July 5, 2019
Why Do People Still Have ADHD?
The Centers for Disease Control reports that 11% of American children have been diagnosed with ADHD. On average, every classroom of 30 students has 1-3 children with ADHD. Additionally, 4.4% of the adult population reports having ADHD. My guess is that every person represented by these statistics will report that they struggle to get through at least some aspect of daily life. If Darwin knew what he was talking about, why does a significant part of the population still have ADHD? Darwin would have us believe that organisms who are better adapted to their environments survive and produce offspring. Thanks to modern science, we know that ADHD is highly heritable. Parents with ADHD have a better than 50% chance of having a child with ADHD. Twin studies place the heritability range at closer to 80%. So if the typical ADHDer reports feeling far from adapted to modern life, why do these genes continue to be passed from one generation to another?
In 2008, Dan Eisenburg of Northwestern University examined two tribal groups in Kenya, one of which had settled into villages while the other remained nomadic. By identifying tribal members with ADHD and by examining a genetic variant associated with ADHD symptoms, researchers showed that the ADHD members of the nomadic tribe were better nourished than the non-ADHD members. Information was shared in this nomadic tribe the same way it has been throughout time - through observation, informal instruction, learning through doing, and play. These researchers also showed that ADHDers in the settled tribe had more difficulty in school. In essence, the traits associated with ADHD make for better hunter-gatherers and worse settlers.
Our modern society does not require hunting for food but instead requires being in places with structured codes of behavior, like school and the workplace. If ADHD traits make for great hunter-gatherers, is it any wonder those same traits can make success in our modern school system hard to come by? Peter Gray, PhD, a research professor in Psychology at Boston College, argues in Psychology Today that ADHD is, on a basic level, a failure to adapt to the conditions of our modern school system. "From an evolutionary perspective, school is an abnormal environment. Nothing like it ever existed in the long course of evolution during which we acquired our human nature."
ADHD is not a flaw or a problem to be solved through medication but instead is a failure to adapt to modern schooling. With a better understanding of our evolutionary legacy, people with ADHD can not only learn to manage the school years better but ultimately pursue a life that better fits the unique structure of their brains. ADHD traits remain in the human population because they always have been valuable, and they remain so in environments that support rather than suppress their expression. The choice of the ADHDer then becomes whether he will change his brain through medication to fit the environment or change the environment to suit his unique brain wiring.
July 22, 2019
ADHD and Longevity
Having ADHD makes it more difficult for a person to self-regulate and to control impulsivity, thereby significantly impacting productivity, relationships, and general life management. But according to new research, these difficulties, if untreated, also translate into a marked decrease in life expectancy.
This study, conducted by Dr. Russell Barkley, clinical professor of psychiatry at the Virginia Treatment Center for Children and Virginia Commonwealth University Medical Center in Richmond, Virginia, found that having ADHD can decrease lifespan by an average of 9 - 13 years, with the worst cases of untreated ADHD decreasing longevity by as much as 25 years.
Dr. Barkley followed a group of people with ADHD from childhood to adulthood, evaluating the connection between the disorder and fourteen other critical health factors, including alcohol use, nutrition, exercise, and tobacco use. After 20 years, the data was evaluated using life insurance actuarial charts which estimated expected remaining lifespan based on lifestyle and health measures. The study found that children diagnosed with ADHD in childhood had a reduction on average of nearly 10 years in their healthy remaining life expectancy. He also found that if ADHD had persisted to young adulthood, the reduction in healthy life was nearly 13 years. “If you look at the four biggest health risks in the US—poor diet, insufficient exercise, obesity, and smoking—ADHD presents a greater risk than all four of these concerns combined,” explains Dr. Barkley. The complete study, Hyperactive Child Syndrome and Estimated Life Expectancy at Young Adult Follow-Up: The Role of ADHD Persistence and Other Potential Predictors, was published in the Journal of Attention Disorders.
The effect of ADHD on longevity is rooted in its complex impact on goal-related behaviors. Underdeveloped cognitive and emotional skills affect not only work and school performance but also the ability to stick to any health-related plan, including eating, sleep, and even driving. Studies indicate that untreated and even under-treated ADHD increases the risk of diabetes, alcohol and drug abuse, smoking, obesity, and auto accidents. Separate and apart from ADHD, each of these health risks decrease life expectancy by several years. Because ADHD makes it more difficult for an individual to stick to an exercise plan, a new diet, a smoking cessation program, or even instructions on how to manage other medical conditions like diabetes, ADHD increases the likelihood of almost every other element that predicts shorter lifespans. Thus, ADHD alone is a more significant danger than anything else on the list.
But the results of Barkley's study should send a message of hope: every predictive risk factor can be changed. However, before they can be changed, ADHD must be treated. Dr. Barkley contends that unhealthy behaviors are not likely to improve until the underlying problem -- ADHD -- is addressed and healthcare professionals begin to look for ADHD as a potential reason for a patient's noncompliance with recommended changes. The conclusion that should be drawn from Dr. Barkley's study is that treatment for ADHD, along with the health risks it poses, has the possibility for adding an average of 9-13 years to the lifespan of those diagnosed with the disorder.
September 9, 2019
The Deal with Dopamine
Dopamine is a neurotransmitter that has much to do with anticipation and reward. Dopamine motivates a person to seek out rewards, so not having enough dopamine leads to motivation issues, procrastination, task avoidance, and ignition problems. If a person does not have the desire to do something, dopamine levels decrease, and if you have low dopamine, your desire to do a task is decreased. This cycle serves to explain one of the most central characteristics of ADHD: the ADHDer can remain focused on and motivated by things that interest him because dopamine is produced and motivation is increased. But he or she will be unmotivated by and unfocused on tasks that are not interesting because dopamine, and hence motivation, remain low.
Dopamine production in the ADHD brain is different from that of the neurotypical brain. This production is more intermittent, so the ADHD brain tends to not have enough of the neurochemical, and what dopamine it does have is used inefficiently. The area of the brain that produces dopamine projects it to both the frontal lobe, which is responsible for executive functions, and the midbrain, which is responsible for emotions. This transmission explains the connection between our executive functions (like focus, prioritization, working memory, self-control, planning, and organization) and our feelings (how motivated or rewarded we are).
So what are some things that lower the dopamine in the brain of the ADHDer? As mentioned previously, disinterest in a topic is a dopamine killer, but similarly, not seeing the point in doing a task lowers dopamine levels. If a person feels a task is too hard and that he might be embarrassed by attempting it, dopamine decreases. Dopamine is also lowered as a result of uncertainty about where to start and fear that doing a little of an unpleasant task will only lead to doing more of the task. When dopamine levels are low during a task, a person might go hunting for more. For instance, if a child has begun a task, but his pace and momentum slow down, and he eventually stops and does something else, this new activity is a dopamine producer for him. Other dopamine killers include sweets, social media addiction, and watching a great deal of television.
So how can the ADHDer accomplish tasks that are uninteresting and therefore unmotivating to him? One solution is to offer external rewards - a piece of candy or a few minutes with a video game upon completion. The key to these external rewards is that they must be fairly immediate. Large late rewards do not seem attainable, so they are not motivating, and delaying gratification is difficult. For instance, telling your ADHD freshman to outline his History homework so he can graduate in 4 years will not be motivating. Stronger and more immediate incentives are more likely to cause behavior modification, so taking the time to think about the things you find rewarding can be extremely helpful. Another strategy is to tie the task to something that the person values or wants to achieve and to continually remind him of that goal or value during the task. Dopamine can be produced while doing the unpleasant task by eating an enjoyable snack or listening to a favorite music playlist. Caffeine enhances dopamine signaling in the brain in the same, albeit lesser, way stimulant medications do. Dopamine-producing foods include wild-caught fish, beets, apples, turmeric, black pepper, and foods that contain tyrosene, like eggs, steak, and dark chocolate. But probably the fastest and easiest way to produce dopamine is through exercise, which floods the brain with a host of other beneficial neurochemicals. Finally, meditation has been shown to increase dopamine and to greatly improve concentration.
A word of caution -- We tend to think, when we use the word "reward," that our brain seeks out a positive response. Ascribing this motivation to the human brain would lead one to believe that our brain has emotions it does not have. Our brain simply senses the deficit of a neurochemical and wants to replenish it, regardless of the means. The brain will find some things that are not necessarily positive to be incredibly stimulating and also dopamine-producing. The best example of this type of stimulus is arguing. A fiery dispute will fill the participant’s brain with dopamine. So when you are in the heat of the homework struggle, recognize that your child's brain is seeking more dopamine, and the object of that search may be satisfied as easily by a Hershey's Kiss as it is a full-on screaming fight.
March 14, 2020
What Does an ADHD Coach Really Do?
People are often confused about the role of any type of life coach, especially one that specializes in helping people with ADHD. Some of my younger clients call me their ADHD tutor, probably because coaching brings to their minds some sort of athletic endeavor. But I am definitely not a tutor. I will not be explaining a child’s schoolwork to them or helping them with homework unless doing so allows us the opportunity to practice a skill or strategy we are working on.
I am not a therapist either, although sometimes exploring the “whys” leads to a deeper understanding which then points to a possible solution. Therapists tend to look back, but I want to know who my client is today. Coaching is very forward-looking and solutions-oriented.
Parents often expect me to make their child want to do something. If I had the ability change another person’s natural desires and interests, I would be charging a lot more for a session! Instead, I work with the family to accept who their child is and to develop strategies to make it easier to accomplish what previously has been difficult.
I have had children and teens very reluctantly attend their initial session because they do not want one more adult telling them what to do. But my simply telling a person with ADHD how to solve a problem would be the least productive way of getting to a solution. I am completely convinced of two things: that I do not know the answers for my client but that, if we collaborate, we have an excellent chance of hitting on the right answer. So I ask a lot of curious questions about who the client is, the client’s goals, desires, and interests. I want to know where they are now and where they want to go. And I look for their strengths and what is working well so that we can use those things for what is hard. I give them ideas to start them thinking, and I listen with the belief that they hold the answers. It is my job to help them find those answers. And because we are working together as equals, my clients do not feel that they have to do anything just to please me. I want them to be unafraid to tell me that a strategy we are trying out was a complete failure. I am not interested in them successfully executing a suggestion of mine. I am interested in finding the best way for them to reach their goals by helping them become more self-aware, helping them learn about their unique brain wiring, and helping them understand how ADHD manifests itself in different situations.
If a client comes to his first session with a look of dread or fear or apathy, I often ask them if they know what the goal of our sessions will be. “To make your life easier and better and happier.” Soon, they realize that being honest with me about not wanting to do the things they are “supposed” to be doing will not only not disappoint me or make me think less of them, but it is actually an incredibly helpful confession that we can use to make doing those things more tolerable for them. As a coach, I want to provide clarity, focus, and assistance in generating choices in order to accelerate my client’s progress towards managing his or her inattention, hyperactivity, and impulsivity.