Monday, March 06, 2006

When ADHD is not a disorder: the adaptive advantages of spontaneity

We have often thought our son would have done well laboring on a farm, or scouting ahead of a tribe spying for enemies, predators, and prey. Alas, his superior visual processing and restless activity are ill-suited to today's world. In our world his ADHD and other traits mean he is profoundly disabled.

Paul Steinberg writes about how a set of traits that are adaptive in on setting, can be maladaptive in another...

Attention Surplus? Re-examining a Disorder - New York Times:
March 7, 2006

... Every generation likes to believe that it is witnessing the most dramatic epoch in history. In the case of the current Western world, that belief may indeed be accurate, particularly in light of the striking changes of the last 30 years.

As the business writer and consultant Peter Drucker pointed out, most people in the United States, Japan and parts of Europe are "knowledge workers." 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...

... 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.

Cardiologists, biostatisticians and consumer advocates may clamor, appropriately or inappropriately, to reduce the use of the medications. But unless we go back to the caveman world, some people will find the drugs increasingly necessary to succeed as knowledge workers in a drastically transformed modern world.

Paul Steinberg is a psychiatrist and writer in Washington.
Paul's primary agenda is to justify the use of Ritalin despite its new 'black box warning'. Even so, it's nice to see some attention given to how a set of traits can become a disorder -- depending on the context.

As to that black-box warning, it should focus minds prior to prescribing stimulant meds of all classes. That's not bad, even though I rather suspect we'll find caffeine has similar problems. In our case, however, we didn't blink an eye. When you're receiving incoming fire, sometimes you drive without a seat belt.

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