ADHD is horribly misunderstood, and it is our fault as therapists that this is true. For years, we have continued to call this disorder “Attention Deficit and Hyperactivity Disorder” despite all recent evidence pointing clearly to the idea that beneath it all, attention and hyperactivity have no more to do with the underlying deficit than, to paraphrase Russell Barkley, hand-slapping has to do with Autism.
All of us have within us the ability to orient in time — to be mindful of our present feelings, retrospective of our past experience, and prospective of future consequences. Fluid movement through our temporal perspective is vital to good decision-making. “ADHD” is what we call a person who is so rooted in the present, that they no longer move internally to the future. They are not avoiding an uncomfortable option that they thought about — they never thought about it in the first place.
To illustrate the difference between this temporal myopia and avoidance, we should examine Antonio Demasio’s work, which has highlighted the often under-appreciated importance of emotions in our decision-making process. When we move through time in our minds, we must be able to connect feelings to the various options we face if there is any hope of those options being realistic choices. Imagine a life where a present choice elicits a strong emotional response, while a future choice elicits no response at all? Would that future choice have any real chance of affecting the present moment?
With this model in mind, it becomes easier to see where both genetic and environmental influences take hold. On a biological level, we are all predisposed to ways of being in the world. Some of us may have strong emotional connections to the present, while others more easily connect emotionally to the future. Add to this relationships that might push you to connect more with the present or future.
Treatment, then, should focus not on “Attention” or “Hyperactivity”, but rather on aiding the client in developing emotional language for future events — in effect to reestablish a link between their emotions and the future.
What do you think? Post your questions or comments below!
Josh,
Your points have been made with great effectiveness and personally, your perspective reflects my own view. I just completed, this morning, notes for our discussion of the role of emotion in high-order cognition. The context was a comment on a variant of “Descartes Error,” wherein the basil forebrain tissues are considered our “reptilian brain” and contracted with the cerebral cortex as the “thinking cap.” How absurd to bifurcate a brain with parallel Distributed Processes into “sectors” of “domain specific” functions.
We feel with our thoughts and think with our feelings as an interlocking concatenate of harmonically oscillating processes. The issue of apppraisal of “affective valance” in Bandura’s social-cognitive terms or from behavioral economics — the evaluation of “future reward utility value” — lies at the core of the ADHD symptom cluster.
I look forward to you comments on the clinical notes that will follow.