with.
Thanks for your reply – I am currently in CBT and we do the typical behaviour therapy, writing diaries, basically trying to teach me how to cope better with stuff how to deal with day to day tasks yadda yadda…Thing is, I tried all this. The amount of “tricks” I tried to “beat” myself into shape and trick my brain into “just getting on with it”…What kind of therapy are you talking about? I can’t do relaxation methods, hypnotherapy etc – I tried it and I just can’t get into the desired “state”..relaxing is something I don’t do. I did counselling, just chatting..it helps me to feel better afterwards but is not a solution to my problem. I read endless books. To be honest, I really can’t think of anything else that could help me. But if you have a better idea I am all ears!
I don’t have a lot of experience working with ADHD, but I wonder if some kind of psycho-dynamic therapy (like, what else would I recommend?!) that focused on the defensive use of distraction in all areas might be helpful. To me, based on my limited exposure in my practice, “ADHD” is a kind of psychic attack on linking, as described by Wilfred Bion, where the defense against pain is to attack the attention paid to that . This may sound a little strange but it’s a familiar phenomenon to anyone who has been exposed to Bion and the way he worked. If that defense becomes habitual and pervasive, then the organ of attention becomes weakened … hence, ADHD symptoms. Just a thought.
Ive been on stimulant medication consistantly every day since age six. Never skipping. No summer breaks. Was born one month premature. Was raised in a relatively non stressful environment. Have a wealthy, kind, non divorced, normal family. There are no environmental concerns outside of the norm. But no family is perfect and like all people im sure there were some issues. I was on ritilin from first grade to 5th….and addreall age twelve until now. Im suffering from severe problems with dapting to adulthood. Im 24, and on a slew of meds. I have a biochemistry degree. And have some inderatandobg of what is goibg on. But i am almost certain i am suffering cell, receptor degeneration from long term effecta of these pills. No ilicit drugs have been used. No trauma. No no family history of abise. There is no expanation. I fight every day to find the answer to my sad, life on psych. Medication. And i battle mentally accepting my problems. When at age six no one asked me if i would like a lifetime of tics, antisocial behavior, aggression associated with my nightly crash after the drugs wear off. No one asked me !!! It was chosen for me. And i die a little inside everyday. Advice to parents. The brain developes into adulthood. Propperly monitor your child, hold them back if you need to. Let them learn to vope unless drugs are last resort. Because adders have low level dopamine as it is. Tryinf to gett off the drugs later in life is near impossible with the major crash, intensified symptoms of add, and the possibility off somekind of brain degeneration/developmental issue. I cant get ooff the pills. I would llose my lob. And insurance. A brain scan cost too much due to the insanity of pur health care system. So no one will ever know whats really goibg on inside a brain flooded with mind altering chemicals. This was my rant.
I’m glad you shared your rant, and that’s very good advice to parents. This is what comes of trusting the “experts”. I’m so sorry, but I fear your conclusions about cell receptor degeneration and long-term neurological damage are correct. Have you read Peter Breggin’s book Talking Back to Ritalin? He also has a book about how to get off psychiatric meds, Your Drug May Be Your Problem.
Thank you so much for the reccomendation. I will def. Read the book. I have avoided the topic of neuro degeneration, becauae ignorance is more comforting. But now i have to accept what i know is true based on what has been happening to me in my adult years. I must ccept that ill never get off the drugs. And if i could ever find the strength to fight the withdraw. I stil will never function right. i must accept that i cant have kids because i cant go one day without my medications. it is a scary road ahead for me and it is one i must travel ali.e. i only have bottles of pills to comfort me and get me out of bed. i feel nothing. but thank u for listening. i know you understand the deptns of what these chemicals do more tha. my pdoc….so im greatful.
This is a very interesting discussion. As a person who was diagnosed with ADHD as an adult 14 years ago, what I have noticed in the ensuing time period using stimulant medications is that my anxiety increased remarkably. My psychiatrist at the time tried to suggest this was undiagnosed bi-polar disorder. While there may be truth to this for some persons, my concern is that the lack of long-term research on the neurological effects of stimulants is missing to counter a current wave of medical ideology similar to my experience. It strikes me that there is a lot of popular writing (eg: http://www.webmd.com/add-adhd/news/20030711/adult-adhd-bipolar-disorder-may-overlap) suggesting undiagnosed bi-polar is the issue, without considering the potential tendencies of stimulants to cause drug-induced mania. My concern is that the logic and research behind this may be more grounded in “Black Swan theory” (http://en.wikipedia.org/wiki/Black_swan_theory)- justifying an unexpected current significant event by rationalizing the past inappropriately.
Another important issue that seems to be missing in the research and discussion is how typcial work expectations are very difficult for a person with ADHD to manage contrasted with the neurotypical person in areas like concentration, consistency, time management, prioritizing, etc. Often times, the person with ADHD is left with the dilemma of needing the recommended stimulant/coaching treatments to ‘pass’ as a ‘functional’ person in society.
I am personally still working on how to meet this dilemma in a more balanced way, but what I can say that has helped a lot was long term therapy with a great psychologist. I live in an isolated area, so blogs like this are also really helpful to keep me sane, thanks for your work!
You’re welcome, and thanks for sharing those links. The more I continue to work with people who suffer from so-called ADHD, the more I’m convinced that (at least for some people) it’s a by-product of a particular defensive maneuver that dominates the person’s psyche, where “distraction” from pain is the rule of the day. Distraction then becomes generalized and undermines the capacity to focus and pay attention.
I hope this thread is still alive. I searched for “ADHD” on your site and found this one and a couple of others that I’ve read.
My husband was diagnosed with ADHD as an adult about 6 years ago – over 20 years into our marriage. He has found Ritalin to be very helpful in various situations – work, conversations, etc. And he’s been more intentional about making adjustments in his life to compensate for his inattentiveness.
I started individual therapy about a year ago for depression. That has lifted but the onion peeling continues and I feel like I’m just beginning to “get somewhere”. My husband and I started couples therapy several weeks ago. Both of us want to be there. But he has serious doubts about whether or not our therapist really understands ADHD and the havoc “it” has wreaked on our marriage. He fears that not addressing “it” will mean that the therapy is ineffective. He has read a lot, taken meds, done some individual therapy – and I’ve done a lot of reading on ADHD too.
This therapist is doing EFT – emotionally focused therapy. As I understand it, the goal is to strengthen our emotional bonding, our connectedness, our sense of safety in the marriage – to stop, or “rewire” the destructive cycle we are in. It seems to me that this kind of therapy could only help with ADHD too. I have learned from experience how safe and connected therapy makes a difference over time in how I feel about myself. The thing is, it DOES take time – and meanwhile feels unsatisfyingly vague. That was my experience for many months. My husband is so frustrated and discouraged by his inability to “fix” himself or our marriage. I have plenty of my own stuff too. And I’m running out of patience with talk about ADHD … the last place I want to hear about “it” is in couples therapy.
From the way you describe it, I would agree that EFT “could only help with ADHD,” as you say. There’s no question that Ritalin can be helpful for the symptoms of ADHD; just be careful about the long-term side effects.
And I’m sorry, but I also meant to say how much I’ve appreciated your website and how helpful it’s been to me in the months since I discovered it! That part of my comment got lost in cyberspace somewhere before I’d finished it … I’d appreciate hearing your thoughts about ADHD and EFT couples’ therapy in light of what you were saying about the brain and emotion and how people change. Looking for some hope that this is a good direction for us …
I don’t know much about EFT, but from what you say, it sounds like it might be useful. My thoughts are evolving on ADHD. I’m working with some clients now who have the symptoms, and I’m learning that it results from a pervasive use of distraction as a defense in order to avoid emotional pain, which then becomes “generalized” and impacts cognitive function and the ability to pay attention.
hey Shane F, I’ve asked help to see what Hallowell said – all leads I checked were maddeningly
not reporting what I need to read in order to reply — I’ll respond when I can access Dr H’s April comments. Dr Bob
What about Ritalin for depression in adults? I am in my mid-60’s and have had a lifetime of chronic mild depression. No anti-depressant ever really helped, so the doc put me on Ritalin three years ago. I take a very low twice a day and it’s helping, but I’m concerned that eventually it is going to cause neurological problems. I understand that there are anti-depressants that can heal the brain. I worry that Ritalin harms the brain. [My mother suffered from dementia].
Any thoughts?
There are no anti-depressants that heal the brain. Staying on any psychiatric medication over a period of years can lead to neurological damage.
I read this sort of statement on the internet medical websites quite frequently: “Counseling and Antidepressants can actually cause neurogenesis (new cell growth) in the hippocampus”.
So I don’t know what to think.
Studies have shown that meditation and psychotherapy can cause the brain to develop in new ways; I’m unfamiliar with any studies that suggest anti-depressants can do the same.
I’ve had several moderately good years at a time using only talk therapy & meditation. I am glad to know that they actually help with brain health – it’s a practice to restart to see if I can beat this depression. The Ritalin works, but does not seem like a prudent long-term solution.
Thanks for your response.
Yes Joseph you are right.
All I can say is Straterra worked great for me the first time I tried it and continues helping me. If it werent for Straterra I would not have been able to concentrate long enough to read your article all the way to the end.