This is how you treat ADHD based off science, Dr Russell Barkley part of 2012 Burnett Lecture

Summary

The transcript delves into the intricacies of ADHD, emphasizing that it is not merely an attention disorder, but an executive functioning disorder. It affects multiple levels of cognitive function, impacting behavior and time management. The speaker advocates for a comprehensive approach to treatment, combining medication with environmental modifications to support individuals with ADHD. Key strategies include making mental information physical through reminders, breaking down tasks into manageable steps, and creating immediate consequences to enhance motivation. The importance of physical exercise and maintaining blood glucose levels for cognitive function is also highlighted. The summary underscores the treatability of ADHD with the right combination of neurogenetic therapies and psychosocial interventions, stressing the need for increased recognition and treatment to prevent the disorder's secondary harms.

Takeaways

• 🧠 ADHD is primarily a performance disorder, not a knowledge disorder. People with ADHD know what to do but struggle to execute it.
• 🕰️ ADHD causes 'time blindness', making it difficult for individuals to plan and aim their behavior towards the future.
• 🚫 The issue with ADHD is not knowing what to do, but rather the inability to do it, which is a disorder of 'when' and 'where', not 'what' and 'how'.
• 💊 Medication plays a crucial role in treating ADHD due to its neurogenetic basis, with 80% of those with ADHD likely to be on medication at some point.
• 🤸‍♂️ Executive function training alone is not sufficient. The environment needs to be engineered to support individuals in demonstrating their knowledge.
• 🔄 Accountability needs to be tightened for those with ADHD, bringing consequences closer in time to address the issue of delayed consequences.
• 📝 Making mental information physical through cues, signs, charts, and reminders can help externalize information and support those with ADHD.
• ⏳ Time needs to be made physical through the use of clocks, timers, and other visual aids to help individuals with ADHD gauge the passing of time and their performance.
• 📉 Breaking down lengthy assignments into smaller, manageable steps can make tasks more achievable and reduce the impact of delays.
• 🏋️‍♀️ Physical exercise and maintaining high blood sugar levels through proper nutrition can boost the executive function 'fuel tank'.
• 🧩 Using tangible, hands-on tools to assist with problem-solving can be beneficial for those with ADHD who struggle with mental manipulation.
• 📈 The success of interventions for ADHD depends on the willingness of others in the individual's environment to support and implement necessary changes.

Q & A

What is the main issue with ADHD according to the transcript?

The main issue with ADHD is not a lack of knowledge but a performance disorder where individuals know what to do but struggle to execute those actions. This is due to impairments in executive functions, leading to what is described as a 'disorder of the when and the where,' not the 'what and the how.'

Why is medication considered a justifiable treatment for ADHD?

Medication is considered justifiable for ADHD because it is a neurogenetic disorder. The use of neurogenetic therapies, such as medication, plays a role in managing the disorder, with 80% of people with ADHD expected to be on medication at some point in their lives.

What is the concept of 'scaffolding' in the context of treating ADHD?

Scaffolding refers to the support structures or systems put in place in the environment of a person with ADHD to help them perform tasks they know how to do but struggle to initiate or complete. This involves creating external reminders, cues, and structures that guide their behavior.

How can the accountability for individuals with ADHD be improved?

Accountability can be improved by creating a system of immediate and frequent consequences for actions. This involves 'tightening up accountability' and making the consequences of their actions more immediate and tangible, which can help motivate individuals with ADHD to perform tasks.

What is the significance of making mental information physical for someone with ADHD?

Making mental information physical is crucial because individuals with ADHD often have a shorter working memory. Using visual cues, signs, charts, and reminders can help externalize the information, making it easier for them to remember and act on what needs to be done.

How can long-term assignments be managed effectively by someone with ADHD?

Long-term assignments should be broken down into smaller, manageable steps or 'baby steps'. This approach reduces the delay often associated with large projects and makes the task more approachable, allowing individuals with ADHD to work through it incrementally.

What role does physical exercise play in managing ADHD?

Physical exercise, particularly aerobic exercise, is beneficial for individuals with ADHD as it helps to boost and refuel the executive function 'tank'. Regular physical activity is associated with better executive functioning and is recommended as part of a comprehensive treatment plan.

Why is it important to keep blood glucose levels up for individuals with ADHD?

Blood glucose in the frontal lobe is directly correlated with executive abilities. Maintaining higher blood glucose levels, especially during tasks that require significant executive function, can help keep the 'fuel tank' of executive functioning partially restored and prevent cognitive fatigue.

How do video games differ from homework in terms of motivation for individuals with ADHD?

Video games provide external, continuous reinforcement, which creates motivation without the need for internal motivation. In contrast, homework often lacks this immediate reinforcement, making it harder for individuals with ADHD to stay motivated and focused.

What is the '10 and 3 rule' mentioned in the transcript?

The '10 and 3 rule' is a strategy for managing ADHD by having individuals work for 10 minutes and then take a 3-minute break. This approach allows for regular refueling of the executive function 'tank' and prevents cognitive overload.

Why is it crucial for the people around an individual with ADHD to be involved in their treatment?

The success of interventions for ADHD relies on the willingness of people in the individual's natural environment to make changes, such as building 'ramps' or 'scaffolding'. This involvement is necessary to create a supportive environment that can help the individual with ADHD manage their condition effectively.

What are some of the programs mentioned for adults and college students with ADHD?

The transcript mentions Steve's or Russ Ramsey's program, which uses cognitive behavioral therapy, Steve Saffron's program, and Mary Santo's program for training executive functioning in adults with ADHD. These programs are designed to boost medication effects and target executive deficits.