Growing skepticism about our understanding of A.D.H.D.

I'm not at all surprised. Back when I was researching my book on music, Beethoven's Anvil, I came across a book by Russell Barkley, ADHD and the Nature of Self Control (1997) which interested me because was about executive control, which is quite important in musical behavior. Barkeley argued that ADHAD does not involved inattention as much it involves poor self-control, which Barkley argues is a failure of some central executive function. In turn, Barkley asserts that the

. . . nature of this central executive . . . is time. More specifically, it is the conjecturing of the future that arises out of reconstruction of the past and the goal-directed behaviors that are predicated on these activities. Such activities . . . permit self-regulation relative to time. (p, 202)

Barkley goes on to point out that “time is an integral, inseparable part of the physical world” (p. 204), that “our will, therefore is . . . at time’s beck and call” (p. 205) and thus that “time, timing, and timeliness . . . become important concepts in understanding . . . goal-directed behavior and in determining it” (p. 209).

Musical performances are, of course, exquisitely timed. My thinking about music, however, seems different in kind from Barkley’s thinking about ADHD (he never mentions music or music therapy in his book) and more like the various holistic points of view one finds on ADHD, especially in the popular literature. That notwithstanding, my views on music are thoroughly materialist and grounded in neurobiology and neuropsychology. Those views may not be correct, but they operate in a conceptual universe much like Barkley’s. Once my book on music was well and done I decided to take a closer look at ADHD. But let's skip that for now.

Let's look at a NYTimes article: Paul Tough, Have We Been Thinking About A.D.H.D. All Wrong? NYTimes Magazine, April 13, 2025.

I’ve spent the last year speaking with some of the leading A.D.H.D. researchers in the United States and abroad, and many of them, like Swanson, express concern over what they see as a disconnect between the emerging scientific understanding of A.D.H.D. and the way the condition is being treated in clinics and doctors’ offices. Edmund Sonuga-Barke, a researcher in psychiatry and neuroscience at King’s College London, described the situation in personal terms. “I’ve invested 35 years of my life trying to identify the causes of A.D.H.D., and somehow we seem to be farther away from our goal than we were when we started,” he told me. “We have a clinical definition of A.D.H.D. that is increasingly unanchored from what we’re finding in our science.”

Despite the questions these scientists have begun to raise, the growth of the diagnosis shows no signs of stopping or even slowing down. Last year, the Centers for Disease Control and Prevention reported that 11.4 percent of American children had been diagnosed with A.D.H.D., a record high. That figure includes 15.5 percent of American adolescents, 21 percent of 14-year-old boys and 23 percent of 17-year-old boys. Seven million American children have received an A.D.H.D. diagnosis, up from six million in 2016 and two million in the mid-1990s.

It's time to rethink things:

That ever-expanding mountain of pills rests on certain assumptions: that A.D.H.D. is a medical disorder that demands a medical solution; that it is caused by inherent deficits in children’s brains; and that the medications we give them repair those deficits. Scientists who study A.D.H.D. are now challenging each one of those assumptions — and uncovering new evidence for the role of a child’s environment in the progression of his symptoms. They don’t question the very real problems that lead families to seek treatment for A.D.H.D., but many believe that our current approach isn’t doing enough to help — and that we can do better. But first, they say, we need to rethink many of our old ideas about the disorder and begin looking at A.D.H.D. anew.

Moreover:

Now, however, some scientists have begun to argue that the traditional conception of A.D.H.D. as an unchanging, essential fact about you — something you simply have or don’t have, something wired deep in your brain — is both inaccurate and unhelpful. According to Sonuga-Barke, the British researcher, the traditional notion that there is a natural category of “people with A.D.H.D.” that clinicians can objectively measure and define “just doesn’t seem to be the case.”

Accurately diagnosing A.D.H.D. can be challenging, for a number of reasons. Unlike with diabetes, there is no reliable biological test for A.D.H.D. The diagnostic criteria in the D.S.M. often require subjective judgment, and historically those criteria have been quite fluid, shifting with each revision of the manual. The diagnosis encompasses a wide variety of behaviors. There are two main kinds of A.D.H.D., inattentive and hyperactive/impulsive, and children in one category often seem to have little in common with children in the other. There are people with A.D.H.D. whom you can’t get to stop talking and others whom you can’t get to start. Some are excessively eager and enthusiastic; others are irritable and moody.

It's hard to find ADHD in the brain:

o the surprise of many, when Hoogman and her team published their results in 2017, they claimed that the data, in fact, showed the opposite, conclusively demonstrating the biological nature of A.D.H.D.: “We confirm, with high-powered analysis, that patients with A.D.H.D. have altered brains; therefore A.D.H.D. is a disorder of the brain,” the researchers wrote. “This message is clear for clinicians to convey to parents and patients, which can help to reduce the stigma of A.D.H.D. and improve understanding of the disorder.”

When I interviewed Hoogman by email recently, I was surprised to learn that she now wishes she could have revised that statement. “Back then, we emphasized the differences that we found (although small), but you can also conclude that the subcortical and cortical volumes of people with A.D.H.D. and those without A.D.H.D. are almost identical,” she wrote. In retrospect, she added, it wasn’t fitting to conclude from her findings that A.D.H.D. is a brain disorder. “The A.D.H.D. neurobiology is so much more complex than that.”

Sonuga-Barke goes further, arguing that the entire decades-long quest for a biomarker has been “a red herring” for the field.

One prominent researcher has concluded that the standard treatment for ADHD, with stimulants, doesn't work:

After three decades of studying stimulants, Swanson differs with many of his colleagues on their value. “I don’t agree with people who say that stimulant treatment is good,” he told me. “It’s not good.” He acknowledges that medication can often produce short-term improvements in children’s behavior. But, he says, “there is no long-term effect. The only long-term effect that I know of has been the suppression of growth. If you’re honest, you should tell kids that, look, if you’re interested in next week or next month or even the next year, this is the right treatment for you. But in the long run, you’re going to be shorter. How many kids would agree to take medication? Probably none.”

Whoops!

Multi-tasking and its vicissitudes [consciousness]

Anna Borges, A Multitasker’s Guide to Regaining Focus, NYTimes, March 11, 2024.

Doing a single task:

First, “multitask” itself is typically a misnomer. According to experts, it’s not possible to do two things at once — unless we can do one without much thinking (like taking a walk while catching up with a friend).

“Usually, when people think they’re multitasking, they’re actually switching their attention back and forth between two separate tasks,” said Gloria Mark, a professor of informatics at the University of California, Irvine, and author of “Attention Span: A Groundbreaking Way to Restore Balance, Happiness and Productivity.”

Let’s consider what happens when you engage in a single task like cooking dinner. From the moment you decide what to make, different regions of your brain, collectively referred to as the cognitive control network, collaborate to make it happen, said Anthony Wagner, a professor of psychology at Stanford and the deputy director of the university’s Wu Tsai Neurosciences Institute.

This network includes areas of your brain that are involved in executive function, or the ability to plan and carry out goal-oriented behavior. Together they create a mental model of the job at hand and what you need to accomplish it. Your brain might do this, Dr. Wagner said, by drawing on both external and internal information, like the ingredients in your fridge or your memory of the recipe.

Switching cost:

As you would probably expect, the potential harm varies depending on the activity and how adept you are at doing it. But, generally, “when we switch between tasks, we pay what’s been dubbed a ‘switch cost,’” Dr. Wagner said. “We’re going to be slower and less accurate than we would have been if we stayed on a single task.”

Speed and precision aren’t the only risks, either. Multitasking is more cognitively demanding, even when we’re doing things we find enjoyable or easy. When we multitask, we can tax our working memory, or our ability to hold and handle information in our mind, Dr. Byers explained. “The more we overload that system and the more we’re trying to keep in our brains at once, the more mental fatigue it can lead to,” she said. And other studies have found that multitasking can set our heart racing, raise our blood pressure, trigger anxiety, dampen our mood and negatively impact our perception of the work at hand.

The article then goes on with advice for focusing on one thing at a time, which is all well and good. For example:

Dr. Mark suggested you start by observing yourself throughout the day, noticing when and how you task-switch without realizing it. From there, the advice is simple yet challenging: You’ll need to practice monotasking, or doing one thing at a time, to gradually retrain your focus and build your tolerance.

Then we have: When to keep multitasking ... by sticking to your strengths weighing the risks, finding break points, and, finally, Use multitasking when it actually helps. And so forth, yada yada, as they said on Seinfeld.

This is all about one of my current hobby-horses, and a recurring theme here on the Savanna, regulating the mind, which is in turn about consciousness. It puts me in mind of Walter Freeman's speculation that consciousness is like frames in a motion picture, flitting from frame to frame at the rate of about 10 frames (of consciousness) per second. I discuss this in, e.g. this post: Two more thoughts on ChatGPT: Conceptual spaces and system time-steps. You might also want to look at an old working paper: Music and the Prevention and Amelioration of ADHD: A Theoretical Perspective. For that matter, I've got a number of posts that mention ADHD, which, I suppose, could be characterized as involuntary multi-tasking.

Virtual co-working [work mode]

Lora Kelley, Would You Pay $40 a Month to Have Strangers Watch You Work? NYTimes, July 15, 2022.

For a monthly fee of $39.99, users can schedule unlimited sessions in Zoom “caves.” There, it’s possible to watch fellow workers furrow their brows and scratch their heads, as they work toward stated goals ranging from “brainstorm outline” to “find clarity.”

Two and a half years into working from home, many people are finding that a desk and a chair — even if it’s a really nice ergonomic one purchased with a company stipend — do not an office make.

With no clear end to remote work in sight for many white-collar employees, some are trying to import something more elusive into their home offices: the feeling of accountability (or simply guilt) that comes from being observed by others while at work.

Often referred to as “virtual co-working” platforms, a slew of tech tools allow people to be seen working — but, crucially, not by bosses who might surveil their output, or co-workers who might want something from them. The platforms are especially popular with freelancers, entrepreneurs, students and people with attention deficit hyperactivity disorder who are seeking structure and accountability.

Fans describe it as combining the freedom of remote work with the extra focus that comes with someone else working nearby — in the next Zoom screen over. Some workplace experts say that for people who are not working in an office, this facsimile of open-plan accountability may be a decent middle ground.

ADHD:

Ms. Padron, Ms. Retter and Ms. De Maci have all said they have A.D.H.D., and that they have found it useful to schedule work blocks to stay accountable and on task. “I think it’s even kind of a fake sense of accountability,” Ms. Padron said. But it still helps.

Strage days, markers:

Tsedal Neeley, a professor at Harvard Business School and the author of “Remote Work Revolution: Succeeding From Anywhere,” said she had not heard of people paying $40 a month for others to watch them get work done. “This is the strangest thing I’ve heard this week,” she said. “It kind of goes counter to all that we know about why people value and love remote work.”

Research, she said, shows that remote workers, in general, value autonomy and independence, and that their productivity is adversely affected when they feel surveilled by managers. But, she said, when other people are working around you, like in a coffee shop, “It signals work and is a marker of work.” Physical co-working spaces have also been drawing more people in recent months.

Regulars:

Like in an actual office setting, users of these platforms may start to recognize the regulars, and some may start to develop relationships, both personal and professional.

Anthony Ronda, 30, a software engineer in Hillsdale, N.J. who is starting a virtual tabletop game company, joins several Focusmate sessions per day and has found value in being accountable to another person while he works. He has also experienced a more personal benefit: He met his boyfriend on Focusmate earlier this year. The two plan to meet in person for the first time later this month.

Perhaps these conditions aren't mental disorders at all (anxiety, depression, PTSD)

Alison Escalante, Researchers Doubt That Certain Mental Disorders Are Disorders At All, Forbes, Aug. 11, 2020.

What if mental disorders like anxiety, depression or post-traumatic stress disorder aren’t mental disorders at all? In a compelling new paper, biological anthropologists call on the scientific community to rethink mental illness. With a thorough review of the evidence, they show good reasons to think of depression or PTSD as responses to adversity rather than chemical imbalances. And ADHD could be a way of functioning that evolved in an ancestral environment, but doesn’t match the way we live today.

Adaptive responses to adversity 

Mental disorders are routinely treated by medication under the medical model. So why are the anthropologists who wrote this study claiming that these disorders might not be medical at all? They point to a few key points. First, that medical science has never been able to prove that anxiety, depression or post-traumatic stress disorder (PTSD) are inherited conditions.

Second, the study authors note that despite widespread and increasing use of antidepressants, rates of anxiety and depression do not seem to be improving. From 1990-2010 the global prevalence of major depressive disorder and anxiety disorders held at 4.4% and 4%. At the same time, evidence has continued to show that antidepressants perform no better than placebo.

Third, worldwide rates of these disorders remain stable at 1 in 14 people. Yet “in conflict‐affected countries, an estimated one in five people suffers from depression, PTSD, anxiety disorders, and other disorders,” they write.

Taken together, the authors posit that anxiety, depression and PTSD may be adaptive responses to adversity. “Defense systems are adaptations that reliably activate in fitness‐threatening situations in order to minimize fitness loss,” they write. It’s not hard to see how that could be true for anxiety; worry helps us avoid danger. But how can that be true for depression? They argue that the “psychic pain” of depression helps us “focus attention on adverse events... so as to mitigate the current adversity and avoid future such adversities.”

If that sounds unlikely, then consider that neuroscientists have increasingly mapped these three disorders to branches of the threat detection system. Anxiety may be due to chronic activation of the fight or flight system. PTSD may occur when trauma triggers the freeze response which helps animals disconnect from pain before they die, and depression may be a chronic activation of that same freeze response.

The article linked in the first paragraph: Kristen L. Syme, Edward H. Hagen, Mental health is biological health: Why tackling “diseases of the mind” is an imperative for biological anthropology in the 21st century, Yearbook Phys Anthropol. 2020;171 (Suppl. 70):87–117, https://doi.org/10.1002/ajpa.23965

Abstract: The germ theory of disease and the attendant public health initiatives, including sanitation, vaccination, and antibiotic treatment, led to dramatic increases in global life expectancy. As the prevalence of infectious disease declines, mental disorders are emerging as major contributors to the global burden of disease. Scientists understand little about the etiology of mental disorders, however, and many of the most popular psychopharmacological treatments, such as antidepressants and antipsychotics, have only moderate‐to‐weak efficacy in treating symptoms and fail to target biological systems that correspond to discrete psychiatric syndromes. Consequently, despite dramatic increases in the treatment of some mental disorders, there has been no decrease in the prevalence of most mental disorders since accurate record keeping began. Many researchers and theorists are therefore endeavoring to rethink psychiatry from the ground‐up. Anthropology, especially biological anthropology, can offer critical theoretical and empirical insights to combat mental illness globally. Biological anthropologists are unique in that we take a panhuman approach to human health and behavior and are trained to address each of Tinbergen's four levels of analysis as well as culture. The field is thus exceptionally well‐situated to help resolve the mysteries of mental illness by integrating biological, evolutionary, and sociocultural perspectives.

FWIW, this line of thought is consistent with my sense of why I enter a melancholy phase at the beginning of the year. Here's three paragraphs from a post where I talk about that:

I do think my mood follows my productivity, or vice versa, and that’s what’s interesting. David Hays once conjectured that melancholy (aka depression) is the price you pay for large-scale reorganization or the sort implied by creativity. “Reorganization” is a term of art from William Powers’s account of the mind. It is so deeply embedded in that theory that there is, alas, no easy gloss.

Start out by thinking of learning. When you learn, your mind is also reorganizing on a large scale. Now think of mourning as well. When you mourn the loss of someone close you have to reorganize your mind for life without them. You don’t actually learn anything, but you have to figure out how to function in those situations where you would have go to that person. It’s unlearning.

In order to be creative you must first unlearn on a large scale. That is accompanied by melancholy. That, on this view, accounts for those troughs in my intellectual output, which is mostly though not entirely through New Savanna. That creates some “slack” in the system. Once enough unlearning has taken place I can then think new thoughts and my productivity goes up. When the slack has been used up, it’s time for more unlearning./blockquote>

My Working Papers on Neurodiversity

I don’t know when I first read the term neurodiversity, but it is likely only within the last decade, or perhaps a bit before. I took a look in Google’s Ngram viewer. I didn’t expect much to show up. I got that right; it didn’t turn up at all. Wikipedia dates the term back to the late 1990s.

Now that I’m aware of it I suppose I first became aware of the phenomenon back in the early 1970s when I picked up a book about the cerebral cortex that was written in the Soviet Union sometimes in the previous decade. I forget the name of the book and, as much of my library is in storage, I can’t dig it out. No matter. It had a number of standard maps of cortical areas as identified by cytoarchitecture, the so-called Brodmann areas. What was particularly interesting is that it had such maps for a handful of different individual differences and the differed from one another in significant ways. I forget whether or not the text talked of behavioral differences associated with those anatomical differences. That, of course, would be important.

But it was the mere fact of difference that most struck me. Up to that point every map I’d seen of Brodmann areas presented them, by default as it were, as pretty much the same from one individual to another. But no, that’s not the case.

ADHD and music

I began to think about neurodiversity in a focused way when I worked on my book on music, Beethoven’s Anvil: Music in Mind and Culture (2001), where the topic came up in connection with autism and with ADHD. Once the book was published I decided to take a look at the literature on ADHD. Here’s the result:

Music and the Prevention and Amelioration of ADHD: A Theoretical Perspective, Version 3, 2009.

Abstract: Russell A. Barkley has argued that ADHD is fundamentally a disorientation in time. These notes explore the possibility that music, which requires and supports finely tuned temporal cognition, might play a role in ameliorating ADHD. The discussion ranges across cultural issues (grasshopper vs. ant, lower rate of diagnosis of ADHD among African-Americans), play, distribution of dopamine and norepinephrine in the brain, neural development, and genes in culture (studies of the distribution of alleles for dopamine receptors). Unfortunately, the literature on ADHD does not allow us to draw strong conclusions. We do not understand what causes ADHD nor do we understand how best to treat the condition. However, in view of the fact that ADHD does involve problems with temporal cognition, and that music does train one’s sense of timing, the use of music therapy as a way of ameliorating ADHD should be investigated. I also advocate conducting epidemiological studies about the relationship between dancing and music in childhood, especially in early childhood, and the incidence of ADHD.

Contents:

Introduction: Lost in Time 1
Grasshoppers and Ants: Cultural Issues 1 2
Music, Time, and Behavioral Mode 3
Play in the Morning 5
Dopamine, Norepinephrine and The ADHD Brain 6
Neural Development 9
Genes and Culture 11
African Americans: Cultural Issues 2 14
Conclusions 15
Appendix: Timing 16

Download at:
SSRN: https://papers.ssrn.com/abstract=1527090
Academia.edu: https://www.academia.edu/238609/Music_and_the_Prevention_and_Amelioration_of_ADHD_A_Theoretical_Perspective

Art and Down Syndrome

Sometime back in the “glory years” of academic blogging I started hanging out at Michael Bérubé’s now discontinued American Airspace (and which is no longer online). He wrote frequently about his son, Jamie, who was born with Down Syndrome. In 2016 he published Life as Jamie Knows It: An Exceptional Child Grows Up (2016). He also posted examples of Jamie’s art online. I looked at it, examined it, and became intrigued. I ended up doing a series of posts, each devoted to a specific kind of non-figurative imagery Jamie explored, and then collected them into a working paper:

Jamie's Investigations: The Art of a Young Man with Down Syndrome, October 2016.

Abstract: Jamie Bérubé is a young man with Down syndrome in his early twenties; he has been drawing abstract art since he was eleven. So far he has explored five types of imagery: 1) fields of colored dots in a roughly rectangular array, 2) tall slender towers with brightly colored horizontal ‘cells’, 3) pairs of concentric colored bands with one pair of concentrics above the other, 4) colored letterforms above a set of colored concentric bands, and 5) arrangements of fairly complex biomorphic forms. Taken together types 1 & 2 exhibit one approach to the problem of composing a page: place a large number of small objects on the page in a regular array. Types 3 & 4 exhibit a different approach: position relatively large objects in the center of the page. In some ways Bérubé’s fifth approach, arrangements of biomorphic objects, can be considered a synthesis of the two other approaches. Moreover the individual objects appear life-like and their arrangement on the page is dynamic, properties not otherwise evident in Bérubé’s art. It is his most recent form of art and may be considered the product of long-term experimentation.

Contents:

About Jamie Bérubé and His Art 2
Emergence: Jamie Discovers Art 3
On Discovering Jamie’s Principle 9
Scintillating Rhythm: Towers of Color 14
Composition: Concentrics and Letterforms 21
Biomorphs, Geometry, and Topology 32
What We Have Discovered? 39

Download at:
SSRN: https://ssrn.com/abstract=2853372
Academia.edu: https://www.academia.edu/29195347/Jamie_s_Investigations_The_Art_of_a_Young_Man_with_Down_Syndrome

Musical “prosthesis” and physical disability

As I understand it, neurodiveristy is about non-pathological differences in the brain and nervous system. By that standard this last paper is not about neurodiveristy; it is about three people who have been so badly disabled that they could not play musical instruments. They were patients at Beth Abraham Health Services in the Bronx, New York (where Oliver Sacks worked when he did the work he reported in Awakenings.) They had been outfitted with devices that allowed them to trigger electronic musical instruments:

William Benzon and David W. Ramsey, Musical Coupling: Social and Physical Healing in Three Disabled Patients, 2002.

Abstract: Some important aspects of physiological function can be conceptualized as a system of coupled oscillators. In a similar fashion, coupled oscillation can be used to understand musical interaction between individuals. The looping circuitry of individual nervous systems can be thought of as a bank of oscillators while musical sound provides the coupling function linking individuals together in a very satisfying form of social interaction. By providing severely disabled patients with simple piezoelectric triggers they can play electronic musical instruments well enough to join together in making music that is satisfying to them and to others as well. This article discusses three such patients and suggests avenues for future research.

Contents:

Introduction: From Shaman to MIDI 2
Music as Coupling: 4
MIDI Instruments for Disabled Patients 11
Group Interaction 20
Lessons and Questions 23
References 29

Download at:
SSRN: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1573747
Academia.edu: https://www.academia.edu/8692351/Musical_Coupling_Social_and_Physical_Healing_in_Three_Disabled_Patients

The A.D.H.D. Industrial Complex

The NYTimes reviews Alan Schwartz, ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic:

The boundaries of the A.D.H.D. diagnosis have been fluid and fraught since its inception, in part because its allegedly telltale signs (including “has trouble organizing tasks and activities,” “runs about or climbs in situations where it is not appropriate” and “fidgets with or taps hands or feet,” according to the current edition of the DSM) are exhibited by nearly every human being on earth at various points in their development. No blood test or CT scan can tell you if you have the condition — the diagnosis is made by subjective clinical evaluation and screening questionnaires. This lack of any bright line between pathology and eccentricity, Schwarz argues, has allowed Big Pharma to get away with relentless expansion of the franchise.

Numerous studies have shown, for example, that the youngest children in a classroom are more likely to be diagnosed with A.D.H.D. Children of color are also at higher risk of being misdiagnosed than their white peers. One clinician quoted in the book more or less admits defeat: “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

Schwarz has no doubt that A.D.H.D. is a valid clinical entity that causes real suffering and deserves real treatment, as he makes clear in the first two sentences of the book: “Attention deficit hyperactivity is real. Don’t let anyone tell you otherwise.” But he believes that those who are disabled by the condition deserve a wider range of treatment options than an endless litany of stimulants with chirpy names like Vyvanse and Concerta.

And Big Pharma has been using ADHD to push pills:

While other books have probed the historical roots of America’s love affair with amphetamines — notably Nicolas Rasmussen’s “On Speed,” published in 2008 — “ADHD Nation” focuses on an unholy alliance between drugmakers, academic psychiatrists, policy makers and celebrity shills like Glenn Beck that Schwarz brands the “A.D.H.D. industrial complex.” The insidious genius of this alliance, he points out, was selling the disorder rather than the drugs, in the guise of promoting A.D.H.D. “awareness.” By bankrolling studies, cultivating mutually beneficial relationships with psychopharmacologists at prestigious universities like Harvard and laundering its marketing messages through trusted agencies like the World Health Organization, the pharmaceutical industry created what Schwarz aptly terms “a self-affirming circle of science, one that quashed all dissent.”

Over a decade ago I wrote up some notes of my own: Music and the Prevention and Amelioration of ADHD: A Theoretical Perspective. Here's the abstract:

Russell A. Barkley has argued that ADHD is fundamentally a disorientation in time. These notes explore the possibility that music, which requires and supports finely tuned temporal cognition, might play a role in ameliorating ADHD. The discussion ranges across cultural issues (grasshopper vs. ant, lower rate of diagnosis of ADHD among African-Americans), play, distribution of dopamine and norepinephrine in the brain, neural development, and genes in culture (studies of the distribution of alleles for dopamine receptors). Unfortunately, the literature on ADHD does not allow us to draw strong conclusions. We do not understand what causes ADHD nor do we understand how best to treat the condition. However, in view of the fact that ADHD does involve problems with temporal cognition, and that music does train one’s sense of timing, the use of music therapy as a way of ameliorating ADHD should be investigated. I also advocate conducting epidemiological studies about the relationship between dancing and music in childhood, especially in early childhood, and the incidence of ADHD.

ADHD Explained?

Richard Friedman in the NYTimes:

Recent neuroscience research shows that people with A.D.H.D. are actually hard-wired for novelty-seeking — a trait that had, until relatively recently, a distinct evolutionary advantage. Compared with the rest of us, they have sluggish and underfed brain reward circuits, so much of everyday life feels routine and understimulating.

To compensate, they are drawn to new and exciting experiences and get famously impatient and restless with the regimented structure that characterizes our modern world. In short, people with A.D.H.D. may not have a disease, so much as a set of behavioral traits that don’t match the expectations of our contemporary culture.

From the standpoint of teachers, parents and the world at large, the problem with people with A.D.H.D. looks like a lack of focus and attention and impulsive behavior. But if you have the “illness,” the real problem is that, to your brain, the world that you live in essentially feels not very interesting.

What's up in the brain and what to do?

These findings suggest that people with A.D.H.D are walking around with reward circuits that are less sensitive at baseline than those of the rest of us. Having a sluggish reward circuit makes normally interesting activities seem dull and would explain, in part, why people with A.D.H.D. find repetitive and routine tasks unrewarding and even painfully boring.

Psychostimulants like Adderall and Ritalin help by blocking the transport of dopamine back into neurons, thus increasing its level in the brain.

Another patient of mine, a 28-year-old man, was having a lot of trouble at his desk job in an advertising firm. Having to sit at a desk for long hours and focus his attention on one task was nearly impossible. He would multitask, listening to music and texting, while “working” to prevent activities from becoming routine.

Eventually he quit his job and threw himself into a start-up company, which has him on the road in constantly changing environments. He is much happier and — little surprise — has lost his symptoms of A.D.H.D.

So,  change your  environment to one that's challenging and unpredictable and you're good to go. As for school:

I think another social factor that, in part, may be driving the “epidemic” of A.D.H.D. has gone unnoticed: the increasingly stark contrast between the regimented and demanding school environment and the highly stimulating digital world, where young people spend their time outside school. Digital life, with its vivid gaming and exciting social media, is a world of immediate gratification where practically any desire or fantasy can be realized in the blink of an eye.

The Academy of the Wall: Transnational Culture in the 21st Century

What are the prospects of using graffiti as the foundation of a transnational cultural academy?

By graffiti I don’t mean just anything inscribed on walls. I mean something more specific, the aerosol art that started in Philadelphia and New York City in the late 1960s and early 1970s and that had gone world-wide by the end of the century. It’s the first form of abstract art to reach a mass audience.

As vandalism, it exists on the borders of existing art culture.

It is nowhere and everywhere.

It is the future.

Is Hyperactivity for Real?

The opening paragraphs of an article in The New York Times:

Nearly one in five high school age boys in the United States and 11 percent of school-age children over all have received a medical diagnosis of attention deficit hyperactivity disorder, according to new data from the federal Centers for Disease Control and Prevention.

These rates reflect a marked rise over the last decade and could fuel growing concern among many doctors that the A.D.H.D. diagnosis and its medication are overused in American children.

The figures showed that an estimated 6.4 million children ages 4 through 17 had received an A.D.H.D. diagnosis at some point in their lives, a 16 percent increase since 2007 and a 53 percent rise in the past decade. About two-thirds of those with a current diagnosis receive prescriptions for stimulants like Ritalin or Adderall, which can drastically improve the lives of those with A.D.H.D. but can also lead to addiction, anxiety and occasionally psychosis.

An abstract for some notes I wrote up a few years ago, Music and the Prevention and Amelioration of ADHD: A Theoretical Perspective:

Russell A. Barkley has argued that ADHD is fundamentally a disorientation in time. These notes explore the possibility that music, which requires and supports finely tuned temporal cognition, might play a role in ameliorating ADHD. The discussion ranges across cultural issues (grasshopper vs. ant, lower rate of diagnosis of ADHD among African-Americans), play, distribution of dopamine and norepinephrine in the brain, neural development, and genes in culture (studies of the distribution of alleles for dopamine receptors). Unfortunately, the literature on ADHD does not allow us to draw strong conclusions. We do not understand what causes ADHD nor do we understand how best to treat the condition. However, in view of the fact that ADHD does involve problems with temporal cognition, and that music does train one’s sense of timing, the use of music therapy as a way of ameliorating ADHD should be investigated. I also advocate conducting epidemiological studies about the relationship between dancing and music in childhood, especially in early childhood, and the incidence of ADHD.

Music and ADD

Stanford University recently held a symposium on music therapy that focused on musical rhythm. Some of the work dealt with ADD (attention deficient disorder):

Harold Russell, a clinical psychologist and adjunct research professor in the Department of Gerontology and Health Promotion at the University of Texas Medical Branch at Galveston, used rhythmic light and sound stimulation to treat ADD (attention deficit disorder) in elementary and middle school boys. His studies found that rhythmic stimuli that sped up brainwaves in subjects increased concentration in ways similar to ADD medications such as Ritalin and Adderall. Following a series of 20-minute treatment sessions administered over several months, the children made lasting gains in concentration and performance on IQ tests and had a notable reduction in behavioral problems compared to the control group, Russell said.

"For most of us, the brain is locked into a particular level of functioning," the psychologist said. "If we ultimately speed up or slow down the brainwave activity, then it becomes much easier for the brain to shift its speed as needed." ...

Thomas Budzynski, an affiliate professor of psychology at the University of Washington, conducted similar experiments with a small group of underachieving college students at Western Washington University. He found that rhythmic light and sound therapy helped students achieve a significant improvement in their grades.

I've posted some notes on Music and the Prevention and Amelioration of ADHD here.

ADD: Drugs Don't Work Long Term

L. Alan Sroufe has an oped in today's NYTimes on the use of drugs to treat ADD (attention Deficient Disorder) in children: Ritalin Gone Wrong.

Attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams. But when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects, including stunting growth.

Sadly, few physicians and parents seem to be aware of what we have been learning about the lack of effectiveness of these drugs.

He suggests that experience may be the cause:

Policy makers are so convinced that children with attention deficits have an organic disease that they have all but called off the search for a comprehensive understanding of the condition. The National Institute of Mental Health finances research aimed largely at physiological and brain components of A.D.D. While there is some research on other treatment approaches, very little is studied regarding the role of experience. Scientists, aware of this orientation, tend to submit only grants aimed at elucidating the biochemistry.

Thus, only one question is asked: are there aspects of brain functioning associated with childhood attention problems? The answer is always yes. Overlooked is the very real possibility that both the brain anomalies and the A.D.D. result from experience.

Here's some informal notes I did some years ago on the experience angle: Music and the Prevention and Amelioration of ADHD: A Theoretical Perspective:

Russell A. Barkley has argued that ADHD is fundamentally a disorientation in time. These notes explore the possibility that music, which requires and supports finely tuned temporal cognition, might play a role in ameliorating ADHD. The discussion ranges across cultural issues (grasshopper vs. ant, lower rate of diagnosis of ADHD among African-Americans), play, distribution of dopamine and norepinephrine in the brain, neural development, and genes in culture (studies of the distribution of alleles for dopamine receptors). Unfortunately, the literature on ADHD does not allow us to draw strong conclusions. We do not understand what causes ADHD nor do we understand how best to treat the condition. However, in view of the fact that ADHD does involve problems with temporal cognition, and that music does train one’s sense of timing, the use of music therapy as a way of ameliorating ADHD should be investigated. I also advocate conducting epidemiological studies about the relationship between dancing and music in childhood, especially in early childhood, and the incidence of ADHD.

Things Change & the Walls Speak

One of the things about graffiti I've been documenting is how it changes. Well, the graffiti itself doesn't have the power to change, but writers go over one another's work so that what's on a wall changes. Here's a simple production the ADHD crew did on a stanchion supporting part of an abandoned freight line:

From left to right it reads FARO NAKED BLOKE. Notice that someone's added gone over NAKED. Now, look at the lower right corner; you'll see KH1 written several times on the base of the stanchion. KH1 = Kosher Howie 1. I took that photo on 30 Aug. 2008, almost two years ago. Here's the same wall as it appeared on 19 Dec. 2009, albeit from a rather more dramatic angle:

In the large, it's unchanged, but in the small, you can see that someone's gone over FARO and BLOKE in orange and there's some blue over FARO that wasn't there before.

Here's the same wall as it appeared last week in a photo I took on 21 August (which is pretty much the same as a photo I took on 3 July, but the lighting is better):

Major changes. You can see the remnants of BLOKE at the right, but FARO and NAKED are all but obliterated. There's a throw-up plus some other stuff over FARO at the RIGHT, but the major action is in the middle, over NAKED. FALSER has gotten up with something that's a bit more elaborate than a throw-up but perhaps a bit austere for a piece. Notice the year in the top stroke of the "F."

Here's what's there today, 29 Aug., eight days later:

FALSER is all but gone. I count at least two layers since last week. There's a green name over FALSER that I can't make out, and there's some writing in yellow, orange, and red over that. If you look to the left you'll see a yellow dreidel outlined in orange and signed KH1 at the lower right. To the right RUOK (I think) has a throwie in while letters outlined in purple. Below that he's written:

"This spot is dead!" Perhaps it is. If so, only for awhile. There's other fresh action only 100 yards away. And where there's fresh action, there's hope. Stay tuned.