Monthly Archives: January 2013

Russell Barkley: AD/HD is No Gift

Russell Barkley, PhD  is professor at the Medical University of South Carolina, and author of more than 200 scientific articles and book chapters on Attention-Deficit/Hyperactivity Disorder. Here, he has a few words for the overzealous:

… Many people may be gifted and talented in various aspects of these other human abilities, but never attribute that giftedness or that success to the AD/HD itself … I want people to understand that while people might be gifted and talented and successful in spite of their AD/HD, it is not because of their AD/HD. The AD/HD itself may, in fact, make you less effective than other people who have equally talented areas in those human abilities.

He’s addressing the Center for AD/HD Awareness, Canada, but he aims fire at all who suggest the disorder brings talents and blessings.

Some writers propose innate distractibility is just the thing for a multi-tasking world.  Sadly, it’s not enough to shift attention rapidly among tasks. You also have to return to those tasks to finish them; difficulty doing so is criterion 1D for the disorder. Lara Honos-Webb, PhD has written several books suggesting AD/HD may bring such vague, unverified capacities as, “attunement to nature,”  and “emotional sensitivity.”  In The Gift of Adult AD/HD, she asks, “Are mistakes and sloppiness anything less than perceiving the world in a way that opens up possibilities?” The answer is yes – much less.  Creativity can involve serendipity. Mistakes and sloppiness are failures to perceive you’ve forgotten to unplug the iron or to add the most important ingredient to a dish. Her books provide helpful coping techniques, but they fall flat when they claim AD/HD is a boon. Consider its’ co-morbidity with  depressive and anxiety disorders and it  appears much more of a curse.

Funny t-shirt. See if you can find the gift in this flow of thought.

Funny t-shirt. See if you can find the gift in this flow of thought.

Barkley’s criticism isn’t aimed at optimists, but those who leave the facts behind. This blogger writes of how he loves (!) his AD/HD. Not because there is anything to love about it, but because nothing is worse than negative thinking.  Barbara Ehrenreich would disagree. In her 2009 book Bright-Sided, she uses America’s vulnerability to the Sept. 11th attacks to show how positive thinking can have drastically negative consequences:

There had already been a terrorist attack on the World Trade Center in 1993; there were ample warnings, in the summer of 2001, about a possible attack by airplane, and flight schools reported suspicious students like the one who wanted to learn how to “fly a plane but didn’t care about landing and takeoff.” The fact that no one — the FBI, the INS, (President George W.) Bush, or (national security advisor Condoleeza) Rice — heeded these disturbing cues was later attributed to a “failure of imagination.” But actually there was plenty of imagination at work — imagining an invulnerable nation and an ever-booming economy — there was simply no ability or inclination to imagine the worst.

Positive thinking encourages people to feel good about themselves, but as Ehrenreich points out, it inevitably carries  harsh, invalidating personal judgments. Are you feeling depressed, angry or uncertain because neurology makes you look like a screw-up? Drop the ‘victim mentality’, ya whiner!

‘Positive’ is nice. ‘Realistic’ is far more important. As Dr. Barkley said to patient advocates at the conference:

It’s going to be very hard for society to take you all seriously if you continue to trumpet this disorder as a gift. There is no way that we can go to Ottawa and walk the halls of Parliament arguing for accommodations, entitlements, funding of AD/HD medications on the one hand, while rah-rah cheering AD/HD as this wonderful giftedness that we have and you don’t.

What’s worse than negative thinking? Falsely boosting people’s self-esteem with unsubstantiated claims that skew public understanding of the disorder. There’s a real danger that attitudes on AD/HD could go from, “There’s no such thing,” directly to, “Why should we make accommodations for your son? Doesn’t he has the gift of AD/HD?”

@ 2013 Jonathan Miller All Rights Reserved

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One More Reason to Quit Smoking

Chill out, pal. Relax. Just don’t smoke a cigarette. Tobacco may make your anxiety worse instead of better.

1933 Lucky Strikes ad. "To anxiety ... I bring relief."

Tobacco ads once implied smoking improved your health by reducing anxiety. Ha-ha! Good one, guys.

Máirtín S. McDermott, Theresa M. Marteau, et al, tracked 491 smokers as they tried to quit.  After six months, 76% of the participants had relapsed, and only ten of those with a psychiatric diagnosis (mostly anxiety and depression) were still tobacco-free. Those who quit reported their anxiety score went down by an average of seven points, while those who relapsed scored three points higher than before.  Which group saw their anxiety drop the most after they quit, or soar the highest when they relapsed? Those who said they smoked, “to cope,” as well as for pleasure.

All the usual caveats apply. 491 smokers is not the world’s largest sample. Pharmaceutical companies didn’t pay for the study, but they’ve paid McDermott to work on smoking-cessation before.  A different  study recently found exactly the opposite effect; these researchers believe low doses  of nicotine (not standard doses or high doses) may clog  a subclass of the brain’s nicotine receptors so they can’t relay anxiety signals. On the other hand, those researchers studied mice rather than people, and most first-time smokers report nausea rather than serenity.

Too many people smoke, and too many rationalize tobacco use by saying, “I need it for my nerves.” We can boost our client’s motivation to quit by explaining tobacco  actually seems to increase anxiety – through our fears for our health, if no other way.

“Sure, cigarettes help you relax,” I’ve said. “They take away the anxiety you get from craving a cigarette.”

Citations:

Change in anxiety following successful and unsuccessful attempts at smoking cessation: cohort study
McDermott MS, Marteau TM, Hollands GJ, Hankins M, Aveyard P British Journal of Psychiatry, 2013; 202: 62-67

Anderson SM, Brunzell DH (2012) Low Dose Nicotine and Antagonism of β2 Subunit Containing Nicotinic Acetylcholine Receptors Have Similar Effects on Affective Behavior in Mice. PLoS ONE 7(11): e48665. doi:10.1371/journal.pone.0048665

@ 2013 Jonathan Miller All Rights Reserved

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“Six Harsh Truths” and depression

David Wong‘s Six Harsh Truths That Will Make You a Better Person is a New Year’s essay for those who lack resolution – one that applies directly to treating depression.

If you want to know why society seems to shun you, or why you seem to get no respect, it’s because society is full of people who need things … the moment you came into the world, you became part of a system designed purely to see to people’s needs.

 Either you will go about the task of seeing to those needs by learning a unique set of skills, or the world will reject you, no matter how kind, giving and polite you are. You will be poor, you will be alone, you will be left out in the cold.

 Does that seem mean, or crass, or materialistic? What about love and kindness — don’t those things matter? Of course. As long as they result in you doing things for people that they can’t get elsewhere.

He’s talking to those paralyzed by the dissatisfaction they feel with their lives, and that includes those with Major Depressive Disorder. As  Marsha Linehan pointed out, the best medicine for unpleasant emotions is often the opposite of what the emotion makes us want to do.  “Opposite action” is Wong’s prescription for those who are disgruntled but inert: do something. Anything. Anything  more than what you do now, that would also be useful to others. He stands with  Roy F. Baumeister, whose research shows we don’t achieve because we have good self-esteem. Per the Florida State University researcher, if there’s a relationship between the two variables,  it’s much more likely we have good self-esteem because we achieve.

It’s a shame Wong builds his argument on Alec Baldwin’s role in Glengarry Glen Ross as a manager who shames and threatens his sales force.  Who gets motivated from abuse? Those galvanized by anxiety – the sort of highly-motivated go-getters who rarely need our help. Wong doesn’t scorn his readers for freezing in fear of rejection and failure. His point is simpler: the world values you for what you do. You can be valued more highly by doing more.

In cognitive-behavioral therapy, the most effective reframes for thoughts of, “I’m worthless,” are usually about accomplishments – grades the client earned, projects they completed, people they have helped. Once I’ve helped a client identify all of the reasons they aren’t garbage, I’m going to ask, “Now that we’ve settled that, what do you want to do that would make you even more worthwhile?”

@ 2013 Jonathan Miller All Rights Reserved

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Ritalin Reduces the Crime Rate

Somebody said she said something about don't let them give your kids Ritalin. (photo copyright 2012 by Alan Light)

Somebody said she said something about don’t let them give your kids Ritalin.
(photo copyright 2012 by Alan Light)

When I worked with disruptive children in North Philadelphia, many mothers were adamant about medication for AD/HD. “I want him to get over this on his own,” they’d say. “I need him to grow up right.”   I’d explain AD/HD is a neurological disorder. They’d cite the most influential woman in the world:  “Oprah said that’s a bad idea.” At least, they thought their neighbor said they remembered the talk-show host said something about it. They were determined their children would not grow up to be one of the local thugs or addicts. They were sure it would happen if they relied on pills.

A new study in the New England Journal of Medicine suggests they may have had it backwards. Paul Lichtenstein, Ph.D., Linda Halldner, M.D., Ph.D., et al at the Karolinska Institutet in Stockholm, Sweden, studied 25,000 people diagnosed with AD/HD from 2005 to 2009. They found the group that took meds committed fewer crimes than the group that didn’t. They found that individuals broke the law less when they took medication than when they didn’t.  Medication alone reduced criminal acts by 32%.

AD/HD is estimated to be two to sixteen times more common in prisoners than the general population. The famed Milwaukee Study (ongoing since 1977!) at The Medical College of Wisconsin has shown those with AD/HD are three times as likely to get into fights, destroy property or break into other’s homes as those without. Lichtenstein, Halldner, et al’s finding fit well with earlier studies which found those who are properly medicated for AD/HD are three to four times less likely to become addicted than those without.

In North Philadelphia, we suspected as much.  If we’d had the numbers to substantiate our hunches, it wouldn’t have meant much to our clients’ mothers. They cared about character;  they didn’t see that AD/HD meds help children persevere long enough to develop it. Over three years of struggling to get parents and teachers to implement behavior-mod plans, I became twitchily resentful towards Oprah.  If the topic was the most effective tool for treating AD/HD, her name always seemed to come up.

My souvenir of my first counseling job: an irrational annoyance towards a woman I’ve never met, over something she almost certainly never said.

Citation:

Medication for Attention Deficit–Hyperactivity Disorder and Criminality
Paul Lichtenstein, Ph.D., Linda Halldner, M.D., Ph.D., Johan Zetterqvist, M.Ed., Arvid Sjölander, Ph.D., Eva Serlachius, M.D., Ph.D., Seena Fazel, M.B., Ch.B., M.D., Niklas Långström, M.D., Ph.D., and Henrik Larsson, M.D., Ph.D. N Engl J Med 2012; 367:2006-2014 November 22, 2012 DOI: 10.1056/NEJMoa1203241

@ 2013 Jonathan Miller All Rights Reserved

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