ADHD 
        Attention Deficit Hyperactivity Disorder
A Brief Outline of Russell Barkley's Model
[Barkley, Russell A (1997). ADHD and the Nature of Self-control (1997). New York: The Guilford Press.]
References   DSM-IV   Description & Symptoms   Other Perspectives (Intro Page)
Barkley's Critique of DSM-IV    Neurological Model  Drug Reactions (Breggin)

For the person with ADD, novelty is a reward. They do well with a rich schedule of feedback. Barkley calls them 'little Ed Kochs', for the New York City mayor known for asking 'How'm I doing?'. Tell them how they are doing -- they want immediate feedback, for they operate on the level of immediate vs. delayed consequences/rewards. Education is delayed gratification; they want what feels good now. Those with ADD generally do better in the morning (even those who are not 'morning people' find it easier to function more close to normal in the morning). Therefore, give them the hard work in the morning, and give them something fun to do later. Its important to realize that symptoms are dependent on the environment; one is not going to see all the problems under all circumstances.

The scientist/philosopher Jacob Bronowski wrote in The Ascent of Man that the most crucial event in the evolution of the human species was the appearance of the ability to wait -- a trait crucial for human function. Barkley sees four aspects to this ability to wait.
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A sense of time
The human mind can keep an event in short-term memory. The mind can freeze time by holding on to an event which has passed. Barkley's theory of the neuropsychology of ADD predicts that people with ADD will have poorer short-term memory than average individuals. If you can hold something in short-term memory you can analyze it. This ability is crucial for mental calculations, analysis, reflection. Humans can use their minds as time machines, as vehicles in which to travel between the present, past and future. Other animals cannot sustain an image in their minds. We call the ability to refer back and forth between past and present hindsight. If however, you don't wait, you don't reflect, and therefore cannot benefit as well from the wisdom of hindsight.

We are the only species in the fourth dimension: time. This sense develops between 7 and 8 years of age. Conversation at this age begins to deal with anticipation, forethought, planning. Children  learn to ignore stimuli which may distract from the task at hand. In contrast, the ADD child doesn't respond until the event crosses their window. They don't respond until hit by the train of time. They don't deal with things until necessary.         Top Of Page

Objectivity
Once you learn to wait, you can stop an emotional response while you examine it. This is emotion vs. objectivity. If you don't wait, you will continue to be emotional, and will have difficulty separating emotion from objectivity. It's facts vs. feelings. Those with ADD are more emotional over the entire spectrum, from happy to sad; they feel their emotions more intensely than average people.

Objectivity is required to serve goal-directed behavior. Perspicacity is the kindling of motivation. Motivation is an emotion. The normal attitude with an unpleasant task is that you 'stick with it', as there is a reward at the end. In ADD, the reward must be in the task itself, not after it. Most children can kindle motivation, the ADD child has to find it in what he is doing at the time -- he has trouble kindling motivation to do an unpleasant task.                     Top Of Page

Reflection
Humans can turn language on themselves. We call it reflection, and it is the bedrock of self-control. Internalized language develops at 3-4 years of age; it is therefore no surprise that ADD is typically first noticed at this age. Speech becomes a means for self-control. You can talk to yourself in order to control yourself. This predicts disorganized internal speech in those with ADD. This was actually seen in research done 10 years ago, but it was ignored because it didn't fit into the prevailing paradigm.

The prediction is that those with ADD will seem younger than their chronological age; they will seem more child-like than their non-ADD peers. That is why ADD children are so 'chatty' and why much of their conversation deals with the present, and not the future.                

Reconstitution
The ability to hold a thought allows you to take it apart and reassemble it in new ways, leading to the observation of new relationships which were not apparent before. We can take nature apart and put it back together as we please. This has several consequences.

We can progressively redistribute parts of a thought for use in parallel processing.

We can reassemble the parts into new messages and events (creativity)

This is the seed of verbal fluency

This leads to a unique world view

It is harder for ADD children to explain things. They don't get to the point: they talk around the point.

Note that ADD children and adults are not lacking the four aspects of the ability to wait -- they are in there, but we often can't see their consequences. Put a child on the proper medication and all four aspects of the ability to wait return -- it was there all along. People with ADD do not lack the ability to wait, they have difficulty drawing upon it.

What are the purposes of the aspects of the ability to wait?

They are related to self-control. Average children are self-regulated, yet they are more free than the ADD child, who being more dependent on his environment, actually operates on the basis of less free will.

They are required for the organization of behavior across the span of time.

They direct behavior toward the future rather than the present.

They are aimed at the maximization of future consequences.

They allow increased prediction and control of the environment (rather than just reaction to the environment)

They permit us to conform the environment to our goals.

ADD is a disorder of response inhibition and executive function, of the ability to wait. This predicts that those with ADD will be: a) deficient in self-regulation, b) impaired in organizing their behavior toward the future, and c) diminished in social effectiveness and adaptation.               Top Of Page