Image: McQuinn/Flicrk
-
The Wisdom of Psychopaths
In this engrossing journey into the lives of psychopaths and their infamously crafty behaviors, the renowned psychologist Kevin Dutton reveals that there is a...
Read More »
Before stimulant drugs such as Ritalin, Concerta and Adderall began their rise to popularity in the 1970s, treatment for attention-deficit hyperactivity disorder (ADHD) focused on behavioral therapy. But as concerns build over the mounting dosages and extended treatment periods that come with stimulant drugs, clinical researchers are revisiting behavioral therapy techniques. Whereas stimulant medications may help young patients focus and behave in the classroom, research now suggests that behaviorally based changes make more of a difference in the long-term.
A new synthesis of behavioral, cognitive and pharmacological findings emerged at the recent Experimental Biology meeting, held last month in San Diego, where experts in ADHD research and treatment gathered to present their work. Their findings suggest that behavioral and cognitive therapies focused on reducing impulsivity and reinforcing positive long-term habits may be able to replace current high doses of stimulant treatment in children and young adults.
Recent surveys indicate that 9 percent of all children in the U.S. have been diagnosed with ADHD. The condition's core symptoms include hyperactivity, inattention, inability to perform monotonous tasks and lack of impulse control. Children with ADHD have trouble in school and forming relationships, and 60 percent will continue to suffer from the disorder well into adulthood.
As of 2007, 2.7 million U.S. children and adolescents with ADHD were being treated with stimulant drugs. But new research reveals that these drugs are not necessarily the panacea they have been thought to be. Psychologist Claire Advokat of Louisiana State University has been looking at the effects of stimulant medications in college students to see what improves with medication and what does not. As expected, she found that people diagnosed with ADHD had lower grades and ACT (American College Testing) scores; they also dropped more classes than their peers. But she also found that these issues were not improved by stimulant medication treatment. Instead, Advokat’s new findings indicate that the ADHD students naturally divided into those who had good study habits and those who did not, regardless of treatment. If students had good study habits, they did not need the medication to bolster their grades. It is not that medication has no effect, Advokat hypothesizes that "it may be that the medications can help, not in helping you remember, but in helping you form the good study habits" necessary for academic improvement. This outcome suggests that if ADHD patients could learn good study habits early on, medication could become less necessary.
Other research has examined the role of behavioral interventions not only for school-age children, but also for their parents. Parents of children with ADHD tend to exhibit more parenting-related stress and difficulties than do those of non-afflicted offspring. After training parents in stress management and giving them behavioral tools to help their children, psychologist Bill Pelham of Florida International University and his colleagues saw significant improvement in their children's ADHD-related behavior, such as the frequency of classroom disturbances.
Independently, Pelham has also shown that behavioral therapy for children also produced effects that were equal to some doses of medication. His data suggests that lower dosages combined with behavioral therapy may provide a far better outcome than stimulant medication or behavioral therapies alone.
Cognitive therapies may also boost improvement: In a 2011 PLoS ONE paper,Julie Schweitzer and colleagues in the psychiatry and behavioral sciences department and the MIND Institute at the University of California, Davis, showed that children with ADHD show extra activity in brain areas associated with "task-irrelevant" information during working memory tasks (those that depend on one's ability to hold and focus on information for immediate reasoning and recall), suggesting that they have less efficient cognitive control. New unpublished results from Schweitzer’s team have shown that cognitive therapy could improve control, again potentially reducing the need for medication to "drown out" extraneous information.
See what we're tweeting about
31 Comments
Add Comment"But new research reveals that these drugs are not necessarily the panacea they have been thought to be"
Reply | Report Abuse | Link to this'thought to be' ?????????? No psychiatrist would have ever claimed to them to be 'the answer'.
85% of these kids do not have ADHD...they just lack structure and discipline in their lives....and good diet and exercise. They were raised by parents of the Sesame Street and video game generation... a generation of which many have the attention span of an amoeba.
I'm sorry, but the subject matter of this article is absurd, not however, the article itself.
Reply | Report Abuse | Link to thisI am 27 and was diagnosed with ADHD when I was 14. My mother refused to put me on medication and instead believed that I could be taught to not have ADHD. It was a ridiculous notion and it never worked and I struggled with marks in the 60s for my entire high school career. In third year at university, a friend told me about Dexedrine and offered me one. Thirty minutes later, I was focused on my work like I had never believed possible.
I continued to buy a pill a week and when I took it, I would get back assignments and essays with grades ranging from 80%-90%, up from the regular 60%. I realized something was working and that I had finally been freed from the fetters of ADHD and it's lack of dopamine in my brain.
A few years later, after battling with my mother to allow me to get prescribed the medication, I almost drank myself to death from depression and woke up in a hospital gurney. I had not planned to kill myself, but had drank so much on account of my overwhelming anxiety.
A few days later, I saw a psychiatrist and told him about my experiences with Dexedrine and Adderall in university. I was put on Zoloft (25mg) and Adderall (10mg x 2) and I haven't looked back.
I'm getting a second degree now and I have literally an A average. My marks this past semester were A,A,A,B+.
The Adderall has changed every aspect of my life. I'm now neat, tidy, clean, organized, friendly, ambitions, intrepid, proactive, physically active and very mentally active. I read an average of 2 books a week, I've immersed myself in subjects like physics, psychology, philosophy and history and I'm excited to tackle the day, every morning I wake up.
IT IS THE MEDICATION. IT IS THE STIMULANTS STIMULATING MY NATURALLY UNDER-STIMULATED BRAIN!
I agree that therapy is a big help IN ADDITION TO THE MEDICATION, but I am 100% certain that any therapy I have given myself over the past 2.5 years of being on the medication, I was able to absorb only BECAUSE OF THE MEDICATION.
To me, telling someone to get over their ADHD is like telling a diabetic to just start producing their own insulin again, so they won't have to shoot up three-four times a day.
There are just some things that we can't consciously tell our brains to do, and making chemicals like insulin or dopamine (what's missing with ADHDers) are included in that.
I always had the car in the driveway, but no gas until now.
I always had the orchestra, but no conductor till now...
Regan: "{A few years later, after battling with my mother to allow me to get prescribed the medication'
Reply | Report Abuse | Link to this?????? later? Why as an adult after university were you battling with your mother to allow a prescription?
geojellyroll: You aren't being helpful. Trolling someone who just told a very personal story of a profound life struggle is just unacceptable. Have some sensitivity (and maturity).
Reply | Report Abuse | Link to thisWell said, Regan 4000!! Although the details may be different for myself the story is really the same! These medications really saved me in so many ways. I only wish I could have known about these meds at 27 like you instead of age 60. Thanks, Regan 400, you have done a great service for many who don't have the courage to tell their story. And you, geojellyroll, need a lot of growing up and a class in sensitivity.
Reply | Report Abuse | Link to thisHey, yeah, no problem. It's really not that big of a deal since I tell the story all the time to people, because I believe so much in the medication.
Reply | Report Abuse | Link to thisAnd Geojellyroll, I suppose I was a little behind in maturity, and cash. I moved home after 4 years away at university when I was 23 and lived there until I was 25 while I worked. I moved out shortly after I started taking the medication. I guess I was still under my mother's authority, being both still at home, and riddled with the debilitating ADHD.
I'm not offended though at your question.
And Reagan4000, my story is similar in some ways; mainly the fact that I struggled most of my life, unmedicated and undiagnosed. It wasn't until my late 20s that I got an official diagnosis (ADD-Inattentive Type, Non-Hyperactive) and began medication. The first day I took it I cried, because I realized at that moment just how hard I had been struggling my entire life with allocation of attention and motivation. Even though I did very well in college (when I finally did graduate), everything was an uphill battle. I am grateful for the meds AND therapy.
Reply | Report Abuse | Link to thisAs a behavior therapist myself, I always tell my clients that meds without the therapy isn't doing as much good as it could. It's like having the air conditioning on with the windows open. Does it help? Yes, but much energy is lost. The combination of meds + therapy has, by far, the best outcome.
geojellyroll--back up your figures and claims, please. Strong claims require strong evidence. I suspect that you can't, though, as the clinical evidence is overwhelmingly against your assertions.
Reply | Report Abuse | Link to thisRegan4000--I'm glad you found effective treatment! I would not dismiss targeted cognitive/behavioral therapies as being ineffective, however. Traditional counseling definitely doesn't improve ADHD symptoms, but there is at least some hope that the approaches mentioned in the article will be of benefit. I am particularly interested in combination therapies (medication plus behavioral therapy) and hope there are more studies in this area.
I would suspect that anything like this sort of data would run the risk of problems based on standards for diagnoses, though, no? I mean, it's very easy for distinct subgroups to be sort of rendered invisible, depending on the statistical analysis, and I would think that would be a huge and constant problem in psych diagnoses in particular, since they're so largely based on symptoms.
Reply | Report Abuse | Link to thisI mean, as with any broad and symptom-based diagnosis, isn't it possible that we're really looking at several different underlying issues when we say "ADHD," some of which may be more rigidly biochemical while others are more open to being shifted behaviorally?
In the end, I do worry about repeated experiences like those expressed above. Meds seem to be vitally necessary for some folks whether they go through other therapy with it or choose not to.
ADD/ADHD is not a straight line, the same for everyone. Some do need medication. Some will benefit from behavior modification. Special ed without the use of behavior modification will do more harm than good, as they feed the behavior they so want to eradicate. I want people to also notice another element that so far has received little attention: environmental influence. I'm not talking about pollution, etc. I'm talking about changes in the physical environment that changed a great deal recently. First, the walking surfaces everywhere have become flat. Second, people wear shoes from the time they get up in the morning until they go back to sleep. Third, children wear sneakers instead of leather shoes, from kindergarten to high school, and well into college. Let me explain why I see this as a problem that influences ADD/ADHD. It all starts from general "State of Imbalance". Modern sneakers have super traction with the ground. This makes them very stable. But it has a hidden side effect. Every time your balance becomes challenged, your brain speeds up in order to process all information and prevent you from falling. If you wear sneakers from birth to college, your cumulative need for balance to be on high alert is reduced. Roads are flat, anti-slip tapes on the stairs, you can't run in school policy, and very good gripping footwear makes you rely on balance control less and less. This, lack of use keeps the brain idling on very low speeds. If you compare how often kids used fall down 30 years ago and today, you will see that today they don't fall as often as before because we have improved safety measures all around and that helps kids not to fall. It also helps the brain to get by on low RPM, and that's where ADD/ADHD gains its own footing. I've wrestled with this for many years. Wrote a book, developed products and training. State of Imbalance is a physical phenomenon and it needs to be addressed through physics. As I said above, it's not a straight line, the same for everyone.
Reply | Report Abuse | Link to thisWell said and I don't need to add more. My 14 year old struggled for years with PDD-NOS and a ADD component before I finally got him prescribed to Concerta. It's like someone took him away and brought back a new child. All the impulsive behavior problems have disappeared also.
Reply | Report Abuse | Link to thisYes we did try some behavior therapies but they were hard to administer and didn't seem to yield results.
O.o
Reply | Report Abuse | Link to thisADHD is caused by toxins in the vaccines and other sources. My 7 yr old step daughter did well in school when given amphetamine. The school decided to call the cops when she began to starve . The drug was given by the brain dead teachers and they simply were clueless as to what was happening . The cops giggled like a girl and destroyed the evidence . The school used the race card to avoid a law suit.
Reply | Report Abuse | Link to thiso.O
Reply | Report Abuse | Link to thisRemarkably Neurofeedback has been left out of this loop - it is an effective alternative to ADHD drugs - you learn what focus feels like and then the brain rewires itself. Simple and studied extensively. Take a look http://www.isnr.org/
Reply | Report Abuse | Link to thisI have ADHD and am treated with medication. This has made the biggest difference in my life. Before, I thought I was stupid. I felt inundated by my schoolwork. I would try to study and could not sit still, I would have to workout for 1-2 hours every day and then finally, around 8-9pm I could study. What I thought was an intense energy level and a paucity of remembering was ADHD. Now, my life is much calmer. I don't have to workout everyday. I can be sedulous in my studies and can study when I need to. I know there is abuse of the drug going on, but I personally am so glad I was diagnosed. First semester I took it my GPA went from a 3.2 to a 3.6. My outlook on my life used to be frustrating and bleak, now it is auspicious and I am excited for what the future holds.
Reply | Report Abuse | Link to thisNormally I tell people that testimonials are not sufficient evidence upon which to base decisions, but after reading your case, I am not so sure. Your case sounds like it was very much a case of biology and you are clearly so much better off with the meds. And your diabetes example is spot-on, ESPECIALLY in light of the difference between Type I (which simply cannot be overcome by behavioral therapy) and Type II (which sometimes can be). Your story added a nice spot of sun to my day!
Reply | Report Abuse | Link to thisAderral, Extera, and Ritalin were introduced to fill in the pockets of pharmo corporate America in collaboration with so called scientists like Joe Bidderman and Professor Change at Stanford Sch. of Med.
Reply | Report Abuse | Link to thisThey wanted money and they made it on the backs of tens of millions of American school children. Talk Therapy, cognitive therapy, effecftive parenting and caring teaching interventions were absent due to infusion of money in the scientific community. Pelham, Advokat, and Schweitzer still are doing research in dark ages.
Aderral, Extera, and Ritalin were introduced to fill in the pockets of pharmo corporate America in collaboration with so called scientists like Joe Bidderman and Professor Change at Stanford Sch. of Med.
Reply | Report Abuse | Link to thisThey wanted money and they made it on the backs of tens of millions of American school children. Talk Therapy, cognitive therapy, effecftive parenting and caring teaching interventions were absent due to infusion of money in the scientific community. Pelham, Advokat, and Schweitzer still are doing research in dark ages.
I did this research years ago when my own kids showed signs of ADHD. There has never been convincing evidence that any long-term outcome is improved in the aggregate with long-term stimulant use. Of course, individuals may find it helpful, but on average, kids who took medication over time did no better than those who did not in any important outcome measure, including test scores, delinquency, high school completion rates, social skills, or self-esteem.
Reply | Report Abuse | Link to thisSo we did what the author suggested: we used strong behavior management techniques and focused on social skill and study skill development, using both alternative schooling and homeschooling approaches because we felt that the regular school environment would be detrimental to our kids due to their unique needs.
The oldest is now a minister at a local church. The youngest is 16 and gets straight "As" and is a very skilled soccer player, with a great group of drug-free friends. Oddly, the one of my three boys who did get into drugs was the only one who DIDN'T have ADHD symptoms.
Trust me when I tell you, both of these boys were pretty strongly ADHD - not the toughest I've seen, but on the severe end of the spectrum. And both were able to learn the skills they needed without medication. We're proud of them both. I wanted to share this so that folks who want to work this way understand that it is possible to teach these skills without medication, even in fairly severe cases.
Use your computers and Google the simple word PANDAS. Read what you get up. It will help those afflicted, and make those who are not afflicted less liable to prejudice. Can psychological problems be cured by antibiotics? Well, get out there and see. incidentally – so called cognitive therapies are just oldfashioned behaviorism, reproduced in a new terminology. These therapies do not concern themselves with the brain, but merely attempt to adjust the person's behavior. Would you cure an infection by trying to tell the afflicted person that his fever can be controlled by his will? Many of these problems are immune-system-disorders. But as I said, check out PANDAS.
Reply | Report Abuse | Link to thisWhile I agree that much cognitive therapy seems to be repackaged behavioral therapy, the preponderance of information shows that altering behaviors can and does 're-wire' the brain by forming new pathways, or adding connections to existing ones. I think the key to any therapy is to take an individual approach, to realize that each person is truly unique, even if a twin (reference recent research-alliteration unintended-into 'gene jumping' in twin brains.
Reply | Report Abuse | Link to thisThat's an iteresting take, but I don't find it to be true in my case. I'm nearly 50, still have extraordinary balance, rarely wear athletic shoes of any technological era, and have wrestled with ADHD my entire life. And, my mind is as busy hopping rocks or logs or flying Immelmans and Split Esses as it is sitting quietly with a good book.
Reply | Report Abuse | Link to thisAnd now a general comment. As I stated above, at nearly 50 I still wrestle with ADHD. It's not a struggle, but more of a tug of war. I have all the usual issues with organization, attentiveness, etc. I have a photographic visual memory, but a tough time with aural input, though if my brain 'blinks', I'll be hard pressed to recall that bit of time visual or auditory. I am certainly able to focus on things that 'reward' me, and find it difficult, but possible, to focus on things I find less enjoyable. I am a big picture person who struggles with details, but I draw some darned good big pictures! I have an incredible ability to scan lots of information quickly and pick useful stuff out, and have a high creative drive. My point in all this wind is that those of us who have ADHD have our own unique experience of it. It seems every week a new cause is found, as well as a new cure. The best first step in working with ADHD, from my vantage point, is to know your experience of it. How does it help you? Creativity, grace under pressure, ability to scan quickly and efficiently? How does it hinder? Poor communication skills, disorganization on lots of levels, seeming flighty to others? I often find those people who have all the habits of highly 'effective' people lack a bit of emotional content or empathy, the ability to walk in other shoes. My days start and end with coffee, black, strong. The middle is filled with loads of creativity, a bit of frustration here and there, some learning, and trying to help my son's mother understand HIS ADHD as best I can. There are no panaceas because we are all different, but there are effective therapies out there. Give a few a try, stick with works for you, share your experience with others, and please do NOT let someone who thinks ADHD is just a lack of discipline or some other easily definable hogwash dictate your course.
Reply | Report Abuse | Link to thisIt's obvious that if you condition a child to believe he must take a drug in order to function, you are doing him (or her) a huge disservice. We tried an ADHD drug with my daughter for a short time and she loved it. But I asked her to please try to make a go of things without it. I told her I believed in her. She got through high school with a B+ average, is now in college and doing GREAT. She is very proud of herself (and so are her dad and I). That said, her "case" was mild and some kids will benefit from replacement of missing chemicals in the brain. But developing human beings have a huge need to know "who am I?" and much of life's accomplishments depend on the answer to that question. If you teach a child that "who he is" is someone who must take drugs to function, you're on a dangerous path.
Reply | Report Abuse | Link to this
Reply | Report Abuse | Link to thisAlso, BTW, in the old days (my father who grew up in the 1920s), ADHD kids did in fact get into more trouble. My father and his brother burned down a barn when they were 6 and 7 years old, respectively. But kids like that, traditionally, DO find a place in life. My dad and uncle went to war, then attended college in the GI bill later in life when they were more settled and more motivated. I say instead of drugging our kids (mostly boys) to make them sit still, why not direct them into activities that use that energy? And also bring back the TECHNICAL & TRADE EDUCATION TRACK in high school. Not everyone is meant to go to college. Humans evolved in a world where the ADHD individual was hugely valuable to the tribe, taking risks others would not, leading the way in difficult times. We need to find a way to value kids like that again.
"Roads are flat, anti-slip tapes on the stairs, you can't run in school policy, and very good gripping footwear makes you rely on balance control less and less. This, lack of use keeps the brain idling on very low speeds.""
Reply | Report Abuse | Link to thisOnly in th'USA buddy!
Thank you for sharing this information. My family and I are just beginning our journey of exploring medication for ADHD and this was comforting to read. I feel hopeful.
Reply | Report Abuse | Link to thisThere are at least 6 type of ADHD yet most therapist do not fully understand nor keep up with the research. The problem is parts of the brain are not being stimulated properly while others get over stimulated. If the brain can become balanced in these areas, the ADHD symptoms go away. The drugs given stimulate areas of the brain, but it is only a band aid and does nothing for the root problem. Behavioral therapy does work and can be sustaining long term but only if the environment (teachers, parents, etc) is consistent and specific skills are taught. To solve for the brain imbalance, skills to balance the brain and build new neurons need to be utilized. This can be done via biofeedback which is expensive, Nueroliminal training (few know about it), as well as other exercises that balance the body and the brain. These alternative methods work but have little long term studies to prove it and the drug companies do everything they can to downplay the effectiveness of these other therapies. Yes some people will always need some medicine to stay focused and function, however, having worked with thousands of people with ADHD, most would benefit with brain exercise therapy (BET) and nutrition. I've seen many go from twice a day pills to none. The only negative part of BET, biofeedback, or nueroliminal training is that it takes 2-6 months before seeing significant results. However, the results are permanent. If you need help with ADHD and in Florida check out enrichment-services.com for information.
Reply | Report Abuse | Link to thisI think this article misrepresents to some extent the results of the study by Advokat. I believe they are referring to the journal article “College students with and without ADHD: Comparison of self-report of medication usage, study habits, and academic achievement.”
Reply | Report Abuse | Link to thisIt seems that the statement “If students had good study habits, they did not need the medication to bolster their grades” is unfounded based on the findings of Advokat. Her research compares students with ADHD who are on medication and those who are not.
It is true that whether students were on medication or not, those who studied ahead of time had GPA’s around 3.15, while those who studied only a day or two before had GPA’s around 2.85. However, here are a couple of complicating factors to consider.
1.These people were not randomly assigned to either take medication or not, instead, Advokat simply looked at study habits and GPAs of students currently choosing to be on medication and those who are not.
2.Students who choose not to take medication may have less severe symptoms than those who take medication, so that may be why those with and without medication function equally well.
3.29% of students on medication studied ahead of time, while only 16% of students not on medication studied ahead of time. Thus, these “better study habits” may in fact be a result of medication. Those on medication may be able to better regulate their own study behaviors in order to plan ahead more effectively.
4.Some of the data represents very small numbers of students. Of about 85 students with ADHD, there were only 3 who did not take medication and studied ahead of time. Thus, the relatively good GPA’s of those who studied effectively and did well without medication only represents three people.
#gotothesource
Regan4000 says the obvious. I do not need to have ADHD to observe the obvious effect and need of medication against this disease. Meta-analysis shows that only meds, fish oil and avoidance of artificial colors have been demonstrated to help the person. Still behavioral methods may well work as an aid, but not alone.
Reply | Report Abuse | Link to thisI am worried that prevalence has passed 8% going towards 80%, and still not even a small percentage of this expected loss of revenue for society is invested in finding the triggers of this disease. Potentially, the value of cleaning up the mess giving infants ADHD is so huge, there is hope someone will finance the elimination of this most important disease of our immediate future.