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ADHD, and good and bad attention

This week’s New York Times had an interesting piece about wandering minds. It noted that there seems to be a huge diminishment in the capacity to pay attention, concentrate and focus. Mindfulness quite rightly was mentioned as something that helps and once again things were said about the increasing speed of modern society, the rushing and short attention spans and the inability to step out of the whirlwind to reflect and be thoughtful.

 

The piece ended with a story of Ted Gup whose son was on Ritalin from age 5 and died at 21 from a drug and alcohol cocktail, and who laments that the quick fix of drugs was used instead of talking and listening.  According to recent figures there are 12 times more children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) in the U.S. than in Europe, and within the U.S., there are almost 50 percent more children with ADHD today than a decade ago. These figures need explaining and although we all have theories, there is no definite understanding of this as yet. This has led Helena Hansen, a professor of both Psychiatry and anthropology to call for a serious enquiry into the social causes of this rise.

While Mindfulness can indeed help, as can psychotherapy, there are bigger questions that badly need addressing. One is whether there is any way of putting the breaks on the runaway juggernaut that is the psychiatric profession’s diagnostic system, driven ruthlessly by the powerful pharmaceutical industry, irrespective of whether the evidence [1] is really there for the drugs that make so many people into lifetime patients [2]. In the UK the hold that the inaptly named evidence based treatment agenda has on psychological services is such that children do not even get treatment without a diagnostic label. So many of the children who I see who have been in public care do not a service because they fail  to meet the thresholds, or when they do get a service it is because they have been wrongly diagnosed, such as with ADHD [3]. It is not rocket science to realise that trauma, stress and abuse gives rise to an inability to concentrate, a hypervigilant monitoring which means that learning and paying attention is all but impossible.

So many  psychological and brain studies show that having a traumatic childhood is highly predictive of being impulsive, dysregulated, having poor executive functioning and also of later drug dependence [4].  In families where high levels of negativity, anger or aggression are common, then not surprisingly children tend to struggle much more with emotional regulation [5]. Where there is violence and aggression we see extreme sympathetic nervous system arousal and many more externalizing behaviours [6]. So many of the children I have worked with who have suffered abuse just cannot bear to wait, are far too easily frustrated, and also quickly feel provoked, seeing aggression and threat where others do not.

But it is not just the traumatised children who are suffering. More and more children have complex routines in which their program of activities leave them little time to play, and little time in which parents can just be with children. The evidence again is clear. Secure attachment, feeling safe and being thought about and reflected upon give rise to better attention, better executive functioning, less impulsive behaviour and overall more wellbeing as well as better relationships [7].

Yet maybe even more important is what they are not doing, particularly old-fashioned playing. Neuroscientist Jak Pannskepp [8] has shown what many of us know intuitively, that play is vital for all kinds of developments, including the stimulus and development of frontal lobe brain regions involved in self-regulation. He suggests that reinstating play as a central component of what children do, especially preschool children, rather than subjecting them prematurely to academic curricula, would lead to better frontal lobe development, less impulsivity and more prosocial behaviours. Children are increasingly deprived of the emotional skills needed to be able to play properly due to busy parenting, the temptation of screens and the pressure of academic and other timetabled activities.  Interestingly Panksepp discovered that in rats bred for generations to be very hyperactive, play opportunities in fact decreased hyperactivity and led to better self-regulation.  The same he states is true of children.

It might be that we are living in a more impulsive, dysregulated world generally, one in which ADHD type symptoms are on the rise in adults of all walks of life. This might partly explain the huge rise in interest in Mindfulness. Anyone who works in the public sector in the UK will recognise this shift in their working lives, with people working harder and harder, more and more pressure, more forms to fill in and demands to respond to, more imperatives from on-high, and partly because of this less and less real work is being done. This was a phenomenon beautifully described in Andrew Cooper and Julian Lousada’s book Borderline Welfare, how as the state has withdrawn from services, massive anxiety is generated which has led to a huge culture of audit, quangos, monitoring and inspection which in turn has led to more and more time in which people are watching their backs, and less real time and attention devoted to the real job of looking after clients.

The psychological and political and economic issues are deeply intertwined. Mindfulness and psychothetrapeutic thinking are incredibly important. Maybe most important psychologically is the message about how important parenting is and how secure attachment relationships lead to calmer, happier, less stressed children who in turn can concentrate more, play better and are less driven and wired. But of course there are far bigger issues at a macro-social level which need addressing for real change to take place.

 

[1]        B. Goldacre, ‘Bad Pharma’, Fourth Estate, 2012.

[2]        R. Whitaker, Anatomy of an epidemic: Magic bullets, psychiatric drugs, and the astonishing rise of mental illness in America. Broadway Books, 2011.

[3]        M. DeJong, ‘Some reflections on the use of psychiatric diagnosis in the looked after or “in care” child population’, Clin. Child Psychol. Psychiatry, vol. 15, no. 4, p. 589, 2010.

[4]        K. D. Ersche, A. J. Turton, S. R. Chamberlain, U. Müller, E. T. Bullmore, and T. W. Robbins, ‘Cognitive dysfunction and anxious-impulsive personality traits are endophenotypes for drug dependence’, Am. J. Psychiatry, vol. 169, no. 9, pp. 926–936, 2012.

[5]        A. S. Morris, J. S. Silk, L. Steinberg, S. S. Myers, and L. R. Robinson, ‘The role of the family context in the development of emotion regulation’, Soc. Dev., vol. 16, no. 2, pp. 361–388, 2007.

[6]        M. El-Sheikh, C. D. Kouros, S. Erath, E. M. Cummings, P. Keller, and L. Staton, ‘Marital conflict and children’s externalizing behavior: Pathways involving interactions between parasympathetic and sympathetic nervous system activity’, Monogr. Soc. Res. Child Dev., vol. 74, no. 1, p. vii, 2009.

[7]        G. Kochanska, J. Koenig, R. . Barry, S. Kim, and J. E. Yoon, ‘Children’s conscience during toddler and preschool years, moral self, and a competent, adaptive developmental trajectory’, Dev. Psychol., vol. 46, no. 5, pp. 1320–1332, Sep. 2010.

[8]        J. Panksepp, ‘Can PLAY Diminish ADHD and Facilitate the Construction of the Social Brain?’, J. Can. Acad. Child Adolesc. Psychiatry, vol. 16, no. 2, pp. 57–66, 2007.

Psychopaths, brains, childhoods and society
Osborne, Philpot, cuts, fairness and Maggie T
 

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Saturday, 24 October 2020

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