I’ve researched ADHD for almost 7 years now, since my own diagnosis with ADD at “Semel Institute for Neuroscience and Human Behavior” at UCLA in Los Angeles, USA. When I started out, I was lost in the vast amount of information, having trouble distinguishing facts from myths and prejudice, and I decided to get to the bottom of this. This article is the story of my travels into the unknown …
My personal favorite scientist within ADHD research is by far, Dr. Barkley. Not only have he worked with the topic of ADHD for more than 40 years, he has 3 Ph.D.’s in psychology and have grown up in a family where his twin brother was diagnosed with ADHD. During my initial research of ADHD, I stumbled upon some of Barkley’s videos on Youtube from his many lectures, and that was the starting point for my introduction to the subject matter.
About 4 years ago, while I was writing an article for my blog, ADDspeaker.net, I came across some scientific information in a study I was quoting, and to make sure that I did not misled anyone with my understanding of the science in the study, I wrote an email to Dr. Barkley and asked if I had understood this correctly. To my surprise, he replied in length and the next, and this have been the starting point for our conversations through the years. I consider Barkley as my mentor, since I do not have any formal education in medicine or psychology/psychiatry, and I have used his work to educate myself, along the way.
Besides my personal involvement with Dr. Barkley, I’ve read most of his major topic books (listed below) and this have given me a solid basis for understanding ADHD, as it is seen from a modern, scientific and evidence-based perspective. At the end of this article, you can get an overview of his career and accomplishments.
The history of ADHD dates back some 250 years, and Barkley have written the complete history in his book Attention-Deficit Hyperactivity Disorder: Fourth Edition: A Handbook for Diagnosis and Treatment (October 17, 2014), so I will not go into detail with the early facts, but instead begin with, what I consider to be the most important scientific breakthrough in ADHD research, diagnosis and treatment. In the years leading up the publications of his book “ADHD and the Nature of Self-Control (August 1, 1997)“, Barkley had done extensive research with evolutionary biology, as well as in child psychology, child development, and he ones told me that Jacob Bronowski had been a major inspiration to his understanding of how self-control (language in particular) is developed and thus it became the foundation for his description of Inhibition, and where ADHD differs from normal development. Likewise he took inspiration from Charles Darwin, Richard Dawkins, B.F. Skinner and many more). He had taken all of these pieces of information and correlated them with his own research, experience and education, and constructed a theory of ADHD, based on the nature of how normal self-control develops, compared to the way he had studied it develop in people with ADHD.
To me, this book is the defining moment in my understanding of what ADHD really is, means and how profound our impairments are, on so many levels. From this book I learned how our “Mind’s Voice” and “Mind’s Eye” both develops from our ability to learn and control language, then privatizing our speech into private and public speech, with then helps develop our ability to “talk to ourselves” and “see to ourselves”, both critical functions in child development, and to our future ability to use passed experiences in calculating the future outcome of our actions, and thereby future consequences of our actions. The human ability to postpone a need until a later time, is what differentiate us from all other species, since we can postpone our gratification now, for a potential larger outcome, at a later time. This is done using our “Mind’s Eye” to simulate multiple possible futures by “looking back, to look ahead, to get ready for, what’s coming at you“. This means that we draw from our past experiences by re-generating an image of a past event, then load all the metadata into it (feelings, emotions, smells, tastes etc.) to get the most accurate representation of our past experience, and then we offer this to our brain, for it to include in its higher functioning systems, Executive Functions (EF), for further analysis, planning and execution of behavior.
ADHD is, to summarize it in a single phrase: Time Blindness!
People with ADHD cannot deal with time. And that includes; looking back, to look ahead,
to get ready for, what’s coming at you. It’s always now!’– Dr. Russell A. Barkley, Ph.D.
The key learning from his first book, is that ADHD is not disease, it is a genetic or neurobiological, specific developmental disorder, in which the physical brain of the child, develops a slower rate, 30-40% latency compared to children at the same age, without ADHD. The core reason for this, is that some “systems” like Motor Control and Inhibition is developed in the reverse order, normally Motor Control comes after Inhibition, but in ADHD it is the other way around, which is the real core reason for the motor hyperactivity, the verbal and non-verbal behavior, the temperament and frustrations exhibited, are all symptoms of the Inhibition System being too late developed to manage the behavior, internally and externally, in the person with ADHD. So the constant moving around, the non-stop talking, the easy to anger and the lack of ability to postpone needs, are all linked to the delayed development of the management system for the Motor Control, Inhibition.
Secondly, it is explained why Inattention is not really inattention, but in fact over sensitivity to stimuli, combined with the lacking Inhibition of the Motor Control, the inability to hold more than one thing in our Working Memory (more on that later) and the missing ability to “Mental Play” to predict future consequences, all mixed up into a set of symptoms that looks like a lack of focus and concentration, called Inattention. But as it is with Motor Control, the root cause of the inattention is based on physiology, not lack of willpower, not due to bad parenting, but on lacking age-appropriate development of the Inhibition System, which causes a brain with ADHD to be unable to suppress stimuli, to not react to irrelevant events and to keep focus on the larger goal. Instead people with ADHD are being pulled along by the nose, jumping from one incomplete task to the other, since they are unable to put the brakes on and prioritize with stimuli is relevant to reach the larger goal, in the future. The joke is, look a squirrel!, and that is not as funny as people might think, since it is not a correct representation of the impairment, it is the resulting symptom of the impairment.
Likewise, Dr. Barkley states in his closing remarks of the book, that he urges the medical professionals, child care takers and parents to understand that the symptoms of ADHD is not something which the person with ADHD can control themselves, the symptoms of ADHD is based on physiology and neuro-chemistry, not due to bad will, evil intentions or calculated behavior to cause havoc around them, this is this disorder. Therefore Dr. Barkley stated, explicitly back in 1997, that ADHD medication is key to a successful treatment plan, since the only way to create long-lasting behavioral changes, are if the neuro-chemical balance within the brain, mainly dopamine levels, combined with special Behavioral Modification Therapy, is the only known combination for creating the optimal quality of life for the person with ADHD, and the best results are seen, if we medicate from an early age, 4 years, and continue to do so, well up into late adolescents, since the delayed development of the brain, is not finished until the person reaches age 30, compared to 18-22 years for persons without ADHD. He also states that the medication is documented to improve functioning on all ADHD symptoms, across the different systems in the brain, and do so safely and effectively, for between 80-90% of all patients, regardless of age. Furthermore, studies have shown that the longer a child with ADHD is in medicinal treatment, the greater the likelihood of the plasticity of the brain is, that it will reconfigure itself and make the neuro-chemically induced neural networks from the medicine, into fixed and permanent synapses, which in turn will mean that the person will have less symptoms in adulthood, than we see in people who have lived with untreated ADHD in childhood.
So in short, Dr. Barkley explained how ADHD differentiate from normal development, what causes ADHD, and what do not cause ADHD, which systems are affected, how they are affected and how medicine can help lessen the impairments experienced in the present and help avoid future complications in adulthood (depression, anxiety, substance abuse, accidents etc.), if medication is provided from 4 years and until age 30, to help the individual cope with all the challenges that this developmental disorder, causes in the early childhood, adolescent years and into adult life.
As a person who was diagnosed with ADHD at age 40, due to stress-induced depression,and burnout, I can only attest to the downside of not being diagnosed and medicated as a child, and maybe have had the chance to avoid my many co-morbid illnesses, like diabetes and anxiety. If I had been treated with medication and special Behavioral Modification Therapy in my childhood, I wouldn’t be in such a sad state, physically and mentally, as I am today at age 46, unemployable, under-educated and with diabetes and 5 diagnoses, ADHD, ASF, Depression, Anxiety and Diabetes.
Dr. Barkley has been awarded a Diplomate (board certification) in three specialties, these being Clinical Psychology (ABPP), Clinical Child and Adolescent Psychology, and Clinical Neuropsychology (ABCN, ABPP). He is a clinical scientist, educator, and practitioner who has authored, co-authored, or co-edited 20 books and clinical manuals. He has published more than 200 scientific articles and book chapters related to the nature, assessment, and treatment of ADHD and related disorders. Dr. Barkley has served on the editorial boards of 11 scientific journals and as a reviewer for numerous others. He was the President of the Section of Clinical Child Psychology, Division 12, of the American Psychological Association (1988), and was President of the International Society for Research in Child and Adolescent Psychopathology (1991).
He has received numerous awards over his career for his work in ADHD and the field of psychology. In 1994, he received the Distinguished Contribution Award from the American Association of Applied and Preventive Psychology, and in 1996, he was awarded the C. Anderson Aldrich Award from the American Academy of Pediatrics for his research career in child development. In 1998, he received the Award for Distinguished Contribution to Research from the Section on Clinical Child Psychology, (now Division 53) of the American Psychological Association. In 2002, he received the Dissemination Award from the Society for a Science of Clinical Psychology, Division 12, of the American Psychological Association for his career long efforts to dispel misconceptions about ADHD and to educate the public and other professionals about the science of this disorder. And in 2004, he received an award for distinguished service to the profession of psychology from the American Board of Professional Psychology. In 2012, Dr. Barkley was given the Distinguished Career Award from the Division of Clinical Child and Adolescent Psychology of the American Psychological Association.
This far-reaching work from renowned scientist-practitioner Russell A. Barkley provides a radical shift of perspective on ADHD. The volume synthesizes neuropsychological research and theory on the executive functions, illuminating how normally functioning individuals are able to bring behavior under the control of time and orient their actions toward the future. Meticulously applying this model to an examination of the cognitive and social impairments manifested in ADHD, Barkley offers compelling new directions for thinking about and treating the disorder. The paperback edition features a new afterword in which the author reflects on current research directions and the continuing evolution of his approach.
Providing a new perspective on ADHD in adults, this compelling book analyzes findings from two major studies directed by leading authority Russell A. Barkley. Groundbreaking information is presented on the significant impairments produced by the disorder across major functional domains and life activities, including educational outcomes, work, relationships, health behaviors, and mental health. Thoughtfully considering the treatment implications of these findings, the book also demonstrates that existing diagnostic criteria do not accurately reflect the way ADHD is experienced by adults, and points the way toward developing better criteria that center on executive function deficits. Accessible tables, figures, and sidebars encapsulate the study results and methods.
This groundbreaking book offers a comprehensive theory of executive functioning (EF) with important clinical implications. Synthesizing cutting-edge neuropsychological and evolutionary research, Russell A. Barkley presents a model of EF that is rooted in meaningful activities of daily life. He describes how abilities such as emotion regulation, self-motivation, planning, and working memory enable people to pursue both personal and collective goals that are critical to survival. Key stages of EF development are identified and the far-reaching individual and social costs of EF deficits detailed. Barkley explains specific ways that his model may support much-needed advances in assessment and treatment.
See also Barkley’s empirically based, ecologically valid assessment tools: Barkley Deficits in Executive Functioning Scale (BDEFS for Adults) and Barkley Deficits in Executive Functioning Scale—Children and Adolescents (BDEFS-CA).
Widely regarded as the standard clinical reference, this volume provides the best current knowledge about attention-deficit/hyperactivity disorder (ADHD) in children, adolescents, and adults. The field’s leading authorities address all aspects of assessment, diagnosis, and treatment, including psychological therapies and pharmacotherapy. Core components of ADHD are elucidated. The volume explores the impact of the disorder across a wide range of functional domains—behavior, learning, psychological adjustment, school and vocational outcomes, and health. All chapters conclude with user-friendly Key Clinical Points.
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