Executive Functions Model Part 3 – Ruination

On his web page, Russell A. Barkley, Ph.D., is described as an internationally recognized authority on attention deficit hyperactivity disorder (ADHD) in children and adults. Dr. Barkley has specialized in ADHD for more than 30 years and is currently a Clinical Professor of Psychiatry at the Medical University of South Carolina.

In 1997 when Barkley first presented a variation on Strang and Rourke’s 1983 Executive Functions model to explain ADHD, Barkely chose to incorporate into his model the existing body of literature of brain function, and to emphasize the similarity between symptoms of pseudopsychopathy (right frontal lobe damage – remember our story about Phineas Gage in Part 1?) and ADHD.

The right-frontal-lobe brain damaged individual has been shown to experience increases in motor activity, talkativeness, and a lack of tact and restraint; symptoms commonly associated with ADHD. Animals with frontal lobe damage cannot adapt to new situations or environments, while humans with such lesions similarly experience extreme difficulties in situations requiring problem solving and unique solutions.

Because he only focuses on similarity of symptoms and because he assumes ADHD to be synonymous with this type of brain damage, Barkley concluded, rather amateurishly and incorrectly, that persons with ADHD are also less capable of creative thought, and stated this hypothesis concerning ADHD and creativity explicitly in several of his writings.

Boy, is that such an obvious gaffe, and yet he still promotes the idea!

As an aside, the Executive Functions model Barkley chose to modify (Strang and Rourke’s 1983 Executive Functions model) was being applied to problems in the relatively new field of NLVD (non-verbal learning disorder) which attempts to identify the neurocognitive, psychosocial and adaptive characteristics of children with learning disabilities, whatever the cause. Strang and Rourke never mentioned anything related to “AD/HD” from what I have read.

So, back to Barkley: About a year after presenting his model for the expressly stated purpose of “explaining ADHD”, Barkley announces the discovery of the polymorphic DRD4 receptor gene and describes his version of the executive functions – presenting both in the September, 1998 edition of Scientific American magazine:

Russell Barkley states that the Executive Functions can be grouped as a set of 4 mental activities:

1) Working memory: Holding information in mind while working on a task, even after the original stimulus is gone. Said to be crucial to timeliness and goal-directed behavior. Also provides the means for hindsight, forethought, preparation and the ability to imitate the novel behavior of others.

2) Internalizing self-directed speech. Said to allow one to reflect to oneself, to follow rules and instructions, to use self-questioning as a form of problem solving and to construct “meta-rules”, the basis for understanding rules about rules – all quickly without tipping one’s hand to others. The idea is to make this self-talk private, preventing others from knowing one’s thoughts.

3) Controlling emotions, motivation and state of arousal. Said to help individuals achieve goals by delaying or altering potentially distracting emotional reactions to a particular event and to generate private emotions and motivations. Those who rein in their immediate passions can behave in more socially accepted ways.

4) Reconstitution. Said to encompass two separate processes: breaking down observed behaviors and combining the parts into new actions not previously learned from experience. Said to give humans a great degree of fluency, flexibility and creativity and allows them to propel themselves toward a goal without having to learn all the steps by rote. Also said to permit children, as they mature, to direct their behavior across increasingly longer intervals by combining behaviors into ever longer chains to attain a goal.

Barkley states the essence of his ADHD model thusly:

“In the early years [In all children], the executive functions are performed externally: children might talk out loud to themselves while remembering a task or puzzling out a problem. As children mature, they internalize, or make private, such executive functions, which prevents others from knowing their thoughts. Children with ADHD, in contrast, seem to lack the restraint to inhibit the public performance of these executive functions.”

…and he states it again:

All 4 Executive functions become internalized during typical neural development in childhood. As normal children grow and develop, they develop the capacity to behave covertly, to mask some of their behaviors or feelings from others. Either through faulty genetics or embryonic development, ADHD children have not attained these covert abilities and therefore display too much public behavior and speech.

The first three things I noticed is 1) the obvious value judgment: “too much public behavior and speech”. How much is too much and who gets to decide and why? 2) the high value that is placed on covert thought and emotion as if the mere expressing of one’s living thoughts and feelings were a criminal offense; and 3) how the focus of this model is obviously on reinforcing the concept of social conformity – the mistaken view that the most important thing is to be approved of by one’s peers and to avoid their punishments.

The same overt justifications can be found in his description of Ritalin’s “benefits”. Here it is in his own words:

“…they tend to be liked better by other children and to experience less punishment for their actions, which improves their self-image.”

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Conclusion?

In my opinion, it’s a very unhappy camper who can abuse a position of trust as a psychiatrist by first, attempting to demolish an individual’s self-esteem –  teaching them that they were born ‘defective’ and that what they must do is to take pills to be ‘acceptable’. Then, to improve the self-esteem he devastates, he reassures them that all they must do is whatever it takes to get people to like them and to not want to punish them.

Perhaps he just feels a bit guilty concerning the rumors of being paid by Novartis (maker of Ritalin), never mind the devastating effects of psycho-stimulants on so many innocent, bright, creative and loving kids.

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Thom Hartmann commentary:
Thom Hartmann states the he and his son is diagnosed ADHD. He’s a prolific author on ADHD and the inventor of the  Hunter vs. farmer theory of the condition.Hartmann (with co-author Vaudree Lavallee) has this to say about Barkley’s doings:
If brain damage research had been used to build the Hunter/Farmer hypothesis, “ADD: A Different Perception” may have explored the difficulties associated with being a right-frontal-lobe-damaged individual in a world taken over by people with left-frontal-lobe-damage.
Described in non-disorder (difference) terms, left-frontal-lobe-damaged “Farmers” could be seen as objective (rather than indifferent), exerting emotional self-control (rather than showing little overt emotion), able to show enough self-regulation to remain silent (rather than showing little or no verbal output), and speaking only when spoken to (rather than failure to initiate conversations).
However, this silly analogy was never used in “ADD: A Different Perception,” or any subsequent Thom Hartmann book or article for that matter, because Hunters are not right-frontal-lobe brain damaged persons, and Farmers are not left-frontal-lobe brain damaged persons: each are, instead, two end-points on a continuum of human variability.
To understand the role of brain pathology research in validating the Executive Functions model, we need to first determine what the Executive Functions model would look like without reference to brain damage.
The Executive Functions model would still compare the more liberal and flamboyant ADHDers unfavorably to the more conservative and restrained “statistical norm.” Americas “brick” factory-like schoolhouses would still be seen as the epitome of human civilization and accomplishment. And, like Phillip Rushton, the Executive Functions model would still see a negative correlation between IQ and promiscuity.
In summary, we would still have an ethnocentric (almost Aryan) commentary of genetic endowment differences.
Without these highly questionable (and, in the opinion of these authors, outright flawed) ideological underpinnings, however, what remains of the Executive Functions model is simply a theory of individual variation.
The Executive Functions model tends to focus on post base-line variation in human response to environmental stimulation while ignoring important differences in how such stimulation may initially be experienced by the individual.
We agree that after controlling for base-line differences between Hunters and Farmers, there may be important executive function differences among Hunters and among Farmers. Additionally, these “executive function” differences may turn out to be one among the many variables which help determine whether ADHD will produce an entrepreneurial success or a chronic criminal.
As the Hunter/Farmer hypothesis predicts, there are base-line differences in the ways individual Hunters and Farmers each experience and cope with depression, boredom, frustration and joy. However, these base-line differences do not fully explain why one Hunter (or Farmer for that matter) may or may not experience depression at a dysfunctional level.
Instead, the Hunter/Farmer hypothesis suggests that it’s the driving need or hunger for aliveness which animates most ADHD/ADD behaviors, and executive function is only a small (but significant) variable that determines how this need or hunger is satisfied (through socially adaptive means, such as a high-stimulation job in an emergency room, or socially maladaptive means like becoming a barroom brawler).
Seen in this light, Barkley’s so called executive system may be nothing more than a fight or flight response mechanism, acting like a rubber band that exerts its influence at both ends of the ADHD continuum. Evidence which indicates that having a “happy temperament” as an infant is associated with improved prognosis for Hunters while some environmental factors, such as having experienced abuse, are associated with negative life chances lends support to the prospect that the Executive Functions model is a theory of within-Hunter variation rather than of Hunter/Farmer differences.
To recapitulate, if one were to divide the population into groups based on individual differences in tolerance of (or desire for) novelty, the individuals in each group would still vary in both their tolerance of and their exposure to adversity or stress.
Theoretically, those in each group whose threshold for stress has been exceeded may exhibit many of the cognitive difficulties associated with the so-called executive functions.
From: ADHD – disorder or difference?, Thom Hartmann & Vaudree Lavallee
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Notes on NLVD:
Principles of neuropsychology, By Eric Zillmer, Mary Spiers, William C. Culbertson, 2008-2001, Thompson-Wadsworth, p. 305-309NLVD non-verbal learning disorder attempts to identify the neurocognitive, psychosocial and adaptive characteristics of children with learning disabilities. His investigations have led him to make two subtypes: R-S for reading and spelling disability and NLVD.
Rourke (1993) considers that NLVD reflects right-hemisphere (particularly posterior) damage, or dysfunction, whereas R-S deficits more closely reflect problems in the left, language-dominant hemisphere system.Also:
Nonverbal learning disabilities represent a discrete and separate diagnostic entity. However, some of the symptoms identified are similar to those described for other disorders.
Individuals with right hemisphere dysfunction (Semrud-Clikeman & Hynd, 1990; Weintraub & Mesulam, 1983), Asperger’s syndrome (Klin, Sparrow, Volkmar, Cicchetti, & Rourke, 1995; Semrud-Clikeman & Hynd, 1990; Wing, 1981), and “central processing disorders” (Rourke, 1982) each possess a number of symptoms that overlap with those seen in NVLD. Nevertheless, these disorders can be differentiated through proper assessment.
The Syndrome of Nonverbal Learning Disabilities:
Clinical Description and Applied Aspects Michael A. Roman
The University of Texas
http://www.nldline.com/michaelr.htm
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About L-bo

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