View Full Version : ADHD as a neurodevelopmental disorder

Kunga Dorji
10-21-13, 07:03 PM
While the importance of genetics in the causation of ADHD is debateable, what is not debateable is that the conceptualisation of ADHD as a "neurodevelopmental disorder" is appropriate,scientifically robust, and useful in that it sheds valuable light upon the problem and how to deal with it.

Calling it neuro-developmental does not imply that it is fixed or permanent, nor does it imply that the causation lies primarily at a neurological level.

Whatever the true nature of consciousness (I am not ruling out spiritual theories here, but simply point out that it is unnecessary to address them for the purposes of this analysis), our consciousness, to all intents and purposes, manifests through the usage of our body.

Therefore, the neurological machinery that is involved in translating a thought into action is inherently involved in behaviour, and any consistent pattern of behaviours, by definition, will correlate reasonably well with a set of behavioural activation patterns.

This observation does not make ADHD a life sentence though, as the principals of neuroplasticity are now well understood, and we are now becoming increasingly skilled at producing behavioural interventions that will assist neuroplastic change.

The psychological requirements for neuroplastic change are well understood:
A novel task
Sufficient activation or interest in the task
Multiple repetitions of the task
and Stable focussed attention upon the task
Re Siegel, D. Mindsight

So it is easy to see that the established instability of attention in ADHD makes new neuroplastic learning difficult to say the least, and theproblem can become self sustaining.

I would personally also add that if we are intervening in any psychological disorder it obviously helps if we understand the neurobiology of the problem- or our interventions are likely to be off target.

So the second part of the definition is the"developmental" part.
The questions here are
1) What is the course of optimal human development?
2) What are the potential obstructions to normal human development?
3) How can those of us who have had an obstructed developmental path reestablish our develomental path and "grow out" of our problems?

The issue of normal human development here is really pretty straightforwards.
As infants, we cannot properly regulate even our body temperature, we cannot see or hear properly, we cannot move effectively, we cannot regulate our emotions, and if something goes wrong- all we can do is cry!

Human development then involves developing perceptual skills, motor skills and the skills of emotional and attentional self regulation that will allow us to function as independent adults who can supply our own needs (physical, social and spiritual) and support those around us in doing the same.

An adult who is fully developed will operate in a state of balance -
Autonomic nervous system function will rest at a point of balance between sympathetic and parasympathetic arousal (which is measurable by looking at heart rate variability, and it will be possible for the individual to quickly and automatically switch from a resting state to an arousal state and back again.

The fully developed adult will have full command of attentional skills, being able to hone in and hyperfocus on a critical point or step back to a gestalt attention fluidly and automatically.

The fully developed adult will be able to sleep when needed, and stay alert when needed, and to transition swiftly between the two states.

The fully developed adult will be able to curb over excitement or despondency, and will relate to others with ease.

It is well established that these skills are largely subconscious, and are highly dependent upon right brain function.
It is also well established that right brain function develops in dependence on our relationship with our caregivers as infants- in other words we learn to self regulate and relate by relating to our caregivers, who act "as our frontal lobes" for us, and effectively teach us the skills of self regulation. We learn these skills through imitation- not through didactic instruction. Infants are not ready for didactic instruction.

Again I would refer the reader to Dr Allan Schore's work:
The pdf is titled:
Relational trauma and the developing right brain:the neurobiology of broken attachment bonds.

Neurological development also is a matter of motor control, and here the need for physical movement and play is paramount, as it is in all young animals. Sitting on a couch, watching TV or playing computer games for the bulk of our spare time does not qualify as meeting these needs.

So- what can go wrong with this process?
If we exclude issues like malnourishment, lead poisoning, other forms of toxic injury to the brain, head injury and major brain malformations we have a simple list to consider:

Factors in the parents:
1) ADHD:

The personality traits of people with ADHD are poor self regulation, deficient impulse control, poor differentiation and a constant need to find distractions from distressing mental states. These distractions can be internal, as in tuning out, or external, as in the need to be stimulated by activities, food, other people, or substances.

These traits are not favourable to well attuned parenting that can pick up on distress in an infant and settle it quickly, and even if a good attachment bond is established, the infant is not going to be able to learn good self regulation by mirroring his parents.

2) Excessive stress or fatigue in the parents-- overly long working hours, worry about debt, illness or accident befalling one parent, parental depression.
None of these leaves any of us in a fit state to do anything well.

3) Social structural factors.
Low wage jobs.
Increasing expenses of living.
Unreasonable demands by employers (often backed up with a "do it or lose your job attitude)"
Absence of adequate extended family and community support for parents of young children.

4) Environmental considerations that prevent children from getting enough fresh air, sunshine, vitamin D and exercise.

5) The mistaken idea that you can make children better people by yelling at them or physically abusing them. It is hardly rocket science to note that children will naturally fall into line and be obedient to an empathic teacher.

Then we have factors in the child that may contribute.

Some infants are restless, have lots of colic, won't go to sleep and may resist touch and cuddling.

These infants are hard to parent, and often having an infant like this will create a degree of parental anxiety which will undermine the parent's ability to parent well.

There is one major cause of this last factor that had been largely missed by the mainstream medical profession:

That is minor injury to the junction between the skull and the neck as an acquired birth injury.
I have written about this before, but finally have a good, well referenced source from a conventional medical source.

I will start another thread for that.

I would be interested in the observations of any parents who can think of anything that I have missed from this list of possible disruptions in the attachment relationship.