Taking Charge of ADHD: Interview with Dr. Russell A. Barkley
Health & Safety

Taking Charge of ADHD: Interview with Dr. Russell A. Barkley

Dr. Russell Barkley, internationally recognized expert on ADHD, and the author of TAKING CHARGE OF ADHD: THE COMPLETE AUTHORITATIVE GUIDE FOR PARENTS, spoke with us about the scientific approach to his research, while clarifying what ADHD is and some of the factors that contribute to a child being diagnosed with it. He also spoke with us about some of the methods and advice he provides parents in his book so they can successfully manage the neurological disorder.

Interview with Russell A. Barkley Ph.D.: The ADHD Doctor

Dr. Russ Barkley PhD - The ADHD Doctor

by Clarke Illmatical

Listen to the Audio Version of this Interview

Based on the information I found, your motivation for writing your book was based on the lack of scientific information within some of the most recent books on the market.

“Yes, trade books. We’re certainly not referring to professional textbooks. Those have been reasonably accurate over the years in representing the science as we know it at the time. The trade books tend to be more with people’s clinical opinions and theoretical musings but not necessarily so much about the science of it. So yes, that’s why I wrote it originally.”

What is the difference between ADHD and ADD?

It started out as the Hyperactive Child Syndrome back in the 60s and even before that it was called Minimal Brain Dysfunction, Brain Injured Child Syndrome, so it’s had a number of names over the last century or more that we’ve seen scientific writing on. The first when there was a discussion in a medical textbook about it.

It’s been ADHD since 1994. ADD is the term was used in the 1980s for the same disorder. What you’re seeing there is that they changed the name. So ADD and ADHD are pretty much much meant to be the same disorder. However, having said that, lately, over the past two years, some practitioners have continued to use the word ADD, to describe a subset of children who only have the attention problems but don’t have a hyperactive and impulsive behavior. That’s sort of a clinical practice that’s not official.

There is no official word ADD anymore. In our diagnostic manual, it’s now ADHD. So it creates a bit of confusion. People are using an outdated term to refer to a subset of children.

It wouldn’t surprise me if you continue to see that term ADD being used in publications or in some books…

One of the things I wanted to make clear, for about 10 years or more, people thought ADHD could be subtyped, due to inattentive only group, called ADHD predominantly inattentive, and then another group that might be predominantly hyperactive and impulsive, they were called MHAD combined type, which is the majority of cases and they had all of the symptoms. And it was felt that might be a useful way of subdividing this disorder. It turned out that after 10 to 20 years of research, that was not useful, ADHD is a single disorder that can vary from any given day and over a child’s development…

We got rid of the subtypes back in 2013 when the DSM5 manual was published. There’s no longer an option for subtyping, it’s just a single disorder called ADHD and you can specific which symptoms may be more prominent on the day the child comes to the clinic but that’s all is really meant to do. There’s no more categorizing or subtyping…”

The disorder causes some children to be hyperactive and impulsive, I’ve found some other information that states that it can also affect a child’s memory. Is this true?

“Yes, you’ve got some children who are namely inattentive and hyperactive, and impulsive. That’s this new group I was mentioning briefly that research is beginning to focus on but there is no diagnostic name for them. I think this is the group that clinicians continue to use the word ADD for.

Researchers call it Sluggish Cognitive Tempo, SCT is the name for it. If you read research papers about this group of children, that’s the term that’s showing up in the journals, but clinicians don’t use it and it’s certainly not a diagnosis in any official manual. It’s a research term to try and capture the nature of these inattentive people who aren’t hyperactive, who aren’t impulsive but can’t concentrate…”

What can cause ADHD? I know that it is hereditary in some instances, but then there are other factors. Could you elaborate on some contributing factors?

“First of all, understand that ADHD is due to multiple causes, so it’s not going to turn out to be just one and it not like there is a contest among them for just being that one.

If we took the disorder and carved it up, it’s about 65% percent or more of the cases of ADHD are inherited. They’re genetic. It runs in the family and other family members… you’re dealing with a strikingly genetic disorder.

In about 25% of the cases, the disorder is acquired by injury to the brain during development. Most of those injuries to brain development are going on during the pregnancy. So you can have a child who hasn’t inherited the disorder, but because of something happening in pregnancy the brain and its development are disrupting and that can lead to this condition. Things that we know contribute to it are things like alcohol intoxication by the mother, smoking during pregnancy, if the mother has mother has multiple infections, it’s likely that some of those have affected the child’s brain development… like flu infections, there’s a chance that some of those infections have resulted in some disturbance in the child’s brain development. In addition to that, you have children who are born premature, if a child is born premature enough that they have to go into a prenatal intensive caring unit, then there’s a much higher risk that the child could have ADHD. The reason is that there’s probably been some injury as a result of the prematurity either from the delivery itself which can be pretty traumatic for that immature brain or just from being exposed to the environment to early, and the brain is not quite ready to develop at that point and encounter that world. Prematurity is another one, an additional one would be the mother taking drugs during the pregnancy, that might lead to malnutrition… it’s possible that the mother’s general health during the pregnancy as you can see is going to be a factor in whether or not there’s additional risk for ADHD. But the big ones are smoking, drinking prematurely and to some extent, other drug use.

Now, you have a small group of children who develop ADHD after they’re born and it’s usually a result of being exposed to something in the environment that is damaging the brain, such as lead poisoning, consuming lead, or the child has head injuries or the child has been exposed to their own infections like meningitis or the child may have had leukemia, and is being treated for their leukemia now, but the treatment also damages the brain, so the child might survive the leukemia, but it’s going to have a pattern of ADHD-like symptoms.

So if you put it in a nutshell, you’ve got 55% - 75% of the disorder is genetic, you’ve got about another 20%-25% that’s prenatal injuries and another 5%-10% that’s after birth. It can be multiple things that are contributing to this…”

There are different types of parenting styles. What effects would a neglectful parenting style have on a child with ADHD? Or what about a parent who uses physical discipline, not realizing that their child has a brain disorder?

I want to make it clear, that parenting styles alone do not contribute as a cause for this disorder, there is no evidence that how you raise a child can turn a child from being normal or typical into ADHD. Having said that, that doesn’t mean that parenting is without any effects.

You have to understand that the differences that we see with parents of children with ADHD arise from two sources, the first is that the ADHD in your child can disrupt the parenting and the family because you’re dealing with a very unregulated, poorly developing, disruptive child and parents are going to respond to that differently and you’ll often find that families of ADHD children have to supervise their children more closely, often have more conflict with their children, often may correct them more often or have to direct them or guide them more often. Maybe less rewarding of the children because there is so much conflict going on. When you see that in a family, that’s the result of that child… that’s how parents would react to an unregulated disruptive individual. With more control, to try to lessen the child’s disruptive behavior. The first contributor to family conflict and disruptive parenting is often the fact that you’ve got a developmentally impaired child whose disruptive.

The second contributor to family conflicts and parenting style is that it least 25% - 35% of the parents of ADHD children have the same disorder. So you have an ADHD adult, raising an ADHD child, the parent’s ADHD is going to disrupt their parenting style, and it’s going to lead them to be less attentive, less likely to supervise, more distracted, more emotional, less organized in their family life, less able to deal with the conflicts that the child is imposing.

Now you’ve got two sources in which ADHD is interfering with family relationships. The first is the child’s disorder, the second is the parent’s disorder, that’s going to make that family situation being worse… what it can lead to is defiance and aggression in the child. Parenting style is related more to oppositional behavior, defiance and aggression than it is to ADHD… “

In your book, chapter 12 is entitled TAKING CHARGE AT HOME, can you share some of the points from that chapter? What will readers learn by reading this book and specifically that chapter?

“There’s a number of things that we go through in the book, both at home and at school.

Some of the first things that parents have to do, is to first of all, accept that their child is developed mentally disabled, in the sense that they have a neurological problem. In other words, the child isn’t doing this to make you angry, it’s not a choice, it’s not willful, you have a child who has a disability. Parents have to reframe the way they think about the disorder. I refer to it in the book in the book as parents needing to change their perspective about why is my child acting this way and they have to accept their child’s diagnosis and accept the fact that it’s largely a biologically caused disorder. The reason we want to do that, the reframing brings more compassion. You’re trying to raise a child who can’t help being the way they are as opposed to blaming the child for their behavior problems… as if that’s a choice that you can get the child to change by punishing them more often. One of the first things we talk about in the book, that you have to do is accept the diagnosis… and understand that you’re raising a disabled child.

The second thing we talk about in the book is getting educated, becoming a scientific parent, we want you to learn as much as you can about your child’s disorder so that you’ll be in a better position to manage it and to understand the available treatments and which ones have scientific evidence, which ones don’t. For instance, we don’t recommend that you go to a chiropractor to have your child’s head massaged, because that’s not going to do any good, you need to educate yourself, about not just the causes and the nature of the disorder but about what treatments have some evidence for their effectiveness.

In the book, we talk about what those treatments are. That’s not just getting educated, but going through the parent training program in which you’re going to learn different ways of managing your child’s disruptive behavior. Of course, there are other medications that I talk about in the book, that are going to be needed for at least three-quarters of the children, are going to require medication in addition to the other things that you’re doing, to try and manage them.

I basically break it down into four pieces, you’ve got to do, you’ve got to get educated, you got to make accommodations in your family life for this child, things will be physically changed in the environment around the child to make it less likely that they’re going to have trouble, with their behavior. Those are things like parents being more organized, and changing the way they ask children to do things and changing the way the kind of work that they ask the children to do. Then of course, is behavior modification, where parents learn to use rewards and sometimes punishments but learn to use rewards like token systems, in order to improve the child’s behavior and then there is the medications.

I refer to it as the four pieces: education, accommodation, modification and medication. You’ve got to be doing those four things if you want to have a more comprehensive approach to management.”

Based on your research have parents been successful using your method and improve their child’s life?

“Yes, there are a number of papers on the value of training parents to manage these children, using the same type of strategies I mentioned in the book. Some of them follow my plans specifically, but my recommendations are part of a larger and more general approached called behavior parent training. So it’s not like mine is something unique or different, it’s part of this larger approach to train parents to use behavior modification with their children.

There is ample evidence to show that it does benefit the child, the family, and the parent. It doesn’t get rid of ADHD, nobody is arguing that it does, what it does, is reduce the conflict in the family and lead to more positive family relationships and makes the child less defiant and less oppositional and the parents report less stress in the family because the child is better behaved.

We certainly don’t promise those parents that by going through a behavior modification training program their child’s ADHD is going to go away, it isn’t. What will go away are the conflicts that you’re having with this child of getting things done.”

For more information about Dr. Barkley, his ADHD research and his books visit: russellbarkley.org

Dr. Russell Barkley on How to Treat ADHD Based on Science

“This is the most treatable disorder that we face. The biggest problem is, most people don’t get treated. 40% of children and 90% of adults with ADHD are not recognized or treated for their disorder. That’s the problem— not that we’re overtreating we are undertreating and we are undertreating the most treatable disorder in psychiatry.”

  • Dr. Russell A Barkley Ph.D.

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