One of the more controversial consequences of our modern psychiatric medication arsenal is the rampant treatment of children for developmental disorders, in particular ADHD.
ADHD is a complex beast. No one believes that it is 100% biologically mediated, as a flu or cold virus might be. Rather, our current understanding suggests that there are both biological and environmental influences that lead each particular patient to either develop symptoms or live an ADHD-free life.
Advocates of medicating all cases of ADHD argue that the biological predispositions — in particular the Temporal Myopia that Russell Barkley speaks of — are still present, even if the patient is able to compensate with learned skills. If this is so, then the medication exists to compensate for the patient’s biological handicap, easing the burden of daily decision-making.
But what if this isn’t entirely true? Recent studies of neuroplasticity suggest that this phenomenon is not limited to youth, and indeed is responsible for our ability to learn throughout life. Rather than having brains with fixed interconnections, we have brains that are malleable and constantly growing, changing, and refining.
If this is true, then one might ask whether it is possible to sufficiently change the underlying neurological structure of the brain enough to actually counteract any biological predisposition for temporal myopia (or any other disordered pattern), resulting in a brain that is wired to perceive emotional context normally and fully. If so, what effect would medicating the patient have on this process? Would it aid in the restructuring, or would it hinder it? Would the brain become reliant on the outside substance, thus reducing any attempts to rewire appropriately? Or, would a lack of medication prevent the patient from having the necessary experiences needed for this process to occur?
You are correct in asserting that the symptom cluster known as ADHD represents a complex and unique clinical phenomena, highly responsive to the vigilant monitored use of cognitively effective medications. Further, you are additionally correct in noting that the enormously prevalent psychopathology has a Core Feature: the recognition that our experience of temporal saliency is a genetic invariant endowment with uneven distribution across the species.
The obviousness of time leads to the presupposition that temporal saliency — temporal distance as foresight or recollected as hindsight as experienced for the lower second and third standard deviation from the mean — is somehow a universal sense.
Rather, it is distinguished from all other DSM nostrums by the quality of temporal myopia which devastates self-efficacious decision-making.
With the tonic modulation of DA/NE levels in the cortical-striatal-thalamic-cortical reentry loop, the Dl-PFC, ACG, and OFC bottom of the striatum serve to provide the amplitude of executive control of volitional agency. The linages are down regulated in DA-NE available adequate volumes, properly sequenced, in the proper neuronal tissues for a person with ADHD to achieve an adequate signal threshold and accurate perceptual experience needed for full agency access to their self-regulation controls.
Properly adjusted medication dampens the noise and increases the signal strength, giving the impaired person a fighting chance to have most of the Executive Functions available for acts of agency. We know the medications are safe and 80% effective during childhood, allowing the person to have better sensitivity to error, interference control, the pre-reflexive mind-time status to reappraise past errors, and permitting their conversion to move away from mistakes and into learning error. We learn by trial and error, yet with mistakes made by a non-medicated ADHD, their cognition floods with shame, their negative expectancy grows with a habitual mistakes followed by the inevitable apology, and self-contempt grows from repeated demoralization. As such, no reappraisal of the error occurs.
Medicated children have a markedly different experience and the research shows they have less inveracity (lying) and greater reading comprehension, which always follows self-efficacious social cooperation. In fact, with improved coordinated collaborative action, their social relations are much smother with them ending up as bully targets a fraction of the 73% typical frequency.
NIMH conducted a 10 year longitudinal study with an N of 225+ in each group of ADHD children. F. X. Costellanos found that kids on medication for 10 years, compared with a matched group of similarly impaired ADHD children without any medication, showed distinctive differences.
The group with medication showed they had caught up with the suboptimal growth in all areas deficient with the ADHD brain, especially the ACG, which for ADHD is on average 14% smaller. The 10 years of medication had given back 70% of the normal lost brain growth, apart and separate from the psychosocial influences from having a more positive childhood experience.
Past age nineteen, the benefit from the long tern use of cognotropic scaffolding does not render the robust, empirical advances obtained from medial support during the open window of childhood maturation. Never the less, giving a person appropriate prosthetics for the volitional agency, does reduce the harmful dysfunction witnessed with this pernicious disorder.