A Psychiatrist Proposes a Radical Redefinition of ADHD

The New York Times published “A Natural Fix for A.D.H.D.” on 11-2-14.  This is an opinion article by the eminent psychiatrist Richard Friedman, M.D.  He teaches at Weill Cornell Medial College, has a private practice in Manhattan, and his specialties include medication management AND psychodyanamic psychotherapy, so he appears to have a broad background that goes beyond the traditional medical model used by most psychiatrists.

In the article Dr. Friedman ties together current research and a progressive, interdisciplinary understanding of ADHD that leads to some interesting treatment options.  He begins by referencing recent neuroscience research that supports the idea that “people with ADHD are actually hard-wired for novelty-seeking – a trait that had, until recently, a distinct evolutionary advantage.”  In other words, it is possible to have a more naturalistic, non-pathological view of ADHD behaviors.  They have, compared to the rest of us, “sluggish and under-fed brain reward circuits, so that much of their everyday life feels routine and understimulating.”  And, “In short, people with ADHD may not have a disease so much as a set of behavioral traits that don’t match the expectations of our contemporary culture.” (italics added)

Dr. Friedman goes on to provide background in support of this view of ADHD.  He describes recent research which found that people with ADHD have less brain receptors for dopamine, which is an important part of the neurological reward system.  In addition, the study found that people with worse ADHD symptoms had LESS dopamine receptors.  And, he reports that medications typically used to treat ADHD, Adderall and Ritalin, help increase the level of dopamine by blocking the transport of it back into neurons – which increases its level in the brain.

Dr. Freidman goes on to provide, in effect, a behavioral  prescription for people with ADHD:  seek out, when possible, environments in which your ADHD symptoms are assets, not liabilities.  And – once again, when possible- avoid, or reduce your exposure to, situations which are not a good match for how your brain works.

Dr. Freidman goes on to report on interesting anthropological research that supports his theory (nomadic tribesmen with ADHD symptoms function better in their environment) and also longitudinal studies about people with ADHD (the rates of ADHD are much higher in children than in adults – he theorizes that adults have more control over their environment and are able to, in effect, self-select environments that are a better match for how their brain works).  He ends by making some recommendations for restructuring school environments for ADHD children, and notes that medication is still helpful and indicated for some of them.

He ends with, I think, a powerful plea to rethink the treatment of children with ADHD:  “..Let’s not rush to medicalize their curiosity, energy and novelty-seeking; in the right environment these traits are not a disability, and can be a real asset.”

Overall, this article is well written, thoughtful, provides research in support of position, and provides a few interesting real life stories that illustrate his view of ADHD. 

 

 

 

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>