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Fun is a better drug than Ritalin and it changes the neurology |
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.
Ways of changing dopamine levels
Since the commonly used quick and dirty sledge hammer way to increase dopamine is to prescribe stimulant drugs, we will discuss that frst. Then we will look at how mood also changes dopamine levels, both up and down.
Stimulants such as Methylphenidate (ritalin) increase dopamine in the brain’s prefrontal lobes. This results in enhanced attention and memory by increasing dopamine in the prefrontal lobes of those with ADHD.
Also, the behavioral level stimulant drugs, such as adderall, concerta, and ritalin, are central nervous system stimulants that temporarily increase the supply of attentional resources. Anyone who has ever drunk a cup of coffee when they are feeling sluggish to refocus their attention can relate. Stimulant drugs act much like the caffeine in coffee. These drugs act as a temporary turbo-charger for attention because they help children override the anxiety, desire to escape, boredom, or whatever negative feeling they are experiencing at the moment. (The effect of these feelings on attention is reported in the literature as attentional avoidance and depletion. These concepts are explained in detail in other sections of this website, but I will use the terms here. Attentional avoidance means one avoids attending to something because it causes aversive feelings. Attentional depletion is similar to exhaustion: that burnt out feeling one gets when you simply have no more mental energy to do something.)
Typically, stimulant drugs have an initial positive effect, but it does not last. While stimulants help override the emotional arousal triggered by schoolwork, they do not reduce the actual drain on attention. They do not make schoolwork more positive, nor reduce frustration, anxiety and anger. They just help the child voluntarily hold their own feet to the fire longer to become temporarily more productive.
Because the underlying frustration and anxiety are still there, the conditioning of attentional avoidance and depletion continues to use up more and more attentional resources just as had happened before stimulants. To compensate, dosage has to be increased to maintain the positive effect. It is a battle between more powerful conditioning and more drugs. Usually, the conditioning “wins.” Eventually, an upper permitted dosage limit is reached, either due to increasing negative side effects, or toxicity. Different drugs are often tried, usually with similar results.
Why stimulants don’t work long-term
When they frst put him on the drug, parents often say his behavior improves, but over time his behavior worsens, almost to the point of where it was before.
This is exactly what one would expect if the environment continues to shape ADHD while it was being temporarily controlled with Ritalin: in other words, if nothing in the environment changes but the addition of medication. The sudden change in behavior at the beginning of drug use results from Ritalin providing the child with a temporary extra boost of volitional attention that he can use to control his attention and negative behavior. The degeneration of his behavior over time is a result of the continued training or shaping of the ADHD behavior by the environment while he is on the medications. The problem is that eventually the “shaping” pounds away and overrides the affect of the medications. This is why medications usually have to be increased.
When a child is taken off the Ritalin, parents face a triple whammy: the disruptive behavior that Ritalin originally helped control, the even more entrenched shaping of behavior that could not be over-ridden with the drug, and the chemical effects of withdrawal from this strong stimulant. The Ritalin has helped the child dig himself into an even deeper hole. Because of this, post-stimulant children are somewhat more diffcult to help than those who have never been medicated.
Many brands of stimulants do not equal better results
The reason there are multiple ADHD stimulant drugs on the market is not because one is an improvement over the other, but because there many different drug companies that want a share of this very lucrative market. To do so, they have to develop a drug that does not violate another company’s patents. Unfortunately, this gives the illusion that each new drug is better than the last. This in turn leads parents to believe that trying the multiple stimulants on the market is actually trying meaningfully different treatments for their child. While some children react slightly differently to different drugs, they all operate on the same principle and have the same problems.
How mood changes dopamine levels
Numerous studies show that positive mood, rewards and cues that rewards are forthcoming temporarily increase brain dopamine levels. The observable correlate of this are studies which show that attention and memory are improved when positive affect is increased.
As you would expect, the opposite is also true. Unhappiness decreases dopamine and interferes with attention and language processing. The low dopamine levels found in ADHD children result from school and home environments that make children unhappy. This unhappiness reduces their dopamine level, which in turn reduces their attention, memory, language processing ability and motivation. With this reduced level of performance, they receive more negative feedback, which makes them unhappier, which reduces dopamine levels, etc. The cycle is easy to follow once you get the idea how it works.
Since dopamine levels can change with the type of activity and the person’s feelings about that activity, it is not surprising that children’s dopamine levels are higher when they are working on computer games or school subjects they like, and lower during ones they dislike. This is why children maintain high attention levels when working on computer games, which they like, and are more distracted and have lower attention levels in say, math or reading, which they often dislike.
Thus, it is no accident that ADHD children do worse in subjects that they dislike (negative affect reduces dopamine) and do better in a subject that they like (positive affect increased dopamine).
Extinguishing the negative feelings that are so prevalent in the ADHD child’s world reverses this downward dopamine spiral. One solution is caer therapy which extinguishes bad feelings associated with schoolwork, homework etc. The reduction of negative affect increases the child’s dopamine levels. As we will now discuss, rather than having a “deficit,” ADHD children have discovered their own way to adjust their dopamine level.
Children adjust their own brain chemistry.
Adults often get annoyed with children when they become what we call “hyper.” To adults, the child seems out of control. Would you say that about yourself at the game, cheering at the top of your lungs? For the child, just as it is for the sports fan, being hyper is fun, and children will tell you that if you ask. Why? Perhaps you have already figured this one out from the preceding discussion. Because it is fun, being hyper increases the dopamine levels in children’s brains, making a feedback loop that self-reinforces being hyper. It is a rush to escape boredom (their word for misery).
Since being hyper is fun, it is useful. This is in contrast to the defcit model which would call it “lack of executive control.” The only lack of control is adult’s lack of ability to control it. Children’s fun experience of being hyper is usually apparent by just noticing the big smile on their face as they do it. Research supports what children know: Arousal feels good and improves task performance.
Thus, children make themselves hyper because it improves how they feel. It is not because they “can’t control themselves.” The experience of the hyping is self-reinforcing. Doesn’t this sound like a good strategy if you were feeling low on dopamine and a positive mood would increase it? Granted, no child is going to say, “I think I am low on dopamine. I should start to hype now.” Rather, they experience their attention depletion as inattentiveness, poor memory, boredom and low mood. They do not like being in this depleted state anymore than anyone else does. Therefore, they solve it the best they can by improving their mood with “hyping.” This is analogous to adults being burnt out Friday afternoon after work then going to the game to get a dopamine boost by cheering and booing at the game.
For a child, being hyper is not a behavior problem. Hyperactivity annoys adults because it interrupts the orderly progression of events that adults like to impose upon school and family activities. When child “velocity” meets adult “order,” confict arises and the child is described as having a behavior problem. Of course, children cannot be allowed to “run wild,” but it should be recognized for what it is, and not considered a defcit in self-control or executive function.
Drugging children with good feelings
Instead of making school more enjoyable, there is an increasing tendency for schools to eliminate or greatly reduce recess, lunch time and PE time for children to have fun, burn off stress and energy, and thereby increase their dopamine levels.
When this increasing pressure does not work, instead of reviving the old recesses and long lunches, children are subjected to even more pressure by having to submit to tutoring programs or detention after school. The strategy seems to be to do more of what does not work or what is even causing the problem, as if the current dosage is insufficient. Maybe the problem is not inadequate dosage, but the current “medicine” may be toxic.
Education seems to have adopted the athletic success axiom of “no pain, no gain.” Though this strategy might have some legitimacy in intellectually low level tasks such as sports, the “pain” uses up mental resources so that they are not available for higher level cognitive tasks such as school work.
Although schools claim to have made school more fun, stimulating and inspiring, they contradict this claim by commonly assigning before and after school detention as a punishment. Using more time in school as a punishment is an implicit admittance that school is not fun and is in fact punishing.
How can children learn if their environment is a punishing experience? As the research above documents, negative affect suppresses dopamine. In effect, children are given dopamine enhancing stimulants to counteract the dopamine suppressing educational practices.
The obvious, safer and more effective way of solving this is to make education dopamine enhancing. That would make learning more efficient so that we do not have to drug children and extend their day with more inefficient learning. This cannot happen until we understand how these problems are a product of children’s aversive experiences at home and school rather than the child’s brain defect. Only then can you undo what has gone wrong and create an effective, efficient alternative.
Learning has to be in some way rewarding. Moreover, there is a way to do this without trying to run a multi-media entertainment circus that attempts to compete with Xbox, Game Boy and the rest. For the parent, it means systematically developing internal, longer lasting, more satisfying reward systems such as industriousness and delay of reward. These sustaining reward systems are part of what differentiates children who struggle from those who excel. Methods and software for developing these internal reward systems are discussed in my book: ADHD: Drug-Free and Doin' Fine.
Fun is a better drug than Ritalin.
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