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ADHD

ADHD Researchers Need to Pay More Attention to All the Variables

The logic of researchers in ADHD.

Key points

  • Researchers into ADHD don't seem to be paying attention when their subjects are paying attention.
  • Adderall and cocaine have many of the same effects and addictive potential.
  • Many findings in ADHD research can be better explained by environmental factors.
 Arcade Games by George Hotelling, C.C. Attribution-Share Alike 2.
Source: Wikimedia Commons: Arcade Games by George Hotelling, C.C. Attribution-Share Alike 2.

About 15 to 20 years ago or so, when I was working at the University of Tennessee Medical School, I went to grand rounds (a teaching conference involving the whole department) to hear a talk about “adult ADHD.” It turned out to be more of a drug commercial for a stimulant the sponsor of the talk was selling.

The person giving the talk said that this diagnosis was incredibly common, affecting up to 14 percent of the adult population. The speaker continued that all the patients should be taking significant doses of this stimulant—a stimulant that is also one of the most dangerous, addictive classes of drugs available by prescription. The stimulant is classified by the FDA in the same category of abuse potential as opiates like morphine (Schedule II substances). In addition, this stimulant is often used illegally.

At the end of the talk, during the question and answer period, the subject of ADHD in children came up. An attendee asked the speaker why so many kids diagnosed with the disorder could go to a video game arcade and concentrate with tremendous focus on the game they were playing despite buzzers, bells, flashing lights, and scores of people milling around loudly. The speaker opined that this was “not concentration.” I’ve heard this sentiment many times.

If it isn't concentration, then what is it?

Another skeptic in the audience, from the child psychiatry department, asked him about the high incidence of alcoholism in the parents of ADHD patients. His response: “If you had a kid like that, you’d probably drink, too.”

No. Alcoholism is not caused by having rambunctious children.

This reminds me of another talk I once heard from someone from the National Institute for Drug Abuse. The speaker was going on about how cocaine, another stimulant, by the way, depletes a chemical in the brain called dopamine, which supposedly makes it nearly impossible for abusers to enjoy anything but the drug. Another attendee (again, not me) got up and asked: “But aren’t we doing that when we prescribe stimulants to our kids?” The speaker’s answer: “But the drugs work so well.”

The speaker completely avoided the question that was actually asked. I’m guessing that the answer was, “Yes.”

More recently, a well-publicized study purports to show that up to 90 percent of children who have attention-deficit hyperactivity disorder (ADHD) may continue to experience residual symptoms of the disorder into young adulthood. Amazingly, the authors add that they may also have periods of remission along the way.

ADHD is a disorder with waxing and waning symptoms. But are other environmental factors triggering the waxing and waning symptoms?

Many parents of kids diagnosed with ADHD resort to negative parenting, including scolding and punishment. And such problematic parenting styles are perhaps the biggest contributor to a child being distractible and out of control in the first place. Conversely, positive parenting may well result in healthier children.

In an article by Thomas Brown in the October 2021 edition of Psychiatric News, he writes that the "Central Mystery" of ADHD is the fact that the symptoms are "situationally variable." Sufferers seem to be very able to focus on certain specific tasks if their level of interest is piqued. Of course, that is also true of anyone who can't concentrate for almost any other reason, short of dementia, like being stressed out or sleep-deprived.

It seems that a lot of researchers in this field really need to start paying in-depth attention to what is actually going on in the lives and relationships of so many of these "cases," instead of only looking at their symptoms.

References

Sibley et. al, "Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD." American Journal of Psychiatry. Published Online:13 Aug 2021. https://doi.org/10.1176/appi.ajp.2021.21010032

Orm and Fjermestad, "A Scoping Review of Psychosocial Adjustment in Siblings of Children with Attention-deficit/hyperactivity disorder." Advances in Neurodevelopmental Disorders volume 5, pages 381–395 (2021).

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