adhd

My repeated failure at academic tasks, particularly reading, sparked raw terror in me. In elementary school, we had regular reading circles. Six or eight kids would sit around in a circle taking turns reading. I would sit there in a cold sweat as my turn came closer and closer. It was my teacher's version of Edgar Allen Poe's "The Pit and the Pendulum." The reading blade kept coming closer and closer.

To try to save face, I would count the number of children before my turn to read and try to calculate which paragraph I would be expected to read. Then I would go over and over this paragraph trying to work out every word. I would try to memorize it because I knew that ...

adhd

This article will be easier to understand if you first read ADHD is a Conditioned Attentional Avoidance Loop

Once an ADHD child is aroused by feelings of anxiety and anger, his ability to learn attentional avoidance increases while his ability to learn math, spelling and the like declines. This happens in a two-stage process.

First, the child experiences both the discomfort of the emotion as well as its negative effects on his performance. And he is overwhelmed by this experience.

Second, he learns to escape this noxious experience through attentional avoidance. Although avoidance feels better in the short run, performance at home and school soon deteriorates.

adhd

ADHD as a Defense Mechanism

The ADHD is a Conditioned Attentional Avoidance Loop ,  appears to be radically different, but in actuality it is a logical extension of traditional theories of psychopathology.

Traditional theories, despite their differences, embrace Sigmund Freud’s notion that psychopathology is the result of an earlier emotional trauma. The adaptation to that trauma results in the psychopathology.

ADHD works by the same processes and serves the same function as traditional psychological defense mechanisms. In fact, it is best thought of as a defense mechanism favored by children.

Freud talked about how repression, suppression, or denial, are ways of keeping noxious thoughts and memories out of one’s consciousness. That is, they are attentional avoidance mechanisms that work just like ADHD.

Freud saw defenses as the patient’s active efforts to adapt, but that ultimately, if overused, backfired. So too, it is with ADHD. Framed in terms of Conditioned Attentional Avoidance Loop Model, the patient is as an active, skilled adapter to the environmental stimuli, just as Freud saw his patients. However, in both cases, defense mechanisms have gone awry.

Like all defense mechanisms, avoidance behavior functions as a way to spare the ADHD child the unpleasant emotions — whether they are triggered by internal or external experiences. It does this by keeping annoyances out of consciousness. But the defense strategy suggested by the Conditioned Attentional Avoidance Loop Model is more obvious than traditional defenses since:

1) The behavior of children is less sophisticated and thus more obvious.

2) The noxious stimuli (parents, teachers, and school-work) are usually here and now a opposed to in the past or far away.

3) Adults are actively engaged in keeping the child from physically escaping.

4) Much to the chagrin of the observing or diagnosing adult, the defense mechanisms of the ADHD child are often a reaction to the adult.

5) ADHD is Felt as an Insult by Adults.

This last point deserves further discussion.

My perspective using the Conditioned Attentional Avoidance Loop Model allows me to focus not only on the ADHD child but also on the adults who play an important role in his environment.

Failure to consider the role of adults in the child’s world has made it difficult to observe accurately and understand ADHD. That’s because the role of the controlling and evaluating adult, whether teacher or parent, is crucial to filling out our picture of the child. The adult is part of the Conditioned Attentional Avoidance Loop and the adult is the one responsible for triggering the attentional avoidance.

The child, simply, is always maneuvering to stay out of reach, and he does this by directing his attention elsewhere. No matter what you ask him, you get evasive, escapist responses — “I don’t know,” “Doesn’t bother me,” “Sure, I have lots of friends,” or “I don’t care.”

These responses occur between bouts of looking away, fiddling with things, wandering off mid-conversation, outpouring emotionally, grimacing, or glowering. These responses are an efficient smokescreen that is both difficult and frustrating for the adult to comprehend and respond to rationally.

Seeing the role of the adult as causal to ADHD behavior may at first feel upsetting and disorienting. We do not like to think of ourselves as the target of someone else’s defense system. The message received is that the ADHD child is defining you as the enemy whether you like it or not.

This differs from traditional psychology that deals with patients who are defending against some internal or historical experience. The latter is much less aversive than when someone is defending against you. Despite his most caring and benevolent efforts, the ADHD child blots the therapist, parent or teacher out of his or her reality.

In fact, it is the nature of the ADHD child to refuse to connect interpersonally with you or conform to your demands. He does not seem to understand that you are trying to act in his best interests. Instead, suddenly, the adult is on the receiving end of rudeness, rejection, or insults. Since the adult feels helpless and frustrated in controlling the child’s behavior, he or she feels personally affronted. It is as if your well-meant offer of friendship is being rebuffed.

Because of this affront to you and your reality, it’s easy to see ADHD children as more defective than they are. Thus, it becomes even more tempting to categorize ADHD children in an unbecoming fashion — as we are likely to do to anyone who rejects us. If the ADHD child does not like us, he must have something wrong with his brain. So we come up with labels like “Minimal Brain Dysfunction” or “neurotransmitter hypothesis,” depending on what is in vogue.

While teachers and counselors insist that they are professionals and thereby do not react emotionally to the antics of children, inevitably they do respond. Not to acknowledge this emotional reaction is to blind ourselves to a major piece of the dynamics driving ADHD. We have been seduced into focusing on only one part of the feedback loop—the child.

adhd

The Conditioned Attentional Avoidance Loop Model hypothesizes that ADHD behavior could be a result of a child's exposure to interpersonal stress before the child is developmentally equipped to handle it. Indeed, attentional avoidance may be the only mechanism for a young child to escape these early stresses, since their physical mobility to escape is restricted and they do not have the verbal or intellectual skills to change the stressor.

adhd

The original learning for ADHD consists of two processes: attentional depletion and attentional avoidance. While there are no pure cases of depletion or avoidance, attentional depletion tends to happen first with avoidance following that. For the purpose of clarity, I will discuss them separately. The first section describes the usual, but not rigid, progression in the development of attentional depletion. Following that will be a description of attentional avoidance.

adhd

adhd

High tech scans of brain metabolism are often cited as evidence that ADHD children’s brains are different, and this is the cause of their symptoms. Though the data from these studies is indisputable, their interpretation is fallacious and misleading.

adhd

The argument that because ADHD tends to run in families, it is of genetic origin, is poorly thought out and false.  Here is why. Those who argue that ADHD is hereditary will point out that one or more, usually male, ancestors of the patient also showed ADHD symptoms.  Thus, they demonstrate a correlation between ADHD symptoms across generations.  But correlation is not causation. For example, there is a strong correlation between the midsummer pavement temperature in New York City and the banana crop in Brazil.  I'm sure that hot asphalt in New York has nothing to do with making bananas grow faster Brazil.  However, both are caused by a third factor, warmer weather.

adhd

The role of dopamine

dopamine is a neurotransmitter in the brain that causes feelings of well-being, happiness, contentment, and enhances motivation, attention and memory. Contrary to what is implied by neuroimaging studies, levels of dopamine are not static, but can change quite rapidly, depending on the activities and the individual’s feelings about these activities. This is a key to explaining how ADHD works at a neurological level and how stimulant drugs work for children.

ADHD symptoms are related to, but not caused by, low dopamine in the prefrontal lobes of the brain.

There is a convergence of neuroimaging, neuropsychological, and pharmacological evidence that dopamine levels are lower in the prefrontal lobes of ADHD children’s brains. This causes poorer attention and memory in those with ADHD. Some parents of ADHD children are pointing to this when they say “he does not want to do anything” or they cannot find any rewards for which he will work. While it may seem that this research supports the “chemical imbalance” theory of ADHD, as you read on, you will discover how this is a result, not a cause of ADHD patterns of thinking and behavior.

adhd

Socially clumsy children usually do not usually have a social skills deficit. Rather, some social situations, particularly with peers, trigger emotional arousal so the child does not have the attentional resources to learn new social skills or demonstrate the social skills they already have. Remove the anxiety and you will see a far more accurate picture of what they can do.