Post by Amtram on Mar 30, 2014 10:48:22 GMT -5
I purchased this book even though it's a textbook because I really appreciate Dr. Nigg's research on and insights into ADHD. Starting off, I've found helpful information already. He's discussing what makes ADHD a disorder, and brings up Wakefield's working definition of impairment (I'm not familiar with it, but he's inserting and analyzing the relevant pieces of it in context.) He doesn't subscribe wholesale to the model, but elaborates on some interesting points.
I share this because I found the distinction between fear and phobia to be especially relevant to the commonly-heard insistence that "everyone has a little ADHD." Yes, they do. In a functional way that fits in with societal norms, and in a way that is evolutionarily normal. When you have ADHD, you have those traits to an extent that impairs your function in society and as an individual. It's normal traits taken to an extreme - hence the disorder.
We often use the examples of needing glasses as a comparison to ADHD. Certainly we can find, somewhere, examples in which farsightedness or nearsightedness could be advantageous from an evolutionary perspective, but that does not mean that poor vision in itself has value. When someone has difficulty seeing, we try to diagnose it and treat it - usually with corrective eyewear. We also accept that extremely poor vision exists and causes problems to the individual even if we ourselves do not experience the same perceptual difficulties as that individual does, and we accepted that well before we had tests to measure visual acuity or lenses to correct vision. As well, we do not even question that visual acuity exists when the corrective lenses are in place, and goes away when the lenses are removed.
So perhaps the traits that mark ADHD could possibly have been advantageous in certain situations or under certain conditions, when they existed in more normal levels. Just like nearsightedness or farsightedness could have been somewhat adaptive, but inability to see the majority of what is visible clearly is maladaptive, ADHD traits are maladaptive because of their extreme expression.
Diagnosis and treatment at this stage is much like the days in which the Snellen eye chart and a small handful of different lenses was all that existed to correct vision. Our current inability to test with mathematical certainty and treat with specifically-targeted medications does not invalidate the existence of ADHD any more than the crudeness of early eye treatment invalidated poor vision.
And finally, the fact that the medications we currently have work only while we take them, and only for the duration in our bodies of a set number of hours is not unlike the effects of glasses on vision. The defect in the eyes that causes poor vision is not corrected by glasses any more than the defects in structure or function in the brain in ADHD is corrected by medications.
Many people can live with some visual impairment and not get glasses. Many people take their glasses off for particular functions. This does not mean their vision is not impaired, nor does it mean they face the same hurdles as someone who cannot function without corrective lenses. Their vision is less maladaptive. By the same token, some people may be more hyperactive or impulsive or inattentive, or have poorer working memory or executive function, but still be able to work around it. Their traits are less maladaptive. They do not face the same hurdles as someone who cannot function without ADHD medications and/or other therapies.
Sometimes it's difficult to fully express why having ADHD is a problem to people who don't have it. I think that Dr. Nigg's perspective helps to fill out that analogy that we try to use to explain ourselves, and I really appreciate it.
Wakefield (1992) advanced the harmful dysfunction analysis. The essence of this analysis is that any disorders (whether it be a medical disease or a mental disorder; he applied the same criteria to both) must include two components to be called a disorder. The first is a "value" component: The condition must cause harm, in the judgment of society. The second component is that there must be a "dysfunction" in a physiological, psychological, neurological, or other functional system that can be scientifically described and identified. The dysfunction is defined by the failure of the mechanism to perform its natural or evolved function. For example, the fear response functions to protect us from danger. In the case of phobia, it no longer performs this function. The dysfunction element is intended to be the scientific or factual component of the definition of disorder. Thus Wakefield attempted to construct a hybrid model - one that recognizes both the value component and the scientific/factual component of disorder, properly conceptualized.
I share this because I found the distinction between fear and phobia to be especially relevant to the commonly-heard insistence that "everyone has a little ADHD." Yes, they do. In a functional way that fits in with societal norms, and in a way that is evolutionarily normal. When you have ADHD, you have those traits to an extent that impairs your function in society and as an individual. It's normal traits taken to an extreme - hence the disorder.
We often use the examples of needing glasses as a comparison to ADHD. Certainly we can find, somewhere, examples in which farsightedness or nearsightedness could be advantageous from an evolutionary perspective, but that does not mean that poor vision in itself has value. When someone has difficulty seeing, we try to diagnose it and treat it - usually with corrective eyewear. We also accept that extremely poor vision exists and causes problems to the individual even if we ourselves do not experience the same perceptual difficulties as that individual does, and we accepted that well before we had tests to measure visual acuity or lenses to correct vision. As well, we do not even question that visual acuity exists when the corrective lenses are in place, and goes away when the lenses are removed.
So perhaps the traits that mark ADHD could possibly have been advantageous in certain situations or under certain conditions, when they existed in more normal levels. Just like nearsightedness or farsightedness could have been somewhat adaptive, but inability to see the majority of what is visible clearly is maladaptive, ADHD traits are maladaptive because of their extreme expression.
Diagnosis and treatment at this stage is much like the days in which the Snellen eye chart and a small handful of different lenses was all that existed to correct vision. Our current inability to test with mathematical certainty and treat with specifically-targeted medications does not invalidate the existence of ADHD any more than the crudeness of early eye treatment invalidated poor vision.
And finally, the fact that the medications we currently have work only while we take them, and only for the duration in our bodies of a set number of hours is not unlike the effects of glasses on vision. The defect in the eyes that causes poor vision is not corrected by glasses any more than the defects in structure or function in the brain in ADHD is corrected by medications.
Many people can live with some visual impairment and not get glasses. Many people take their glasses off for particular functions. This does not mean their vision is not impaired, nor does it mean they face the same hurdles as someone who cannot function without corrective lenses. Their vision is less maladaptive. By the same token, some people may be more hyperactive or impulsive or inattentive, or have poorer working memory or executive function, but still be able to work around it. Their traits are less maladaptive. They do not face the same hurdles as someone who cannot function without ADHD medications and/or other therapies.
Sometimes it's difficult to fully express why having ADHD is a problem to people who don't have it. I think that Dr. Nigg's perspective helps to fill out that analogy that we try to use to explain ourselves, and I really appreciate it.