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Revisiting ADHD (ADD) with Dr. Russel Barkley: Attention Deficit Disorder or “Executive Function Deficit Disorder”

I’m not quite sure how any condition often labeled as a “cognitive deficit” disorder could be misconstrued as a gift, but out here on the “West Coasts”—Alaska and California—two places I’ve most recently lived, there are supposedly numerous risk takers and adventure seekers with this “gift” called Attention Deficit Disorder, that also presents as a mental health condition.

It is difficult to grasp how having the attention span of a fruit fly, provides an adaptive advantage for a human, but some suggest that these people prone to distractibility, are indeed, gifted with exceptional creativity and intuitiveness. In fact, the author Daniel Pink, in his review of The Gift of Adult ADD by Laura Honos-Webb, asserts that the ADHD mind may rapidly become in high demand.

I talk to one of the world’s foremost experts on ADHD (ADD), Dr. Russel Barkley, about this cognitive disorder, which if anything may be mislabeled to the detriment of so many who suffer from the impairment—many of whom would be hard-pressed to consider this deficit a gift at all.

Jordan: Could you provide a brief clinical definition of ADD as it presents in the adult population?

Dr. Barkley: ADHD is currently viewed as a developmental neuropsychiatric disorder that consists primarily of age-inappropriate degrees of inattention, impulsive, and/or hyperactive behavior that often develops in childhood or adolescence, is relatively persistent in most but not all cases, and results in impairment in major life activities. These symptoms are believed by many researchers to reflect a deficit in the development of self-regulation.

Jordan: Is there a biological basis for this disorder, which many clinicians still refuse to recognise?

Dr. Barkley: Yes. The evidence is overwhelming that ADHD is the result of neurological factors and that these problems with brain development and functioning can arise from difference in genes that construct and operate the brain, particularly the executive networks. But it is also possible for some ADHD to arise from neurological injuries especially during pre-natal and post-natal brain development, such as through exposure to toxins (like maternal smoking and alcohol use), exposure to prenatal infections, and to toxins such as lead after birth as well as head injury and other factors that can affect brain development. Genetic and environmental hazards can interact to increase risk for the disorder as well. There is no evidence that purely social factors can produce the disorder.

Jordan: Does the impairment confer any special gift based on your clinical research or from work with your own patient population?

Dr. Barkley: No. Thousands of studies of people with ADHD have never documented that such people experienced any benefit, gifts, or other positive effects from having the disorder across more than a hundred measures of psychological traits.

Jordan: Are effective treatments out there for ADHD?

Dr. Barkley: Yes, ADHD is a highly treatable disorder but must be approached like diabetes – as a chronic condition that must be managed to prevent secondary harms from happening to the individual. The most effective treatments for adults at this time are ADHD medications followed by cognitive behavioral therapy focusing on training in executive functioning skills and how best to compensate for the self-regulatory deficits. Counseling about the nature of the disorder as well as obtaining educational and occupational accommodations can also be helpful. Coaching for ADHD in adults has some clinical support but has not yet been studied in rigorous research.

Jordan: It seems that there are a lot of cormorbid psychiatric conditions found in the ADD adult population. Can you mention some of the more benign to more severe that are commonly found in these adults?

Dr. Barkley: ADHD is most commonly associated with oppositional defiant disorder, learning disorders, and conduct disorder. However, up to 25-35% may also experience substance use disorders, anxiety disorders, depression, and even personality disorders.

Jordan: How is ADD most commonly diagnosed?

Dr. Barkley: Typically by taking a careful history from the patient and others who know them well, reviewing archival records, such as schooling, using behavior rating scales completed by patients and significant others, and giving brief psychological tests to determine any intellectual or learning disabilities. The clinician than compares this evidence against the professional diagnostic criteria, such as in DSM-5, to see if the criteria for the disorder are met.

Jordan: If you could re-lable the disorder what might you call it and why?

Dr. Barkley: Personally I think Disorder of Self-Regulation or Executive Function Deficit Disorder would be more accurate but that is not likely to happen given that the term ADHD appears in many entitlement programs, disability rights legislation, educational regulations, etc. and so one does not want to change the name and disenfranchise people from these various entitlements, protections, and accommodations.

Jordan: What does the future hold for ADD research. Is there hope for treatment. Is there concern as we learn more about the disorder and possible etiologies?

Dr. Barkley: Much. The fastest advances now are occurring in neuro-imaging of the disorder, molecular genetic studies of the genes that may contribute to it, and development of potential new medications for its management.

Websites I recommend are:

Dr. Barkley: russellbarkley.org, ADHDLectures.com

CHADD Organization: chadd.org

ADDA Organization: add.org

Charles Schwab Foundation (for Learning Disorders): SchwabLearning.org

Council for Exceptional Education (CEC): cec.sped.org

American Academy of Child & Adolescent Psychiatry: aacap.org

American Academy of Pediatrics: aap.org

Learning Disabilities Association of America (LDA): ldanatl.org

National Institute of Mental Health: help4adhd.org

National Information Center for Children and Youth with Disabilities: nichcy.org

ADD Warehouse: addwarehouse.com

Coaching Network: Contact Nancy Ratey. email: nancy@nancyratey.com