ADHD: The problem is simply diffused attention

To the man who only has a hammer in the toolkit, every problem looks like a nail.
–Abraham Maslow

As I’ve maintained for years, if we keep thinking of ADHD as unalterable brain damage, dysfunction, or dysregulation, it will be difficult to move forward with positive change. I contend that ADHD is a trait in the spectrum of human neurological variation. It is essentially no different that other genetic traits like intelligence, or eye and hair color, etc. Therefore, a new conceptualization of the basic nature and etiology of ADHD behaviors is necessary in which current known research about human potential and learning are incorporated to produce a scientific, systematic approach to teach sustained attention and improve subordinate deficits in related cognitive skills like short-term memory.

The problem is simply diffused attention. While this statement is quite simple, diffused attention greatly affects every aspect our one’s life. It makes the learning process much more difficult and therefore subsequently affects one academically, socially, and personally. However, having focused attention to a task, currently termed fluid intelligence, can be improved by providing correct challenges – both cognitive and behavioral. Therefore, one can learn to focus on any level of stimulation. The brain has a remarkable ability to compensate by either strengthening current neural networks.

In the very recent past, the brain was considered a gray lump that declined in function as it aged. We now know that this is entirely false. The brain is in a constant state of reorganization. This restructuring/reorganization of the brain is termed neuroplasticity. One of the root words is plastic. Its denotation is moldable or pliable like clay. It is not used in the sense of the hard plastic case covering a computer. Recent advances in brain scanning and analysis have revealed that the brain is plastic – always reorganizing not just in a sense of shuffling files, but architecturally as well. The wiring or neural circuitry is constantly changing depending on external challenges.

Children and adults with brain injury or developmental difficulties offer dramatic proof of the brain’s amazing capacity to compensate if provided a correct challenge that will stimulate the growth of a compensatory neural network or strengthen a previously existing one. Many neurological journals report cases where children who lose language due to a stroke at a young age often recover the ability to speak. This is due the fact that the brain is able to shift this function to another area (compensation through adaptive neural networks). According to UCLA pediatric neurologist Dr. Donald Shields, “if there’s a way to compensate, the developing brain will find it.”

Scientists apply the term neuroplasticity to the action of brain growth and adaptation in response to challenge. Provided the correct challenge and environment, children and adults frequently compensate (shift brain function from one area to another) when a certain area of the brain cannot function correctly. It is documented in many medical and neurological journals that the brain will increase activity in another region to overcome loss of another region.

Implications for ADHD

There is no question that the brain can compensate even if it has problems focusing attention. However, it has to be provided the correct environment prompting challenge. As recently as twenty years ago, scientists believed that the genes we were born with wholly determined the structure of our brains. However, current extensive research performed by scientists worldwide proves that how our brains develop, learn, and grow depends on the vital interaction between nature and nurture. Nature, or more accurately, genetic endowment, is directly affected by the environment, care, challenges, and teachings received (nurture).

As recently as twenty years ago, scientists believed that the genes we were born with wholly determined the structure of our brains. However, current extensive research performed by scientists worldwide proves that how our brains develop, learn, and grow depends on the vital interaction between nature and nurture. Nature, or more accurately, genetic endowment, is directly affected by the environment, care, challenges, and teachings received (nurture). Furthermore, the old notion that early childhood experiences have little impact on later development has been proven false. We now know that the brain is directly and decisively affected by early experiences. This includes the architecture of the brain and the nature and extent of adult capacities; the actual capacity to form new neural networks is directly affected by early childhood experiences.

It was also thought that brain development is linear: the brain’s capacity to learn and change grows steadily as an infant matures into adulthood. It is now known that brain development is non-linear: there are optimum times for acquiring different kinds of knowledge and skills. For example, it is often easier for a very young child to learn a new language than a person past the age of 25. However, the brain can grow and continue development through death provided the right conditions are met.

When I was training at university, psychologists contended that an infant’s brain was very inactive. However, scans now reveal an infant’s brain to be three times as active as that of a college student. Much has changed in the last ten years. In upcoming commentary, I’ll describe how learning takes place, its connection to neural networks and neuroplasticity, and site studies which support that brain development can be greatly enhanced via cognitive re-education.

In upcoming articles, I’ll discuss how we learn. We’ll look at this perspective from an external cognitive approach to learning and then proceed to an internal perspective involving the actual structural neural changes that occur when we learn. Finally, I’ll examine the molecular (DNA) changes that trigger the learning process and encode it to long-term memory.

ADHD: Difference or Disability?

In the landscape of spring there is neither better nor worse.
The flowering branches grow; some short, some long.
– Zen saying

No Known Biological Marker For ADHD

Dr. Russell Barkley essentially has created an industry surrounding his name and ADHD. While saying little that’s new to the field, he regurgitates the repetitive paradigm that essentially places AD/HD children and adults into the minimal brain dysfunction category, i.e., ADHD people are brain damaged. He pathologizes ADHD even though no known biological marker exists; no certain neuropathology or brain abnormality exists that definitively establishes the presence or absence of the disorder. The NIH Consensus Statement – Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder, states: “Although research has suggested a central nervous system basis for ADHD, further research is necessary to firmly establish ADHD as a brain disorder.” In short, does anyone know the cause? No. Has it been identified with a biological marker? No. Has it been positively attributed to heredity? No. The NIH publication, A Look At Attention Deficit Hyperactivity Disorder  states, “The exact cause of ADHD has not yet been found.”

ADHD Is A Subjective Diagnosis

In other words, if one had a tumor, it could be located via scanning or possibly via X –ray and acted upon accordingly. Since AD/HD has no biological marker like a tumor, it is not identifiable as to physical location or magnitude. Simply stated, ADHD is a subjective diagnosis, an educated guess whose cause is unknown but is replete with theory.

 A Neuropsychological Paradigm

 While Barkley and others advocate the brain damage paradigm, this contradicts many psychologists’ current views that ADHD may naturally fall on the spectrum of genetic human traits like intelligence and hair color. Barkley’s neuropsychological paradigm predicts that ADHD will be found to have pathology, perhaps a single pathology. Proponents of this theory are looking for the Holy Grail of AD/HD – a single brain difference or dysfunction that will indicate the presence of ADHD. For many years researchers utilizing nascent technologies like SPECT, MRI, and QEEG etc., have produced reported structural and functional brain differences between subjects considered to be normal and those considered to have ADHD. Some research has demonstrated that ADHD people have brain sizes 2% – 5% smaller than their peers. Ridiculous as it may seem, this research, amounting to little more than a new phrenology, has contributed to a belief that these measurable differences establish a neurological basis for ADHD. This research has fundamental flaws and has greatly contributed to confusion regarding the cause of ADHD. Since no test exists to determine the presence of ADHD, and the diagnostic criteria are all subjective (and modified over the years), how does one select a group of normal subjects?

A Problem Of Antecedence

Assuming one could precisely find a normal group for comparative study, we still have the mystery analogous to the chicken and the egg – a problem of antecedence. Available research supports that any measurable differences in brain wave electroencephalography (EEG) or structural MRI (brain scanning) simply are the consequence of (and not the cause of) behaviors that define AD/HD or simply reflect personality differences.

ADHD Study: Faster Diagnosis Urged

One of the current gurus in the field of ADHD is Dr. Russell Barkley, a former Professor of Psychiatry and Neurology University of Massachusetts and currently Professor of Psychiatry at the Medical University of South Carolina. He is author of numerous books on ADHD and has performed research on ADHD, much of which has been sponsored by the pharmaceutical industry.

This includes his most recent survey, Without Boundaries – Challenges and Hopes for Living with ADHD: An International Survey, conducted for the World Federation for Mental Health. The focus of the survey was to determine the average length of time for diagnosis of ADHD and the family impact. The research was funded by Eli Lilly Pharmaceutical, and reveals that the average time to get a child diagnosed with AD/HD is one to two years. Not surprisingly, Dr. Barkley and Lilly think this is too long as children could be started on medication and behavior modification much sooner. While one must agree that a proper, quick diagnosis should be available to all children and adults, sponsorship of the survey is hardly altruistic of Lilly who makes millions of dollars, if not billions off of their ADHD meds. Are they requesting a quicker diagnosis to sell more medication quickly?