March 7, 2006

Is attention deficit a disorder?

From today's Science Times, psychiatrist Paul Steinberg writes:
We live in an information age, in a knowledge-based economy.

For those of us who have "attention-surplus disorder" — a term coined by Dr. Ned Hallowell, a psychiatrist in Boston who has A.D.H.D. — this knowledge-based economy has been a godsend. We thrive.

But attention disorder cases, up to 5 to 15 percent of the population, are at a distinct disadvantage. What once conferred certain advantages in a hunter-gatherer era, in an agrarian age or even in an industrial age is now a potentially horrific character flaw, making people feel stupid or lazy and irresponsible, when in fact neither description is apt.

The term attention-deficit disorder turns out to be a misnomer. Most people who have it actually have remarkably good attention spans as long as they are doing activities that they enjoy or find stimulating. As Martha B. Denckla of the Kennedy Krieger Institute in Baltimore has noted, we should probably be calling the condition something like "intention-inhibition disorder," because it is a condition in which one's best intentions — say, reading 50 pages in a dense textbook or writing a 10-page paper in a timely fashion — go awry.

Essentially, A.D.H.D. is a problem dealing with the menial work of daily life, the tedium involved in many school situations and 9-to-5 jobs.

Another hallmark, impulsivity, or its more positive variant, spontaneity, appears to be a vestige from lower animals forced to survive in the wild. Wild animals cannot survive without an extraordinary ability to react. If predators lurk, they need to act quickly.

This vestige underscores the fact that human genetic variability, the fact that we are not all simply clones of one another, has allowed us to survive as a species for 150,000 years in a variety of contexts and environments.

In essence, attention-deficit disorder is context driven. In many situations of hands-on activities or activities that reward spontaneity, A.D.H.D. is not a disorder....

If it is indeed a context-driven disorder, let's change the contexts in schools to accommodate the needs of children who have it, not just support and accommodate the needs of children with attention-surplus disorder.

For those with attention disorder who wish to be full participants in a knowledge-based world, medications equalize their opportunities. The drugs should and can be used only as needed in the context of dealing with the tedium of school or the drab paperwork of some jobs.
It's frightening to think that the modern world has been organized around what are aberrant capacities (like "attention surplus"), putting those with normal capacities (that were useful when evolved) at such a disadvantage that drugs -- dangerous drugs -- must be used to compensate.

54 comments:

Goesh said...

I was hoping we could blame it all on processed sugar. I've read several places that Omega 3 fats can greatly offset ADD, but then that may be industry hype - who knows these days, but force-feeding brats fish oil makes more sense that using prescription meds..

Ann Althouse said...

Here in Wisconsin, we grill our brats.

PatCA said...

I'm sure our lives are at a certain variance with our animal neurobiology, but I wouldn't agree that we have trouble with our daily tasks because they are "dull." They are just human. I know lawyers and judges who had trouble writing an opinion or brief, not because it was a dull case, but because they could not break down one big task into something doable, in other words, writer's block. How exciting is a job supposed to be?

Sure, it must have been exciting hunting dinosaurs and gathering nuts, but people started farming for a reason: it enabled them to live a better life, longer. The ability to envision a different future, to formulate a plan, to manipulate one's environment to get there, is a uniquely human trait no matter what job you're in. So I would say the notion of delayed gratification is more at work here than our "dull" lives.

Freeman Hunt said...
This comment has been removed by a blog administrator.
anon1L said...

I'm a 1L, in one of Prof. Althouse's classes, as a matter of fact. I've also struggeld with ADD for as long as I can remember. Its been a long time since I've read something as insightful as this about it. When I came to law school I left a full time job, and my benefits, including prescription coverage. University Health Services here in Madison does offer reduced rates on some of the medications that can help, but I'm in the middle of a ~4 month process before they'll give me a prescription.
Luckily I find Con. Law interesting enough I can do fairly well, but keeping up with the reading can still be difficult and for other classes sometimes impossible. The structure of law school with its end all be all exams at the end of the semester and very little structure leading up to them doesn't help.

leeontheroad said...

ooh, terrible pun, Prof. (of course, I'm grinning.)

From the article:

"If it is indeed a context-driven disorder, let's change the contexts in schools to accommodate the needs of children who have it"

if only. I work with two students with recent ADD diagnoses. They're both women, and the more commonly known hyperactive impulsivity marker wasn't evident when they were K-12. Now they're at university, and the trouble is their recall of large blocks of information in lecture courses (Bio, Chem, e.g.). They're underperforming in terms of both their expectations and what we thought we'd see.

Still, unless we change higher ed so there's less (over- ?)reliance on straight lecture/reading for intro courses, I can't see how the students can make it to courses where labs and other activities better suit them. They're going to have to process 200 pages per week about cellular respiration before moving on to a different 200 pages about Mendellian genetics. And for this they have meds. And additional time on tests.

Goesh said...

-spare the charcoal, spoil the brat-

vbspurs said...

Here in Wisconsin, we grill our brats.

This is some weird University of Wisconsin sheet!

I have a friend who works there (not in the Law School though), who once replied to a similar "brats" reference of mine, in exactly the same way.

And here I'd just like to say that "attention surplus disorder" sounds something vaguely Stalinistic.

Like:

"Comrade, we have found your section has a surplus of attention. Revolucion o patria, venceremos!!"

Someone will explain to me how I can be an ace multi-tasker, such as listening to the radio, watching television, reading, talking to my pet, cooking, and writing blogposts, but I cannot sit in the beach for more than an hour at a time.

I get jittery, antsy, and feel claustrophic.

Which is surely a good description of symptomatic ADD.

Cheers,
Victoria

Ann Althouse said...

You folks need to know that people of the Wisconsin persuasion, on seeing the word "brat," always picture something like this.

Freeman Hunt said...

All this talk of brats is making me hungry for lunch, but no brats are to be found in my town.

Victoria, your "comrade" comment made me laugh out loud.

Bad Penny said...

I have "attention surplus disorder", I'm pretty sure. I have an unquenchable thirst for more more more information. It's a medical condition. My boss needs to accomodate this disability by allowing me unlimited web surfing. Yeah, that's the ticket.

vbspurs said...

You folks need to know that people of the Wisconsin persuasion, on seeing the word "brat," always picture something like this.

Bratblogging! Awesome pics, Ann. That place looks a treat in summer.

But here I thought that brat blogging was when John Althouse Cohen, your son, used your internet account.

(duck!!)

And Freeman, muchas gracias. :)

Perhaps a quick whirl to my blog might make you chuckle out loud again, since I have a blogpiece on why women love to critique other women's dresses (emphasis, post-Oscars).

Why this is uniquely feminine, etc.

Cheers,
Victoria

knoxgirl said...

"I know lawyers and judges who had trouble writing an opinion or brief, not because it was a dull case, but because they could not break down one big task into something doable"

I have a friend who was diagnosed with ADD and this seems to be a big problem for her. She had a lot of trouble packing her belongings and prearing for a move last year because she literally could not comprehend/decide on where to start. The task was simply overwhelming for her and she was incapable of seeing how to tackle it in more "doable" pieces.

She says the medication really helps her focus when she's studying (she's in grad school) and is glad to have it. I am, of course, happy that she has found something that gives her relief. But it is still hard to see this particular disorder as somethiing that a pill can really treat.

Eugene said...

Children, Frank Smith pointed out a quarter-century ago, are wonderfully well-equipped to protect themselves from pointless drudgery--they get bored, they get restless, and then they find or make distractions. Schools are designed to brainwash children into believing boredom is synonymous with learning. It doesn't work in all cases. That's what the drugs are for.

jeff said...

Ritalin = lifesaver

At least to me it was. One of the things about being ADHD is "hyperfocus" where you can simply concentrate on something of interest to the exclusion of all other stuff.

People have learned to get my attention - and confirm they have it - before trying to start a subject with me.

Especially if I'm on the computer - it used to drive one of my grandmothers nuts how I could be watching TV and essentially never hear a word she was saying to me.

bearbee said...

Omega 3 fats:

walnuts and flax seed....

Ann Althouse said...

Jeff: In that condition, as a caveman, you'd ignore bears, as well as grandmas and perish.

Freeman Hunt said...
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Freeman Hunt said...

Jeff: In that condition, as a caveman, you'd ignore bears, as well as grandmas and perish.

Ann, I think that skill was supposed to help you hunt the bears.

Ann Althouse said...

Eugene: exactly. That's what I'm afraid of.

We need to learn to value our instinctive resistance to tedious things. I know I have.

Ann Althouse said...

Freeman: No. The problem is that if you are absorbed in one thing, how hard is it to be distracted by something else? That is, you might well be absorbed in tracking one animal, but you need to be distractable by the other animals that would threaten you. Locking on to the one thing you want to do is dangerous in the wild.

Palladian said...

Ann, that was the wurst pun ever!

Freeman Hunt said...

I would think it depends on what you couldn't be distracted by. You may be able to be distracted by something pertinent while tuning out extraneous things. Being distracted by grandma is much different than being distracted by a bear.

Steven Taylor said...

This is one of those topics (ADD/ADHD, the use of drugs, etc.) where I was once a substantial critic and skeptic. Without going into a great deal of detail, I will state that I have directly (but not personally) experienced the reality of this situation, and the wonders that medication can perform.

Ann Althouse said...

Steven Taylor: Granted that there are cases where the drugs are worth taking, don't you still think it is likely that they are overprescribed and inflicted on children to help adults manage them?

Goesh said...

I laughed my buns off over that one - "the wurst pun ever"

Hamsun56 said...

anon1L: I too have struggled with ADD as long as I can remember. As a kid, I couldn't sit still in elementary school and was constantly being disciplined for bad behavior.

I never had a problem reading when I was I was interested in something, but it was extremely difficult to force myself to read or pay attention to something I wasn't interested in. As a consequence, I barely graduated High School.

My undergraduate degree was a bit of a fluke. I wanted to live and work in Europe and the only way to do that legally was as a university student. In order to stay in the country I had to make academic progress. Luckily classes weren't obligatory and exams were held once a year based on a required reading list, so I could read when I felt like it, which made thing easy for me.

I took the LSAT for the heck of it and got a scholarship to a good law school in the States because I tested in the top 1% (they had no way of judging my undergrad work and I think they wanted to bolster the LSAT scores of their students). Since I had a scholarship, I though I’d give law school a try. The first year of law school was not fun. It brought back the ADD problems as I had to force myself to read texts that I had little interest in (Civil Procedure was the worst !). It was very painful at times, but it did get better after the first year. I graduated with OK grades and passed the California Bar with no problems, but I decided that I didn’t want to work as an Attorney. I had clerked for a firm and found that I was too erratic in my work. When I was interested in something, I felt that I could hold my own with anyone. When I wasn’t interested in something, I had to struggle just to do mediocre work. It wasn’t an enjoyable experience and I didn’t want to spend my life doing it.

I’ve adjusted my life to my ADD, and now do a variety of different things to earn a living. BTW, Con law was the only course in law school that I truly enjoyed.

Maxine Weiss said...

Well, ok Ann, something we agree on, I think.

Parents using these drugs as a babysitter and form of social control. In the old days they sent these kids away to reform schools. I guess you have to be rich to do boarding school.

ADD/ADHD = nothing more than a failure to multi-task well enough.

Peace, Maxine

Matt Barr said...

My 11 year old has been diagnosed with ADHD, which diagnosis I have little use for, but he also very definitely has Asperger Syndrome, and among his sensory problems associated with AS is that he can't tune out background noise. When you're easily distracted and can't tune out noise so as to focus, you're in trouble. He wears special headphones now that drown everything out but the teacher, which has been a great help. We were worried he'd get made fun of, but consensus has evidently been that the rest of the kids want headphones, too. (All of which makes ancient me wonder aloud when they started not making kids be quiet when the teacher was talking.)

Maxine Weiss said...

Autism, Asperger, .....all that stuff is just symptoms of mercury poisoning and thermerisol in vaccines.

Noise pollution, toxins etc....the solution is not to blame the victim. The solution is to decrease the pollution and toxins/mercury.

Radiation from cell phones. Human beings are suffering from tech/radiation/pollution overload.

The Amish don't have autism, ADHD, high-blood pressure, or depression----which I don't even believe exists.

Big Pharma has labeled everything a disorder, and the public has bought into it in order to drug themselves out of facing reality. Human beings can only take a certain level of toxic overload, and once the scales are tipped....increased heart disease, autism etc...

Drugs are just increasing the toxins and pollution in the body.

I'm not a Scientologist, either.

Peace, Maxine

howzerdo said...

When did they stop making kids be quiet? Good question. I wonder too. When my nephew (who is not completely deaf, but he has some hearing problems) was in junior high (10 years ago) that was his chief complaint - he could not hear the teacher because the kids in the back of the room talked so much during class. In my undergraduate university classes (which are not huge, maybe 25-30 students) there are always a few students chattering away. They are quiet if I tell them to stop talking - but at the next opportunity, the din returns.

howzerdo said...

Sorry forgot to sign my name to the above comment.
Gina (the other "me").

Ricardo said...

Goesh said: "I've read several places that Omega 3 fats can greatly offset ADD ...."

I'm a fan of the works of Christiane Northrup, who is an M.D. from Maine, specializing in women's care. One of her themes is the use of Omega-3 for ADD and similar issues. What you are really looking for is the DHA (take at least 400mg a day) which is necessary for normalized brain function, and which is found in fish oil and fish oil supplements. The "great American diet" is sorely lacking in DHA, and many adults and children experience an immediate improvement in mental functions upon bringing their DHA intake up to the minimum 400mg/day level. It's also cheap, because a month's supply of DHA supplements (usually found as a combination of DHA/EPA essential fatty acids) costs around $10-15 (depending on which brand). Isn't it worth trying something like this, before putting kids on pharmaceuticals? It may not work for everyone, but it could if the person's physiology is deficient in DHA.

M. Aaron Smith said...

MaxineWeiss: or depression----which I don't even believe exists.

Maxine, I'll take my experience with depression over your disbelief. Those of us who have suffered through it need no more convincing.

btw, I don't own a cell phone. ;-)

Eli Blake said...

Myself and two of my kids have A.D.D. (one really bad-- on at least one occasion recently I had to grab her and pull her back out of the street because she was completely unaware of her surroundings and wandered right out into the street in front of a truck.) However, with medication, I am fully aware (though liberal :) ) and my daughters are both straight A students.

What concerns me is that at least our prescription plan won't pay for their medication once they turn 14. Luckily I have the resources to pay anyway (though it will be a strain), but doesn't this seem odd-- just as kids get to junior high school, where we have a huge sudden drop off in achievement anyway among American kids, they also want to quit paying for medication?

Pogo said...

Re: "The Amish don't have autism, ADHD, high-blood pressure, or depression----which I don't even believe exists."

The Amish? Sure they exist!
They're all over the place in my town. All dressed in black, and riding horse-drawn carriages.

Need a link for proof?

lindsey said...

Back in college, all my engineering friends abused Ritalin and Adderal in order to get their work done. The work was just so excruciating for them that they had to drug themselves to get it done. I think only two of them were ADHD. Interestingly, both of those were kids whose parents were recent immigrants. I mention this because my mother has an interesting theory that Americans are more likely to be diagnosed wtih something like ADHD because the kind of people who would hop up on a boat or a plane to travel to an unknown place to begin a new life would have certain characteristics in common with having ADD.

AJD said...

It is frightening that someone with no expertise whatsoever in mental health issues can spew such nonsense.

I guess your charmed life has not intersected with someone with this disorder. Or maybe it did and you didn't notice. Being so swept up in yourself has that side effect.

Hmmmm. Is narcissism a disorder?

Ann Althouse said...

Polk: Paul Steinberg is a psychiatrist, so what are you talking about? We are all commenting on his article that appeared today in the NYT, in the Science section.

Steven said...

Well. Maybe Big Pharma can come up with a drug to cure Maxine's Intelligence Deficit Disorder. People have died because of the spewing of such ignorant nonsense. Depressives already have enough of a tendency to believe their lives are worthless; people like Maxine help convince them that their condition is a moral failing. That makes things worse, and can be what tips a borderline case into suicide.

Of course, since she doesn't believe that depression exists, Maxine isn't going to believe her attitude kills people. But she's still got blood on her hands all the same.

Maxine Weiss said...

Now now, insult the post, not the poster.

I never said anything about moral failing, or morality.

I did say a lot about toxins and pollution which stress the body. Dr. Thomas Szaz (am I spelling that correctly?)

He talks about the myth of mental illness, and it is truly a myth, created by the Big Pharma/Mental Health machine, and backed by Ment-o-crats....in order to hook you on the latest and greatest. Psychiatrists = bunch of drug pushers. Those are Dr. Thomas Szas's (sp?) words....not mine.

The Columbine shooters were on anti-depressants.

Stress is being mislabled as depression. Inability to focus, inability to multi-task.

Sodium Benzoate (Benzene?) in Shamrock shakes. Pesticides in our food supply. Mercury/metals poisoning.

Parents: Your child needs an Allergist, not a Psychiatrist/Drug Pusher.

By the way: Make sure your fish oil supplements are mercury free and cholesterol free!

Nobody wants to think they are addicted to drugs, and it's easier to get angry with me, than the drug pushers/Big Pharma/Psychiatrists.

Go ahead, use me, and Dr. Szaz as a punching bag.

Just don't call me a wacky Scientologist, because I don't believe in Scientology or subscribe to it.

Peace, Maxine

Johnny Nucleo said...

Maxine,

It's arguable that psychiatrists are over-reliant on pharmacology. But mental illness, though mysterious, is no myth. If the body can be out of whack, why is it so far-fetched that so can the mind?

Surely you've seen some of the chilling footage of shell-shocked soldiers from WWI. I know nothing about psychiatry, but I do know that those men were mentally ill.

As far as the other stuff you assert: If we're all being poisoned, why are we living longer?

amn said...

Mental illness denial is so cliche. If you don't believe that depression exists, do you deny the existence of suicide, too?

Maxine Weiss said...

The soldiers are suffering from post-traumatic stress. Trauma causes stress. It's not depression. But depression sells drugs, and people like the label---and there you have it. DSM-IV = $$$$.

Drugs are keeping people alive longer, with a lack of quality. Yes people are living to be zombies and teched out robots.

I believe in a drug-free life. That's not the philosophy of the Mental Health community, or the DSM-IV. They'll pathologize anything and everything in order to create a drug to combat it.

Cling to your mental health labels, and nobody need take responsibility for the world we've created.

Toxins, pollutants and drug side effects.

Big Pharma and big profits keep it going.

Peace, Maxine

Daryl Herbert said...

Polk said: "It is frightening that someone with no expertise whatsoever in mental health issues can spew such nonsense." (referring to Maxine's comments, not the NYT article)

I disagree. It would be frightening if people with medical expertise were saying what Maxine was saying. You know, if you needed surgery or something and that was your sawbones.

One lone "big pharma is Satan I blame everything on dadgummed new technology" health conspiracy theorist? Not so frightening.

L. Ron Halfelven said...

Now we know why the Amish never got cars or TV or anything: they've been plowing all their R&D money into the miraculous Amish Toxin Shield.

Henry said...

How weary, stale, flat, and unprofitable seems to me the uses of this world.

Hmmm. I wonder what Hamlet was taking? Perhaps cabbages and Banbury cakes.

Steven Taylor said...

Ann:

I suspect that the drugs are, in fact, over-prescribed. Indeed, this is almost certainly the case. Still, I am less affected by that argument now than I was some years ago, again based on direct experience.

What I find in listening to this debate over time (and in reading some of the comments here) is that a lot of people get quite absolutist (e.g., the commenter who doesn't believe in depression) on their views on these conditions and the treatments thereof.

It is often like someone who doesn't have allergies saying that they don't believe that allergies exist because they haven't experienced them. Of course, when it comes to physical ailments we find such assertions ludicrous, because clearly physical ailments are more easy to diagnose in an empirical fashion. Mental issues are more difficult to identify--not to mention the general problem with defining "normal".

In regards to the toxins argument--on one level I can't dismiss these hypotheses, as I am not a biologist nor a chemist, but it has always struck me as trite and rather over-simplistic. Yes, the big drug companies are vested in denying these ideas, but if it rally was that simple, I have a hard time accepting that university-based researchers wouldn't be willing to say so. At a minimum, to be the researcher who fixed the ADHD problem by proving that X diet change would fix the problem would be quite famous, and so I don't buy that there is some clear incentive for such a researched to be quiet.

BTW, for those who have no direct experience with the usage of these substances, I would note that it is far from the case that one administers a pill and it solves all the problems of the person who takes the medication. This is not just some simplistic response for lazy parents or adults who are hypnotized by big drug companies into taking the latest oddly-named drug.

Do people take these drugs who don't really need them? Clearly this is the case, but this fact doesn't these issue fantasy.

Steven Taylor said...

btw, that last sentence should read: "Clearly this is the case, but this fact doesn't make these issue fantasy.".

Maxine Weiss said...

And yet the DSM-IV does that, it attempts to define normal and assigns judgments. People have had their lives ruined, their property confiscated, drugged, ....all because the a psychiatrist, citing DSM-IV said such and such.

Why do research into toxicology and allergy? There's no money in it. The costly research is financed by the drug companies, who don't have to reveal negative results. Depression is a cottage industry employing several million people. If depression were found to not exist, several millions would be out of jobs.

There's too much money and jobs tied into the "Depression" industry. Toxicology and Allergy don't pay.

It conflicts with the big drug companies who finance the research.

Those who finance the research control the outcomes, and whether or not to suppress unfavorable results.

No incentive for the Government to finance research studies on their own, since politicians are getting big PAC donations from Big Pharma, and the conflicts of interest at the FDA----numerous board ties to stock in the drug companies.

Big Pharma wins, and public enjoys idea of popping a pill to change personality.

Peace, Maxine

Bezuhov said...

There is some truth in Maxine's paranoid exagerration. There can be reinforcing dynamics at work even absent any nefarious intent.

Evansvillehousewife said...

I live and work amongst the Amish,
Some of the kids are just as flaky as the English kids.
There is depression and pain and illness just like in our society.
They just don't talk about it. Amazing how when a lot of people are in denial, something doesn't exist.

I'm different as well. I hyperfocus. It's great now that I am in a position that requires attention to detail and ability to concentrate, as well as seek out and assimilate mass amounts of technical info.

However, it was lousy in high school- I just couldnt be a cute, adorable, little blonde that is worried about breast implants or celebrity news.

Too often, in my opinion, it's the kids that don't give a crap about the social posturing bullshit that goes on in a public school environment that get labled ADD.

Also, don't discount the toxic effects of these drugs. Yes, toxic. These are POWERFUL drugs. The neural plasticity of young minds is easily melded to "need'these drugs. A 5 year old on Strattera becomes a lifelong customer to big pharma. These drugs forever alter glucose metabolism and growth.

Silent Cretin said...

ADD does exist. The problem is the use of it as an excuse. It is an explanation of behavior, not a excuse.
This guy makes people with ADD sound lazy because we're able to focus on things we are interested in and not able to focus on things we are not interested in. We're not lazy. I'm pretty sure the hyperfocus on interesting things has to do with the fact that the way dopamine is administered to our system is screwed up.

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