|
ADHD:
Disorder or Difference? by Thom Hartmann & Vaudree Lavallee The
"Hunter in a Farmer's World" metaphor was first used in the
original 1993 version of "ADD: A Different Perception" to
characterize the life situations in which those with ADHD often found
themselves. "ADD:
A Different Perception" provided a more feasible (and substantially
more accurate) reinterpretation of the widespread fable used by those who
wish to depict ADHD persons as "deficient" and
"disordered." In subsequent Thom Hartmann books and articles,
more attention was directed toward building the skills and self-esteem of
ADHD children and adults. These efforts have been widely embraced by many,
but aggressively opposed by those in the ADHD circuit who responded to our
call to keep ADHD children's egos intact with, for example, Barkley's
Marie Antoinette-like retort , "If feeling good is the clinical goal,
then why not just give them heroin ?"(2) In
contrast to such unfortunate and derisive rhetoric, the Hunter/Farmer
hypothesis maintains that self-esteem is not a drug used to pacify but a
sword that can be used to fight off the evils of despondency and
self-hatred, and to provide hope for ADHD children. The
Hunter/Farmer hypothesis presumes that, irrelevant of where one places on
the ADHD continuum, one not only has weakness to be compensated for, but
also ADHD-related strengths that we must nurture. Contrarily, Barkley and
those who consider ADHD to have no value whatsoever promote an absolute
acceptance of the "disorder" perspective and a total reliance on
compensatory or defensive strategies, offering "authoritative"
advice about how to "take charge" of such children.(4) Their
disorder perspective assumes that there is one, single, superior
(non-ADHD) way of behaving and being in the world, in all times and
cultures, and that all other humans not so endowed are defective, lack
creativity and have reduced intelligence (Barkley, Goldstein, etc.) Barkley's
recommendation that ADHDers be authoritatively controlled and taught to
avoid pursuing new opportunities for themselves
(stimulation-seeking/risk-taking),(2) however, is like telling an
entrepreneur to quit looking for new market and business opportunities, an
inventor to stop trying to see how things work (or how they could work
better), or a hockey player to stop trying to scoring goals! Some ADHDers
might be able to find contentment under the scourge of such defeatist (and
possibly self-fulfilling) prophecies, but not without giving up many of
their lives' hopes, aspirations, and goals along the way. The debate
concerning whether ADHD is a disorder or a difference has considerable
implications, not only for ADHD research, but also for those adults and
children along the ADHD continuum who deserve more than a life spent only
meeting the minimum threshold of their real potential. Like
the perpetually dueling Smothers Brothers, with their constant refrain of,
"Mom always liked you best," the world of ADHD research and
speculation often seems to devolve into acrimony around whose theory is
most or least supportable (or which brother is superior: the ADHD one or
the over-focused one). Unfortunately, in this process one of the early
causalities has been accuracy. Because of Barkley's newsletter's wide
circulation, it seemed important to provide readers a rebuttal, and to
correct at least a few of his mischaracterizations of the genesis,
reasoning, and details of the Hunter/Farmer metaphor. In
two recent issues of his for-profit newsletter, Barkley has editorialized
that the Hunter/Farmer metaphor was "laughable" and
"inconsistent with evolutionary theory" since, according to his
(mis)interpretation of the Hunter/Farmer metaphor, he says it states that
hunters have evolved into farmers rapidly over the past 10,000 years since
the agricultural revolution. We are, however, more apt to agree with those
who state that biologically humanity has evolved very little since our
hunting and gathering days, (21) or that existing differences between
populations are likely due either to founders effects (genetic differences
among founding families, many who were immigrants) or to the differential
"pruning" effects of nature, pestilence, culture, and
rivalry.(20) We
have always suggested that the cluster of "Hunter genes" and the cluster of
"Farmer genes" have been with us since the earliest dawn of the
human race: neither "evolved" from the other. (Indeed, this
spectrum of behavior is seen within species across the animal kingdom,
from dogs and cats to chimps and the great apes.) There
has always been a need, in all societies, for the "adventurous
explorer" and for the "careful bookkeeper," whether it be
hunting and then skinning animals, or planting crops and entertaining the
planters. The core of the hunter/farmer hypothesis, in short form, is that
in hunting/gathering societies those persons with the "hunting
gene" are rewarded and have an increased the probability of
procreation, and among agricultural and post-agricultural/industrial
societies (such as today) the "farming gene" is celebrated and
increases the social and procreative advancement of farmers. All
theories on human development, regardless of content, fall into two
categories: those, such as the Hunter/Farmer hypothesis, that take the
difference perspective and those, such as the executive functions model,
that take the disorder perspective. The perspective one decides to
incorporate into one's model or hypothesis has enormous implications
concerning how one treats individuals and how one interprets their
behavior. For
example, no one will argue that hunters do not exhibit extreme difficulty
in reciting nonsense syllables in correct sequence, or that they do not
have poor rote memories. The disorder perspective attempts to
"cure" such deviancy by encouraging (or forcing) ADHD children
to work harder on sequence and rote. Alternatively,
the difference perspective assumes that different people may need to
utilize different techniques to achieve the same goals. The difference
perspective presumes that there are different ways of remembering, and
different ways of processing and organizing input. As an example,
researchers indicate that, in contrast to the excellent rote memories
possessed by Farmers, intelligent Hunters not only boast, but are also
able to take advantage of their "superior" incidental
memories.(9),(26) In other
words, since Hunters are predisposed to scan their environments, they are
more apt to record and then later utilize background information.
Conversely, Farmers are more likely to think in terms of an object devoid
of context. The
limit in scope of the disorder perspective is both its major asset and its
greatest liability. It's easily grasped and propagates readily because it
neatly compartmentalizes a complex range of variables, and appeals to the
latent moralist in our culture and in each of us. On
the other hand, it ignores the fact that both people and environments are
complex and variable, largely disregards the effects of context on
performance, and overlooks evidence that human weaknesses in one
environment often turn out to be powerful or even vital and adaptive
assets in another.(10),(17),(20),(26) For
example, rather than questioning the desirability of the "brick"
factory-style school house with it's large class sizes and homogeneous
instruction methods, the disorder perspective places blame for failure
squarely on to the child .(22) Not
surprisingly, the disorder perspective sees adaptation and disorder as two
distinct categories, rather than two aspects of a single phenomenon .(2) What
is an Adaptation and is ADHD one? An
adaptation, according to Barkley, is something that appears in hindsight
to have been "designed for some purpose" or to solve
"particular problems." The human thumb is commonly considered an
such an adaptation, although the real adaptation may be the human
creativity that allowed us to find a use or two for this oddly positioned
finger. Other inventions, such as handcuffs or the inside of jars, could
be used to "prove" that the thumb may also be maladaptive in
certain circumstances. Which is view of the human thumb is right? Probably
all three. The thumb debate is but a small example of the importance of
avoiding absolute statements in an evolutionary context. Likewise, Barkley
has described the type of absentmindedness often experienced by persons
with ADD/ADHD as proof of a mental "deficit," whereas other
scientists view it as one of the "side consequences of a generally
adaptive architecture that sometimes gets us into trouble."(23) As
you can see, a disorder may not be the opposite of an adaptation, but its
compliment. The
topics of evolution and adaptation were also explored extensively by
Pinker(21) in a book that can best be described as an intelligent
elaboration of Dawkin's selfish gene theory. Nonetheless, Barkley's use of
Pinker's work to discredit adaptation in the Hunter/Farmer hypothesis is
inappropriate since Pinker indicates that at least one cornerstone of the
Executive Functions model, delay of gratification, may be maladaptive.
Pinker proposes that not only is going for the quick reward more adaptive,
but that risk-taking, another common hallmark of ADHD, is also more
adaptive in the long run. In other words, defining disorder and adaptation
as absolute opposites is a fallacy that's not supported by most
evolutionary theorists and researchers. In
1997 when Barkley first presented a variation on Strang and Rourke's 1983
Executive Functions model to explain ADHD , Barkely chose to incorporate
into his model the existing body of literature of brain function, and to
emphasize the similarity between symptoms of pseudopsychopathy (right
frontal lobe damage) and ADHD. The right-frontal-lobe brain damaged
individual has been shown to experience increases in motor activity,
talkativeness, and a lack of tact and restraint,(19) symptoms commonly
associated with ADHD. Animals with frontal lobe damage cannot to adapt new
situations or environments, while humans with such lesions similarly
experience extreme difficulties in situations requiring problem solving
and unique solutions(19) . Because he assumes ADHD to be synonymous with
this type of brain damage," Barkley(3) concluded, rather incorrectly,
that persons with ADHD are also less capable of creative thought, and
stated this hypothesis concerning ADHD and creativity explicitly in
several of his writings. If
brain damage research had been used to build the Hunter/Farmer hypothesis,
"ADD: A Different Perception" may have explored the difficulties
associated with being a right-frontal-lobe-damaged individual in a world
taken over by people with left-frontal-lobe-damage. Described in
non-disorder (difference) terms, left-frontal-lobe-damaged
"Farmers" could be seen as objective (rather than indifferent),
exerting emotional self-control (rather than showing little overt
emotion), able to show enough self-regulation to remain silent (rather
than showing little or no verbal output), and speaking only when spoken to
(rather than failure to initiate conversations). However, this silly
analogy was never used in "ADD: A Different Perception," or any
subsequent Thom Hartmann book or article for that matter, because Hunters
are not right-frontal-lobe brain damaged persons, and Farmers are not
left-frontal-lobe brain damaged persons: each are, instead, two end-points
on a continuum of human variability. To
understand the role of brain pathology research in validating the
Executive Functions model, we need to first determine what the Executive
Functions model would look like without reference to brain damage. The
Executive Functions model would still compare the more liberal and
flamboyant ADHDers unfavorably to the more conservative and restrained
"statistical norm." Americas "brick" factory-like
schoolhouses would still be seen as the epitome of human civilization and
accomplishment. And, like Phillip Rushton,(11) the Executive Functions
model would still see a negative correlation between IQ and promiscuity.
In summary, we would still have an ethnocentric (almost Aryan) commentary
of genetic endowment differences. Without
these highly questionable (and, in the opinion of these authors, outright
flawed) ideological underpinnings, however, what remains of the Executive
Functions model is simply a theory of individual variation. The Executive
Functions model tends to focus on post base-line variation in human
response to environmental stimulation while ignoring important differences
in how such stimulation may initially be experienced by the individual. We
agree that after controlling for base-line differences between Hunters and
Farmers, there may be important executive function differences among
Hunters and among Farmers. Additionally, these "executive
function" differences may turn out to be one among the many variables
which help determine whether ADHD will produce an entrepreneurial success
or a chronic criminal. As
the Hunter/Farmer hypothesis predicts, there are base-line differences in
the ways individual Hunters and Farmers each experience and cope with
depression, boredom, frustration and joy. However, these base-line
differences do not fully explain why one Hunter (or Farmer for that
matter) may or may not experience depression at a dysfunctional level.
Instead, the Hunter/Farmer hypothesis suggests that it's the driving need
or hunger for aliveness which animates most ADHD/ADD behaviors, and
executive function is only a small (but significant) variable that
determines how this need or hunger is satisfied (through socially adaptive
means, such as a high-stimulation job in an emergency room, or socially
maladaptive means like becoming a barroom brawler). Seen
in this light, Barkley's so called executive system may be nothing more
than a fight or flight response mechanism, acting like a rubber band that
exerts its influence at both ends of the ADHD continuum. Evidence which
indicates that having a "happy temperament" as an infant is
associated with improved prognosis for Hunters while some environmental
factors, such as having experienced abuse, are associated with negative
life chances(13) lends
support to the prospect that the Executive Function model is a theory of
within-Hunter variation rather than of Hunter/Farmer differences. To
recapitulate, if one were to divide the population into groups based on
individual differences in tolerance of (or desire for) novelty, the
individuals in each group would still vary in both their tolerance of and
their exposure to adversity or stress. Theoretically, those in each group
whose threshold for stress has been exceeded may exhibit many of the
cognitive difficulties associated with the so-called executive functions. Researching
ADHD Adaptation, and Self-Esteem The
myopic nature of the disorder perspective leads to narrow and incomplete
answers. Previously, disorder perspective researchers seemed to believe
that everything we needed to know about ADHD we could gain through a
better understanding of the workings of methylphenidate. Now, Barkley(2)
writes that we should only ask the purpose of the executive function
system rather than consider whether there are also adaptive functions
associated with ADHD-like behaviors. Although knowing a little bit more
concerning methylphenidate, such as its effects during pregnancy, or
concerning the function of executive control processes may provide some
benefit, neither is an adequate replacement for a better understanding of
humanity and its complexity throughout the ADHD continuum. Some
self-proclaimed empiricists appear to have difficulty with what they
consider murky constructs, such as self-esteem, which are associated with
subjective emotions. In
contrast to the so-called ambiguousness of self-esteem, these
"empiricists" appear more comfortable with the presumably more
precise language used in the DSM-IV definition of ADHD, such as
"often," "excessively" and "extraneous."
Other researchers, however, are less predisposed to automatically dismiss
clinical observations and case studies, and more apt to report trends and
to design research studies so as to settle theoretical disagreements and
uncover a wider range of truths. It is to these other researchers that we
will now turn. According
to longitudinal ADHD research, a positive self-esteem is associated with
resiliency, autonomy, and a sense of humor,(18) all factors that are known
to boost the immune system and improve one's general physical well being
in a wide range of studies. Conversely, low self-esteem is associated with
the feelings of helplessness stemming from a belief that personal failure
is due to unchangeable factors such as inherent inability or inferior
intellect. (8) Considering
these associations between self-esteem and how one's life turns out, one
should not be surprised that, when asked, many ADHD individuals indicate
that what was most helpful to them while growing up was having an adult
who believed in them,(18) or that ADHD children who have a good
relationship with their grandparents fare better.(13) Whether they be
parents, teachers, or clinicians, adults wield a great deal of influence
over the self-concepts and performance of those children with whom they
are entrusted. Often the single most significant variable in a child's
life that will determine his or her success was the presence of an adult
who believed in and supported the child. Rosenthal
and Jacobson were the first to show that experimental manipulation of
teacher expectations may influence student outcome. The researchers
informed teachers that the performance of randomly picked students was
going to improve dramatically. These "spurter" effects were more
pronounced in first and second graders and in students with whom teachers
traditionally held lower expectations, such as minority students .(7) The
question left unanswered by Rosenthal and Jacobson's research is how
specifically did teacher expectation lead to changes in student grades. Elementary
school teacher Jane Elliot proposed that a teacher's expectations
influence student performance through its influence on teacher behavior.
She dramatically illustrated the power of self-concept by using eye color
differences to explain the concept of discrimination to her students. She
found that her students actually performed better at their assignments on
the day when their eye color was deemed superior and worse on the day when
their eye color was considered inferior.(7) Researchers
Becker, Place, Tenzer and Frueh(6) also found an association between
teacher's impressions of and behavior toward various students when they
exposed teachers to one of three taped conversations between a female
librarian and a young girl. The second and third tapes were identical to
the control tape, except that in one tape the child interrupted the adult,
and in the other the child engaged in three acts of tangency. For example,
when the librarian suggest French food as a possible topic, the girl in
the tangency condition started talking about how she lost her tooth after
biting into an apple. As
expected, teachers' perceptions of both student ability and the likeliness
that the student would receive their help were lower in both the
interruption and tangency condition than in the control condition. Not
surprisingly, teachers described the child in the interruption condition
as a "poor listener", and the same child in the tangency
condition as having "poor attention" or being a "dumb
blond." More needs to be known concerning the effects of these
attitudes on teacher and student performance. A
more detailed look into the impact of self-esteem on both hunters and
farmers may also benefit greatly from the body of research on priming and
relational schemas (scripts). Priming
is a scientific term denoting any experimental or naturally occurring
manipulation, which makes some memories or information more readily
accessible than other information.(1) A priming stimulus can be anything
-- a word, a picture, an instruction, a facial expression, or even an
emotion. For example, what Weiss(27) refers to as "flooding" and
what Hallowell and Ratey(14) refer to as "hyperfocusing on the
negative" may just be the effects of priming combined with the
interconnection of emotion and memory retrieval. Since ADHD questionnaires
tend to focus on the negative aspects of ADHD, it is possible that the act
of filling these questionnaires out immediately prior to task performance
can call forth (prime) negative memories and emotions in ADHD participants
that may influence task performance. The potential for priming to bias
research results has not previously been explored in ADHD research. The
failure of ADHD researchers to reduce the occurrence of this type of bias
when designing studies is one of the ways in which many of the existing
studies into ADHD and its outcomes are potentially flawed and altogether
at odds with accepted scientific models. In
summary, we find the work of those who attempt to position ADD/ADHD
entirely as a pathology, "a failure of evolution," or a
character trait of "no value whatsoever," to be more rooted in
thinly-veiled pseudo-morality and eugenics than in science. Vast bodies of
literature -- as well as common sense and the positive personal
experiences of millions with ADHD -- are conveniently ignored, overlooked,
or dismissed. In Barkley's words we find contempt and a reductionist,
mechanistic world-view that allows only for pathology and non-pathology. By
obsessively focusing on negatives and refusing to acknowledge any evidence
of value in ADHD, anywhere, anytime, under any circumstances, the
increasingly small circle of "pure pathology" advocates are
bringing only pain, power-based relationships (between parents told to
"take charge" of their ADHD children, as well as between
professionals and their clients), and the most massive labeling,
segregation, and ostracizing seen in our public schools since the early
days of "separate but equal" education among the races. There
are those who are more concerned about the appearance of being a
"good" parent or "good" teacher who may take comfort
in the pronouncement that their children were "born with this
problem" and that "you should neither assign blame to yourself
or accept it from others."(4) Such fatalistic pronouncements serve
only to release parents, teachers and researchers from their
responsibility and guilt concerning their children's failures.(22) The
wounding wreaked on millions of children by their being told they are
brain-deficient and have a mental disorder, however, is largely ignored by
the pathology proponents, as is the agony endured by other parents who
read in Barkley's newsletter that their children's condition, "rather
than representing an adapted evolved set of valuable qualities, reflects
weaknesses in the evolution.. ." It
is time we set aside this one-dimensional "villain story" which
focuses solely on "the burden of ADHD to affected individuals, to
their families, and to society.., "(5) and on how ADHD is a
"deficiency in functioning" which makes one "less
capable."(2) Science doesn't support the absolute pathology model,
common sense doesn't support it, and certainly any sincere hope for
therapeutic outcomes and healthy children don't support it. It's time to
stop the wounding, the finger pointing, and the critical, condescending
tone used to refer to and address those with ADHD and their advocates.
It's time to walk away from the doomsayers and look to the light of a new
day and world where all children are valued for their unique gifts. REFERENCES (1) Baldwin,
M. (1992). Relational Schemas and the processing of social information. Psychological Bulletin, 112, 461- 484. (2) Barkley,
R. (2000). More on evolution, hunting, and ADHD. The ADHD Report, 8, 2,
1-7. (3) Barkley,
R. (1997). Behavioral inhibition, sustained attention, and executive
functions: Constructing a unifying theory of ADHD. Psychological Bulletin,
121, 65-94. (4) Barkley,
R. (1995). Taking Charge of ADHD: The Complete Authoritative Guide for
Parents. Become an Empowered Parent - A World-Renowned Expert Tells You
How to Help Your Child and Yourself! (5) Barkley,
R. (2000). Genetics of childhood disorders: XVII. ADHD, part 1: The
executive functions and ADHD. Journal of the American Academy of Child and
Adolescent Psychiatry, 39, 477-484. (6) Becker,
Place, Tenzer and Frueh (1991). Teachers' impressions of children varying
in pragmatic skills. Journal of Applied Developmental Psychology, 12,
397-412. (7) Boocock,
S. (1980). Sociology of Education - An Introduction, Second Edition.New
York: University Press of America. (6) Brooks,
R. (1994). Children at risk: Fostering resilience and hope. American
Journal of Orthopsychiatry, 64, 545-553. (7) Ceci,
S., & Tishman, J. (1984). Hyperactivity and incidental memory:
evidence for attentional diffusion. Child Development, 55, 2192-2203. (8) Ceci,
S. (1996). On Intelligence - A Bioecological Treatise on Intellectual
Development. Cambridge:Harvard University Press. (9) Di Cresce, G. (2000). Rushton's racial link to IQ rapped - Prof. Dismissed as
crank. The Winnipeg Sun, February 3, 4. (10) Goldstein,
S., & Barkley, R. (1998). ADHD, hunting, and evolution: "just
so" stories. The ADHD Report, 6, 5, 1-4. (11) Grizenko,
N., & Pawliuk, N. (1994). Risk and protective factors for disruptive
behavior disorders in children. American Journal of Orthopsychiatry, 64,
534-540. (12) Hallowell,
E., & Ratey, J. (1994). Driven To Distraction: Recognizing and Coping
with Attention Deficit Disorder from Childhood through Adulthood. New
York: Pantheon Books. (13) Hartmann,
T. (1993). Attention Deficit Disorder: ADifferent Perception. (14) Hartmann,
T. (1999). Whose disorder is disordered by ADHD. Tikkun, July/August,
17-21. (15) Hartmann,
T. (2000). Thom Hartmann's Complete Guide to ADHD. (16) Hechtman,
L. (1991). Resilience and vulnerability in long term outcome of attention
deficit disorder. Canadian Journal of Psychiatry, 36, 415-421. (17) Kolb,
B., & Whishaw, I. (1990). The frontal lobes. In WH Freeman. Fundamentals
of Human Neuropsychology -3rd Edition. New York. (18) Nesse,
R., & Williams, G. (1995). Why We Get Sick - The New Science of Darwin
Medicine. New York: Vintage Books. (19) Pinker,
S. (1997). How the Mind Works. New York:Norton. (20) Reid,
R., Maag, J. & Vasa, S. (1993). Attention deficit disorder as a
disability category: A critique. Exceptional children, 60, 198-214. (21) Schacter,
D. (1999). The seven sins of memory - Insights from psychology and
cognitive neuroscience. American Psychologist, 54, 182-203. (22) Semrud-Clikeman,
M., Steingard, R., Filipek, P., Biederman, J., Bekken, K., & Renshaw,
P. (2000). Using MRI to examine brain-behavior relationships in males with
attention deficit disorder with hyperactivity. Journal
of the American Academy of Child and Adolescent Psychiatry, 39, 477-484. (23) Schacter,
D. (1999). The seven sins of memory - Insights from psychology and
cognitive neuroscience. American Psychologist, 54, 182-203. (24) Shaw,
G., Brown, G. (1991). Laterality, implicite memory and attention disorder.
Educational Studies, 17, 15-23. (25) Weiss, L. (1992). Attention Deficit Disorder In Adults - Practical Help for Sufferers and their Spouses. Dallas: Taylor Publishing Company.
Copyright © 1999, 2000, 2001 by Thom Hartmann,
all rights reserved.
|
|
|
|