When you say ADHD, most people automatically turn to the subject of ... meds ... Most people believe that they know what it is, how it works, and whether or not it is safe and effective ... and unfortunately even more often ... if it is necessary or not ... The evidence (and 60 years of clinical practice) is crystal clear: It’s both, It’s extremely effective, and ... IT IS SAFE - AND - NECESSARY ... Why!? Well, let me tell you and you can judge for yourself ...
When you say ADHD, most people automatically turn to the subject of … meds …
Most people believe that they know what it is, how it works, and whether or not it is safe and effective … and unfortunately even more often … if it is necessary or not … The evidence (and 60 years of clinical practice) is crystal clear: It’s both, It’s extremely effective, and … IT IS SAFE – AND – NECESSARY … Why!? Well, let me tell you and you can judge for yourself …
Medication is a drug or other form of medicine that is used to treat or prevent disease, disorders, and illnesses. They are often designed to work in the human body to provide a single task, like pain relief for instance.
Most medication works by altering or regulating the systemic functioning of the body’s PHYSIOLOGY (functions and systems that regulates how the body responds to internal or external stimuli) and do not normally have any effect on the body’s ANATOMY (the bodily structure of humans, Into its separation of parts, e.g. an arm or a leg, heart, lung etc.). PSYCHOLOGY is the term used for describing the end result of this complex, yet orchestrated, dance between our anatomy and physiology, and this result is termed: VERBAL (what you say, your voice tonality, speech intensity and speed) and NONVERBAL (body language, voluntary as well as involuntary physical movements) behaviour.
Since ADHD is defined as a Neurodevelopmental Disorder in both the DSM-5 and in the ICD-10/11, it confirms that ADHD is – in essence – not a simply a state of insanity or of a mind gone completely bonkers, but rather that the behaviour which persons with ADHD exhibit, is outside the normative, sociocultural expectations for a person of similar age, gender, socioeconomic group, education and so forth, what is mostly termed NEUROTYPICAL(or NT for short), which is what we, as a society of homo sapiens sapiens collectively have decided to call: NORMAL
What many people do not know, however, is that ADHD is like seeing the tip of an iceberg and expecting to thereby have seen – the whole iceberg … but as you very well know, the tip of an iceberg only shows around 10% of it’s total size and mass. ADHD is exactly the same, what we diagnose after and what you experience when interacting with persons with ADHD, is simply the end result, called BEHAVIOUR that this person presents themself with.
So when a kid, age 10, is acting with the ability to restrain their sudden urges to do – whatever – that is more in line with what you would expect from a child, let’s say … age 7 … then what you see (the physical age of the child) is not congruent (matching) with the behaviour that you see this child have (because he is a impulsive as a 7 year old).
This is THE only visible evidence that you will have, that clearly indicates to you, standing outside and watching in onto that kid, right? You have no idea what is going on, inside this kid’s mind or body, and you can therefore solely judge the behaviour, based on what you can observe. (for more information, see the video below on what The Barkley’s 30% Rule is …)
BUT … Since what you see, is only the tip of the iceberg, and you are not even aware of the remaining 90% of it which hides below the surface, you should intuitively now realize, that you really have no clue what ADHD really is … right?
This article has two purposes:
The only constant in the known universe is … change …ADDspeaker, 2020
Shall we begin?
Attention-deficit/hyperactivity disorder (ADHD) is a prevalent and morbid neurobiological disorder estimated to affect up to 11% of children and 5% of adults. It is associated with high rates of many adverse functional outcomes including comorbid psychiatric disorders, academic impairments, accidents and injuries, and car accidents, among many others (Boland et al., 2020)
Well let’s see …
Morbid is defined as: characterized by an abnormal and unhealthy functioning in a disturbing and unpleasant behaviour, which can potentially lead to death and chronic systemic dysfunction, or disorder, of … [insert function here].
Neurobiological is defined as : Neurobiology is the branch of biology that is concerned with the anatomy and physiology of the nervous system.
Disorder is defined as: a disturbance of the expected, and regular or normal functions of … [insert object here]
So that must mean that we are talking about something which we could describe as follows:
A condition that is characterized by an abnormal and unhealthy functioning in a disturbing and unpleasant behaviour, which can potentially lead to death and chronic systemic dysfunction, or disorder of behaviour, that is concerned with the anatomy and physiology of the nervous system, which results in a disturbance of the expected, and regular or normal functions of … [in our case the object is] behaviour.
That means, that ADHD is at it’s core, a disturbance of the expected, normal functioning of behaviour, as it is perceived, compared to other persons of the the same age, gender, socioeconomic …. etc.
Behaviour is NOT something that is within a person’s complete and willful control. It is more the result of a complex system that through our Autonomous Nervous System – ANS (the invisible hand that pull on Pinocchio’s strings, without him realizing that he is not in control, at all). The ANS is the body’s safety and management control system, that have one and only one objective – survival …
And since everyone who’ve ever met another human being knows, they are not to be trusted to be able to carry out such an important task, without ‘Adult Supervision’, right? This Adult Supervision is called: The Inhibitory System.
Imagine a dog sitting in front of a treat, starring it down as if it could taste it if only it vision could use it’s Transmogrify ability to ingest that sucker … got the image ready? Good … Now think what would happen if you left the room, without instructing the dog to … staaayyyyy … You know what would happen, the moment it realized that your gaze had shifted its attention away from it, right! CRUNCH!!!! … This is The Inhibitory System in action, simply put!
Inhibitory Self-control is the ability to postpone the instant gratification of any potential need, in order to receive an even larger gratification, if you can wait a little bit longer. Again, try putting a treat in front of the dog and tell him that if he can wait 5 minutes, without eating it – even when you leave the room – then he would receive TWO treats after the test … NEVER GONNA HAPPEN, right!?
Inhibitory Self-regulation is the ability to distract or alter our attention away from the temptation, by altering our internal dialogue (don’t do it!!!!), or by blocking the stimuli from your attention (covering your eyes or eyes), or by invoking a system which physically prevents you from acting out the nonverbal behaviour required to reach your gratification (kid sitting on his hands, staring a the piece of pie right in front of him).
Inhibition, as it is called, is a core feature of human survival, as it is the means by which the ANS controls what the MIND (you) actually acts out, as verbal or nonverbal behaviour.
It is the annoying mom of a teenage girl, constantly knocking on her door to offer up some completely random thing, just so that she can – interrupt or regulate – the girl’s behaviour … when her boyfriend is visiting … get it!?
We’ve ALL been there, right!?
No THANKS mom, we do NOT want to taste your new Quinoa/Kale Brownies, OKAAAAYYYYYY!?!?!?
Disinhibition, as it is called, is when mom is out at a school meeting, and some poor sucker have left DAD in-charge of – regulating teenage behaviour – while the Bronco’s are playing …
So what does this all have to do with ADHD, and why is this relevant for understanding what ADHD medication is, how and where it works, and why it is not ‘nice-to-have’?, but indeed is – NEED-TO-HAVE …
ADHD is a neurodevelopmental disorder, which just means that it is something that you are born with (it gets ‘gifted’ when you parents exchange their chromosomes and create your unique DNA), and since genes account for 95% of the behaviour that is associated with ADHD (yep, that’s true, 95% of everything that annoying person with ADHD is doing, is due to his genetic makeup, not lack of self-control, stupidity or negligence, but is just as non-controllable as you eye-colour, skin-colour, height, weight etc.), since neither you as the parent of, or the person with ADHD are only able to regulate and control 5% of the behaviour of the person with ADHD.
Take that, all you ignorants who have been tricked into believing …’ Look at that mom over there with that awful kid, she surely only gives her kid those narcotics because she is not able or willing to take care of her own child ...’
No, she do not … She is educated, knowledgeable and super concerned about her child’s well-being, both in the here and now and in the long run as well.
She understands, that what her kid DOES is not always within his/her own willful, cognitive control, but is dictated by and due to a neurodevelopmental delay of 30-40% in her child, compared to your child, with the same – chronological – age!
Your 10-year old and her 10-year old are, physically and intellectually at the same level, but her kid only have the inhibitory control of that which you would expect from a child that was 30-40% younger.
Said in another way, her child looks 10, but acts like a 7-year old, but only when it comes to DOING WHAT YOU KNOW, not in regards to KNOWING WHAT TO DO!
This is called The Executive Age by dr. Russell A. Barkley, PhD, the author of the ‘Unifying theory of ADHD’ which since 1997 have been the basis for all diagnostic systems, DSM-5 and ICD-10/11, since. His book “ADHD and the Nature of Self-control” explains and provides scientific evidence for, what it is that is different and thereby causes the unwanted behaviour, which is associated with ADHD.
What he tells us, is that in order to self-control and self-regulate, we must first learn to ‘talk to ourselves in our Mind’s Ear, and see for ourselves with our Mind’s Eye, so that we become able to SIMULATE the outcome of a giving action BEFORE we put the behaviour into verbal or nonverbal behaviour, so as to make the best decisions – long term …
He explains that when a kid, aged 3-5, suddenly begins to speak on behalf of its toys, or acting out elaborate social interactions (you know, the tea party where all the Teddy’s are seated around the coffee table engulfed in intellectual debate …), because by training the child’s own ability to ‘pretend to be someone else, and speak on their behalf’, the child is training it’s ability to SELF-CONTROL, by talking to itself, later on in life, without saying a sound, within its own Mind’s Ear, is the key to INHIBIT responding to every little stimuli, regardless of whether it has any bit of being of – relevant or irrelevant importance – for the task at hand.
By developing the Mind’S Ear and Mind’s Eye, homo sapiens sapiens are the ONLY known species in the Universe, that is able to ‘predict the future’ …
Humans are able to see within their MIND‘s Eye what possible outcomes may result in taking this action or that action, before the BODY actually put it out there, as behaviour. We get a free ride and a leg up on all other species, and this is the primary reason that it is you who are testing if your dog can inhibit itself from eating the treat, or not your dog testing you out … just so you know this 😉
“GET TO THE POINT; WILL YA!!!!!” OK, ok, ok, gotcha …
ADHD is a neurodevelopmental disorder, which causes a 30-40% delay in the normal development of inhibition, resulting in dysfunctions in inhibitory self-control and inhibitory self-regulation, as well as emotional self-control and emotional self-regulation, combined with the inability to focus attention solely on task-relevant stimuli, and to ignore task irrelevant stimuli.ADDspeaker, 2020
In other words, your kid with ADHD is not the least bit less able to LEARN the same stuff as all his peers at the same age, but he/she is NOT able to USE the skills they do know beforehand, BEFORE their autonomous nervous system have already given the green light to react to any incoming stimuli, relevant or not, and without any thought to the future consequences of said taken action … Ring any bells, people!?!?
“But Mom, I PROMISE you that today will be a perfect day in school and I PROMISE that I will do everything I’m told by the teachers, PROMISE …” – 2 hours later you get the usual call to go pick up the kid at the principal’s office … again …
He really means that he WISH and WILL do the right things, in his mind, but since his mind is not in control of his body, he is powerless to use, what he has learned and stored in his MIND, since it is his BODY that have already acted or reacted, before the decision was even close to getting into the grasp of the MIND taking control …
So persons with ADHD is just as clever, smart, knowledgeable and skilled as anybody else, they are sadly just not able to use it all, because their BODY has ransacked everything, long before their MIND and all that wisdom, comes into play …
I AM NOT A BAD KID, BUT SOMETIMES WHAT I DO IS BAD …
ADHD medication is, put it short and simply, your externally provided inhibitory control, which helps the MIND to retake control of the BODY, so that you can use your MIND’s Ear and your MIND’s Eye to have the behaviour which is expected by persons in your age group (adults as well, trust me, I’m one ‘those kids myself’).
Like Cinderella who has to return to her little room in the attic, after the ball at the castle, so will I and every other person with ADHD, as soon as the ‘ball is over’ (when the medication’s effect is used up, 4-6 hours later).
Think of it as a break from being the bad kid, the kid who always gets all the blame, who can remain seated in class, can’t stop teasing her brother, and please, please – don’t forget, the little girl in the back of the class, who simply is all alone within her own MIND’s Eye and MIND’s Ear, disconnected from the world, in a day-dreaming hypnotic state, but never causing any trouble or calling for anyone’s attention … all these kids, they get a brief moment in which they are able to feel JUST LIKE ALL THE OTHER KIDS ….
Now tell me – are you still against giving your child medication!? Let me know in the comments …
Barkley R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychological bulletin, 121(1), 65–94. https://doi.org/10.1037/0033-2909.121.1.65
Boland, H., DiSalvo, M., Fried, R., Woodworth, K. Y., Wilens, T., Faraone, S. V., & Biederman, J. (2020). A literature review and meta-analysis on the effects of ADHD medications on functional outcomes. Journal of psychiatric research, 123, 21–30. https://doi.org/10.1016/j.jpsychires.2020.01.006
Cortese, S., Adamo, N., Del Giovane, C., Mohr-Jensen, C., Hayes, A. J., Carucci, S., Atkinson, L. Z., Tessari, L., Banaschewski, T., Coghill, D., Hollis, C., Simonoff, E., Zuddas, A., Barbui, C., Purgato, M., Steinhausen, H. C., Shokraneh, F., Xia, J., & Cipriani, A. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. The lancet. Psychiatry, 5(9), 727–738. https://doi.org/10.1016/S2215-0366(18)30269-4
Franke, B., Michelini, G., Asherson, P., Banaschewski, T., Bilbow, A., Buitelaar, J. K., Cormand, B., Faraone, S. V., Ginsberg, Y., Haavik, J., Kuntsi, J., Larsson, H., Lesch, K. P., Ramos-Quiroga, J. A., Réthelyi, J. M., Ribases, M., & Reif, A. (2018). Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 28(10), 1059–1088. https://doi.org/10.1016/j.euroneuro.2018.08.001
Krinzinger, H., Hall, C. L., Groom, M. J., Ansari, M. T., Banaschewski, T., Buitelaar, J. K., Carucci, S., Coghill, D., Danckaerts, M., Dittmann, R. W., Falissard, B., Garas, P., Inglis, S. K., Kovshoff, H., Kochhar, P., McCarthy, S., Nagy, P., Neubert, A., Roberts, S., Sayal, K., … ADDUCE Consortium (2019). Neurological and psychiatric adverse effects of long-term methylphenidate treatment in ADHD: A map of the current evidence. Neuroscience and biobehavioral reviews, 107, 945–968. https://doi.org/10.1016/j.neubiorev.2019.09.023
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