Hi Daryl. Have you looked at dr Joel nigg's work? He wrote a book titled 'getting ahead of adhd' that I would argue is the best deep dive on adhd', and is very readable. He also has a great blog, as well as webinars and podcasts on additude.com. I haven't seen anyone else do a better job both zooming in and out on adhd'.
Such an interesting topic, and of timely, personal relevance for me. My 17yo recently requested an ADHD assessment after watching YouTube videos. She was searching for answers about herself, trying to understand herself better and her experience. I paid for the assessment hoping it would help her to achieve some of those goals of great self knowledge, knowing full well that "ADHD" wasn't the answer. I got the report, which confirmed what I already knew, and I realised that my own goals for her assessment were probably a little too lofty.
I was struck however, by the parallel between my daughter's experience and mine. As an early career mental health professional, trying to find my feet in a new role, I desperately wanted to buy into the medicalised model of mental health that I was being sold left, right and centre (Medicare, 10 session "cures", if-this-then-that treatment plans e.g. if ADHD then medication). I really wanted to buy into that. The simplicity was so attractive in the midst of the chaos of an exponential learning curve.
In hindsight I'm reminded of Lisa Feldman Barrett's body budget. When you're under stress, the brain makes budget cuts and one of the first things to go is complex cognitive functioning. Black and white thinking is efficient. Thinking through complexities takes up a lot of brain power.
Which makes me wonder if my daughter, and maybe some others, facing the difficult questions of identity and meaning which we all face, in the midst of the stresses of a 17yo's life, was drawn to what seemed to be the simplest answer. A label. Because that would be cognitively more efficient than thinking through the complexities of human nature, more efficient than trying to find the answer to the question, who am I? of sorting through the messiness of life and the beauty of our perfect and at the same time flawed nature.
Both my daughter and I are still on our own separate quests for knowledge and meaning. For my part, I'm learning to live in the grey. In relation to ADHD, one of the articles I found most eye-opening was the following:
Kazda L, McGeechan K, Bell K, Thomas R, Barratt A. Association of Attention-Deficit/Hyperactivity Disorder Diagnosis With Adolescent Quality of Life. JAMA Netw Open. 2022;5(10):e2236364. doi:10.1001/jamanetworkopen.2022.36364
"In this cohort study, ADHD diagnosis was not associated with any self-reported improvements in adolescents’ QOL compared with adolescents with similar levels of H/I behaviors but no ADHD diagnosis. ADHD diagnosis was associated with worse scores in some outcomes, including significantly increased risk of self-harm".
Thanks Daryl, really appreciate these thought-provoking posts.
- My current thinking on the use of labels: most diagnostic labels are too broad and over-encompassing.
- instead, specify descriptions, rather than an ill defined label, wld be more helpful. e.g. diffused attention, disorganised in planning, vs. ADHD
3. Medicalisation of Our Lives
- The over-medicalisation of our humanity is causing us separation from ourselves.
- at it's centre, the over-medicalisation runs the risk of being reductionistic. even the vogue of neuroscience is at risk of doing that to us, in the way we explain things to ourselves (e.g. "it's because of a chemical imbalance...")
- Allen Frances' Saving Normal touches on these points.
- on the Topic of Separation, Charles Einsentein's Ascent of Humanity has also really resonated for me .
4. Living in the Grey:
- good point! but I would say, that's where all the colours are!
- The question is this: how do we use all of the colours existing in our temperaments, neurochemistry and biological, to make good art of our lives?
Thanks for the sharing that article. I have not come across it. Will definitely check it out!
Your daughter is blessed to have you thinking through these stuff critically. We hope to pass down these patterns of thought to the next generation, and subvert the overly-simplistic stories all of us are prone to tell ourselves.
Thanks for the resources you pointed to Daryl. I too am seeing many clients asking whether they or their children have ADHD &/or receiving a diagnosis accompanied by medications, before being offered any behavioural or lifestyle modification options, as in your guideline of "Dailys —> Strategies —> Skills —> Pills". I lean towards Allen Frances' view that we are over-diagnosing ADHD as a recent addition to the list of labeling fads in our field.
Hi Daryl. Have you looked at dr Joel nigg's work? He wrote a book titled 'getting ahead of adhd' that I would argue is the best deep dive on adhd', and is very readable. He also has a great blog, as well as webinars and podcasts on additude.com. I haven't seen anyone else do a better job both zooming in and out on adhd'.
Hey Austin, Big thanks! I am familiar w the website, but not Joel Nigg's book. Will chk it out.
Cheers Daryl. If u don't have time for a deep dive I would check out his work on lifestyle factors and his analysis of the MTA study results.
Such an interesting topic, and of timely, personal relevance for me. My 17yo recently requested an ADHD assessment after watching YouTube videos. She was searching for answers about herself, trying to understand herself better and her experience. I paid for the assessment hoping it would help her to achieve some of those goals of great self knowledge, knowing full well that "ADHD" wasn't the answer. I got the report, which confirmed what I already knew, and I realised that my own goals for her assessment were probably a little too lofty.
I was struck however, by the parallel between my daughter's experience and mine. As an early career mental health professional, trying to find my feet in a new role, I desperately wanted to buy into the medicalised model of mental health that I was being sold left, right and centre (Medicare, 10 session "cures", if-this-then-that treatment plans e.g. if ADHD then medication). I really wanted to buy into that. The simplicity was so attractive in the midst of the chaos of an exponential learning curve.
In hindsight I'm reminded of Lisa Feldman Barrett's body budget. When you're under stress, the brain makes budget cuts and one of the first things to go is complex cognitive functioning. Black and white thinking is efficient. Thinking through complexities takes up a lot of brain power.
Which makes me wonder if my daughter, and maybe some others, facing the difficult questions of identity and meaning which we all face, in the midst of the stresses of a 17yo's life, was drawn to what seemed to be the simplest answer. A label. Because that would be cognitively more efficient than thinking through the complexities of human nature, more efficient than trying to find the answer to the question, who am I? of sorting through the messiness of life and the beauty of our perfect and at the same time flawed nature.
Both my daughter and I are still on our own separate quests for knowledge and meaning. For my part, I'm learning to live in the grey. In relation to ADHD, one of the articles I found most eye-opening was the following:
Kazda L, McGeechan K, Bell K, Thomas R, Barratt A. Association of Attention-Deficit/Hyperactivity Disorder Diagnosis With Adolescent Quality of Life. JAMA Netw Open. 2022;5(10):e2236364. doi:10.1001/jamanetworkopen.2022.36364
"In this cohort study, ADHD diagnosis was not associated with any self-reported improvements in adolescents’ QOL compared with adolescents with similar levels of H/I behaviors but no ADHD diagnosis. ADHD diagnosis was associated with worse scores in some outcomes, including significantly increased risk of self-harm".
Thanks Daryl, really appreciate these thought-provoking posts.
Esther, really appreciate you sharing this story. I have many reactions to the notes that you've hit... I'd try to be concise:
1. Body Budget:
This is a really under-appreciated concept that List FB raised in her work, How Emotions are Made...
2. Labels:
I've been a contrarian of using labels, but over the years, I've noticed that there are times when it has a useful effect on people.
Here's a really good feature on this topic from the podcast You Are Not So Smart: https://youarenotsosmart.com/2017/07/22/yanss-104-labels-rebroadcast/
- My current thinking on the use of labels: most diagnostic labels are too broad and over-encompassing.
- instead, specify descriptions, rather than an ill defined label, wld be more helpful. e.g. diffused attention, disorganised in planning, vs. ADHD
3. Medicalisation of Our Lives
- The over-medicalisation of our humanity is causing us separation from ourselves.
- at it's centre, the over-medicalisation runs the risk of being reductionistic. even the vogue of neuroscience is at risk of doing that to us, in the way we explain things to ourselves (e.g. "it's because of a chemical imbalance...")
- Allen Frances' Saving Normal touches on these points.
- on the Topic of Separation, Charles Einsentein's Ascent of Humanity has also really resonated for me .
4. Living in the Grey:
- good point! but I would say, that's where all the colours are!
- The question is this: how do we use all of the colours existing in our temperaments, neurochemistry and biological, to make good art of our lives?
Thanks for the sharing that article. I have not come across it. Will definitely check it out!
Your daughter is blessed to have you thinking through these stuff critically. We hope to pass down these patterns of thought to the next generation, and subvert the overly-simplistic stories all of us are prone to tell ourselves.
What are your thoughts on Gabor Mate's take on ADHD? He has a book on it I've heard.
https://youtu.be/itcD7f0H64A
Ah, got that in the pipe for next week, actually!
Thanks for the resources you pointed to Daryl. I too am seeing many clients asking whether they or their children have ADHD &/or receiving a diagnosis accompanied by medications, before being offered any behavioural or lifestyle modification options, as in your guideline of "Dailys —> Strategies —> Skills —> Pills". I lean towards Allen Frances' view that we are over-diagnosing ADHD as a recent addition to the list of labeling fads in our field.