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Re: wahjjhugo post# 24625

Friday, 03/27/2009 1:44:58 PM

Friday, March 27, 2009 1:44:58 PM

Post# of 52265
FWIW, here is my perspective on the ADHD issue, based more on clinical background than anything else, though being the parent of a teenage girl with ADHD is also instructive:

One of the difficulties underlying the debate is the illusion that ADHD is a homogenous entity/category (the same is also true of most psychiatric disorders). Besides the well-known hyperactive dimension (boys far more likely to have this variant), there are other factors. The biggest is whether or not a kid is what they are now calling a "2E" child, where there is another area wherein they are exceptional, on the upside. It can be music, drama, math, or even general intellectual excellence, but ADHD is a different entity, with a different treatment plan and prognosis, when it exists within a context of other strengths. Such a kid, particularly if they are able to see, or be directed to see, themselves in terms of those strengths instead of as being defective, will tend to be much more able to utilize behavioral strategies, and will be seen differently by teachers--which makes the school experience something more than just chronic failure.

For the brightest of these kids, ADHD seems to be associated with the capacity for innovative 'out-of-the-box-thinking.' Richard Branson of Virgin Records/Air/Etc is an excellent example of this. But I have also seen very bright children/teens for whom ADHD really undercuts their ability to channel and utilize their intellectual strengths. There's a limit to what can be accomplished with coaching and structured learning environments (and the capacity of strained public schools, or the willingness of private schools to provide the latter is limited at best). Medication makes a difference for many of these kids--it's observable, they see it, and it lets them function closer to potential.

When kids don't have concurrent strengths, that's a real dilemma, because then their identity, and identification within school systems, ends up defined by what they cannot do. There can be other learning disabilities, and school becomes a source of humiliation. This is when conduct disorders and impulse control problems can come to the forefront.

It's been known for a long time that some (and the percentage is unclear) people eventually wire up their frontal lobes and for the most part 'grow out of' their ADHD. That subgroup, if undefined in this kind of epidemiological research, can obscure the need for, and benefit from, longerterm ADHD meds. I have no doubt that there is a subgroup for whom the need does not go away after two years, if at all. You can see adults who are generally functioning OK in some areas, and would be defined by these common endpoints as 'normal.' Yet their ADHD impacts their ability to resist impulses, to not seek hyperstimulation, and their ability to see how their behavior affects others. There can be a longterm cost to relationships.

I don't think for a minute that the MTV short-attention-span texting-twittering culture causes ADHD. But to the degree to which experience, and practice, influences the plasticity of the brain, and helps the interwiring to occur, I'd agree that the current deemphasis upon sustained-attention activities and entertainment reduces the corrective impact that would otherwise have been possible. So it may make the disorder more chronic for some who otherwise might have been among those who 'grew out of it.' But this is just my opinion, if there is data to support or contradict this, I'd be interested to see it.


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