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|Posted on May 19, 2013 at 5:43 PM||comments (107)|
Russel A. Barkley is an expert in ADHD [Attention Deficit Hyperactivity Disorder]. In His 2o12 Burnett Lecture Prof Barkley describes ADHD as Executive Function Deficit Disorder. He says that this new reconceptualisation has profound implications over how ADHD should be tested in the USA.
His theory is extremely interesting; I question his conclusions as he seems to over-emphasise medication [he is a consultant for pharmaceutical companies who produce the drugs that are used to treat ADHD in children]. The over-use of drugs is a problem as many children out-grow this developmental gap.
Summary of the theory of ADHD as EFDD
There are five brain structures involved in executive functioning: the medial prefrontal cortex, the dorso-lateral prefrontal cortex, the basal ganglia [striatum], the amygdala and the cerebellum. Together they create three distinct neural circuits, which are dopamine based [Javier Castellanos]
The frontal-striatal circuit: associated with deficits in response suppression, freedom from distraction, working memory, organisation and planning, known as the "cool" EF network
The frontal-limbic circuit: associated with symptoms of emotional discontrol, motivation deficits, hyperactivity-impulsivity and proneness to aggression, known as the "hot" EF network
The frontal-cerebellar circuit: associated with motor coordination deficits, and problems with timing and timeliness of behaviour, known as the "when" EF network.
[For a longitudinal study of the development of the ADHD brain see the research of Philip Shaw.]
These three circuits are associated with the following functions: timing of actions and behaviour [as well awareness of self in time], goal orientated behaviour, coordination and gracefulness of our movements [and thoughts], working memory [a memory of what I am here to do], emotional inhibition and meta-cognition [self-awareness, planning, problem solving, self-regulation.
What is executive functioning?
Dimen [198o] describes EF as the seat of social intelligence without which cooperation, reciprocity and group living would not be possible.
EF is self-regulation [self-control]. Self-control is anything we do to ourselves to change our behaviour. Through EF in the present we are trying to change a distant outcome. [exercising now to get fit and toned in the future], or changing behaviour to change the future that comes towards us.
There are seven different executive abilities. These abilities develop in a sequence and they are observable [externalised] in young children. In adults they become symbolic/private, unless we are alone and we are less inhibited and give ourselves commands out loud.
o-3 years - no self talk
3-5 years - audible self-speech [no voice in the head]
5-7 years- the child gives himself commands out-loud but starts suppressing the vocal cords and later the face movements
after 7 years - the voice in the head/the voice governs our behaviour privately
Emotional and motivational self-regulation
Self-talk helps us create and manage emotions and if we can manage our emotions we can manage our motivations. Anticipating pleasure in the future can motivate us to tolerate the time delay in getting the reward.
Starts at around three months of age and takes ten years to mature. Involves turning attention and sensing to self; self-monitoring; self-watching
Self-restraint or executive inhibition [stopping self from performing an action, resisting distraction]
Non-verbal working memory:
is the visual imagery system [theatre in the mind] that guides us to our goals. We resurrect images of our past to guide us towards the future.
Planning and problem solving
Children's play solves as a template for problem solving because it involves analysis/synthesis, the source of all human imagination and invention [Daniel Coleman- Thinking fast and slow]
Acting at a distance: interacting towards the future and preferring delayed rewards to immediate ones.
The pre-frontal cortex only fully matures in our early thirties. The older we get the more we expand our window to the future [anticipation of future events, thinking months and years ahead]. EF helps us create a scaffolding with the group and culture requires: being methodical, self-reliant, self-determined, resisting being manipulated by others to their advantage, being able to put a 'wall or filter' between yourself and others so you cannot be manipulated, self-defensive, reaching out and interacting with others, building friendships, reciprocity, sharing, turn-taking, initiating cooperative enterprise which is the basis of communities and government.
Understanding ADHD in adults
Time blindness - are nearsighted to time, adrift in time, are "getting pulled along by the 'now'".
Performance disorder: doing what you know and not knowing what to do; having a lot of knowledge but not being able to use it. It's a problem with knowing when to do and where to do rather than what to do and how.
Using the past at your point of performance - the place and time where you should have used your skill but didn't
It is an intention deficit disorder.
Treatment recommendations: Working at the point of performance. Neuro-genetic therapy [using drugs to work at the level of molecular mechanisms, a form of genetic treatment]. Make rewards positive and concrete; visualising and imagining rewards; time-management training - make time concrete through the use of clocks and timers; breaking down long tasks into small chunks; breaking tasks and taking breaks every ten minutes to allow for refuelling [EF depletes our resources]; keep the sugar levels in the bloodstream up; routine aerobic exercise to oxygenate the brain; make problem-solving physical [manipulating objects]; positive self-statements; biofeedback.