ADHD Seminar Notes
Dr. Barkley's ADHD Seminar Notes
Dr. Russell Barkley, widely considered to be the leading research
psychologist working on ADHD, is Director of Psychology and Professor of
Psychiatry and Neurology at the University of Massachusetts Medical
Center. He has authored several books on attention deficit disorder,
including the classic 'Attention Deficit Hyperactivity Disorder: A
Handbook for Diagnosis and Treatment.' The following notes are from a
seminar Barkley presented in Cleveland on 29 April 1994. The seminar was
sponsored by the Institute for Adult Development and the Institute for
Child & Adolescent Wellness in Beachwood, Ohio.
While compiling these notes, the liberty was taken of replacing such
terms as 'normal' with 'average'. For while ADD certainly impairs the
ability of people to function with expected efficiency at certain tasks
in industrialized societies, it is not to be seen merely as a disorder.
Lets not minimize ADD, but lets not pathologize it either. Indeed, many
psychologists now speak of ADD as an outlier in the spectrum of human
neurological variation, and therefore little different from other
genetically-determined human traits like hair or eye color, height,
intelligence, etc. As Thom Hartmann and Ned Hallowell have advocated,
ADD should be seen as much as a gift, and indeed many people with ADD
have high intelligence, whether inborn or acquired as a compensating
response necessary to function in a complex society. While much of
Barkley's presentation was oriented toward ADD children, the extensions
to adult ADD are in most cases straightforward. Note that one does not
necessarily have to agree with all of Barkley's views, (especially with
regard to a single cause underlying all ADHD) in order to gain useful
information from this essay.
The notes below, were not taken from any recording. Notes may be
redistributed only if the above commentary is included.
Russell Barkley seminar on ADHD
Calling ADHD an attention disorder trivializes it; it is not an attention
deficit. Barkley is working on a new theory to explain the psychobiology
beneath the spectrum of symptoms usually considered to be part of the ADD
syndrome. All of these symptoms are observed in 'normal' people at one
time or another - they differ in people with ADHD by reason of their
presence since childhood, their persistence beyond childhood, and their
ADD has in the past been termed post-encephalitic behavioral disorder,
brain-injured child disorder, and minimal brain disorder. The hallmark
triad of symptoms are:
- inattention or inconsistent attention,
Barkley says that ADD has more to do with lost interest than with an
inability to concentrate. He estimates that ADD affects 2 million
children in the USA, with the condition persisting into adulthood in
chronic form in over 50% of these. Boys are affected at three times the
rate. ADD crosses all social barriers, and is present is all ethnic
groups and social classes.
Barkley says that it is misleading to speak of three primary
characteristics of ADD. Might a single underlying cause account for the
wide range of characteristic behaviors? He believes so, and points to
persistence of effort as the cornerstone of ADD. Some think ADD arises
from a faulty 'filtering' mechanism, but this is not the case - it has to
do with motivation. As a result, telling children or adults to try
harder is futile and should be stopped - rather, the interest of the
curriculum (or job, etc.) should be increased to keep ADD children
interested and motivated.
ADD is not an attention disorder, but a disorder of impulse control. ADD
children do things other kids think of, but don't actually do. The urge
to act is not being inhibited. The first response is the immediate
response. People with ADD have trouble resisting the attractiveness of
things other than that immediately before them. The observed
hyperactivity is not independent from, but born of, the impulse control
problem. To be ADD is to be hyper-responsive, not hyperactive. Failure
to inhibit is at the core of the problem.
ADD has an early onset. 95% are identified by age 7; the mean is age 4.
By this time, 'normal' children are learning self-control. All young
children are impulsive, but they eventually learn control. 20-30%
outgrow the condition. >60% (Barkley thinks it to be 75%) carry the
condition in some form into adulthood.
ADD children act better in a one to one setting than in groups. They
behave better in the presence of fathers than mothers. This is also
observed in other children. Barkley thinks that in the mind of the
child, the person (parent) who talks loses, the one who acts wins.
Mothers tend to talk; fathers tend to act. He suggests that you not try
to reason with your children in every situation - ADD is not a failure of
reason, neither is it a failure of knowledge.
For the person with ADD, novelty is a reward. They do well with a rich
schedule of feedback. Barkley calls them 'little Ed Kochs', for the New
York City mayor known for asking 'How'm I doing?'. Tell them how they
are doing - they want immediate feedback, for they operate on the level
of immediate vs. delayed consequences/rewards. Education is delayed
gratification; they want what feels good now. Those with ADD generally
do better in the morning (even those who are not 'morning people' find it
easier to function more close to normal in the morning). Therefore, give
them the hard work in the morning, and give them something fun to do
later. Its important to realize that symptoms are dependent on the
environment; one is not going to see all the problems under all
The scientist/philosopher Jacob Bronowski wrote in 'The Ascent of Man'
that the most crucial event in the evolution of the human species was the
appearance of the ability to wait - a trait crucial for human function.
Barkley sees four aspects to this ability to wait.
1. A sense of time
The human mind can keep an event in short-term memory. The mind can
freeze time by holding on to an event which has passed. Barkley's theory
of the neuropsychology of ADD predicts that people with ADD will have
poorer short-term memory than average individuals. If you can hold
something in short-term memory you can analyze it. This ability is
crucial for mental calculations, analysis, reflection. Humans can use
their minds as time machines, as vehicles in which to travel between the
present, past and future. Other animals cannot sustain an image in their
minds. We call the ability to refer back and forth between past and
present hindsight. If however, you don't wait, you don't reflect, and
therefore cannot benefit as well from the wisdom of hindsight.
We are the only species in the fourth dimension: time. This sense
develops between 7 and 8 years of age. Conversation at this age begins
to deal with anticipation, forethought, planning. Other kinds learn to
ignore stimuli which may distract from the task at hand. In contrast,
the ADD child doesn't respond until the event crosses their window. They
don't respond until hit by the train of time. They don't deal with
things until necessary.
Once you learn to wait, you can stop an emotional response while you
examine it. This is emotion vs. objectivity. I you don't wait, you will
continue to be emotional, and will have difficulty separating emotion
from objectivity. It's facts vs. feelings. Those with ADD are more
emotional over the entire spectrum, from happy to sad; they feel their
emotions more intensely than average people.
Objectivity is required to serve goal-directed behavior. Perspicacity is
the kindling of motivation. Motivation is an emotion. The normal
attitude with an unpleasant task is that you 'stick with it', as there is
a reward at the end. In ADD, the reward must be in the task itself, not
after it. Most children can kindle motivation, the ADD child has to find
it in what he is doing at the time - he has trouble kindling motivation
to do an unpleasant task.
Humans can turn language on themselves. We call it reflection, and its
the bedrock of self-control. Internalized language develops at 3-4 years
of age; it is therefore no surprise that ADD is typically first noticed
at this age. Speech becomes a means for self-control. You can talk to
yourself in order to control yourself. This predicts disorganized
internal speech in those with ADD. This was actually seen in research
done 10 years ago, but it was ignored because it didn't fit into the
The prediction is that those with ADD will seem younger than their
chronological age; they will seem more child-like than their non-ADD
peers. That is why ADD children are so 'chatty' and why much of their
conversation deals with the present, and not the future.
The ability to hold a thought allows you to take it apart and reassemble
it in new ways, leading to the observation of new relationships which
were not apparent before. We can take nature apart and put it back
together as we please. This has several consequences.
- We can progressively redistribute parts of a thought for use in
- We can reassemble the parts into new messages and events (creativity)
- This is the seed of verbal fluency
- This leads to a unique world view
It is harder for ADD children to explain things. They don't get to the
point: they talk around the point.
Note that ADD children and adults are not lacking the four aspects of the
ability to wait - they are in there, but we often cant see their
consequences. Put a child on the proper medication and all four aspects
of the ability to wait return - it was there all along. People with ADD
do not lack the ability to wait, they have difficulty drawing upon it.
What are the purposes of the aspects of the ability to wait?
ADD is a disorder of response inhibition and executive function, of the
ability to wait. This predicts that those with ADD will be:
- They are related to self-control. Average children are self-
regulated, yet they are more free than the ADD child, who being more
dependent on his environment, actually operates on the basis of less free
- They are required for the organization of behavior across the span of
- They direct behavior toward the future rather than the present.
- They are aimed at the maximization of future consequences.
- They allow increased prediction and control of the environment
(rather than just reaction to the environment)
- They permit us to conform the environment to our goals.
- deficient in self-regulation,
- impaired in organizing their behavior toward the future, and
- diminished in social effectiveness and adaptation.
Evaluation of suggested causes
- There are some psychosocial theories (not widely accepted).
- Underactivity in the forebrain (the classic Zametkin studies), i.e.,
reduced circulation in the prefrontal lobe and striatum, but this may be
a consequence rather than a cause of the ADD. The areas affected are
thought to be involved in response, attention and sensitivity to reward.
- Food/diet. That sugar is somehow involved is part of the folklore.
Co-morbidities: Defiance, oppositional behavior, argumentative. 20-30%
have learning disabilities, 30% have delayed motor skill development.
Heredity is the best explanation of the facts. 25% of fathers and 17-25%
of mothers have the condition. There is a 40% chance that one of the
parents has ADD. A 35% chance that one other child in the family has it.
A 95% chance that a twin will have it. Can have multiple causes: anything
affecting frontal lobe development, including smoking and drinking during
pregnancy, but most overwhelming majority of cases due to inheritance.
The neurochemical balances which lead to the syndrome of symptoms we call
ADD should not be seen only as a pathology, but a genetic characteristic
like height, weight, and intelligence, which can have outliers.
Variations in height and weight are accepted are seen as natural until we
see someone who is extremely tall, short, large or thin. People with ADD
are 'neurochemical outliers' who are more easily noticed in western
With adolescents and young adults the absolute level of symptoms declines
relative to childhood, but 70-80% are fully ADD. The brain is not fully
formed until the late 20's or early 30's. Barkley suggests that while
people with ADD continues to improve with age, their level of self-
regulatory behaviors is 30% below that of their non-ADD peers. As a
guideline he suggests that one subtract 30% from someone's chronological
age to get an estimate of their self-regulatory behavioral maturity. As
a result, Barkley recommends breaking down assignments into manageable
ADD teens have four times the auto accidents when they start driving. He
says that using the guideline above, 16 year olds have the self-
regulatory behavioral maturity of 12 year olds, which suggests one delay
their driver training. [ I don't know whether this applies to
successfully medicated 16 year olds as well ]. The above information is
not meant to stigmatize these children, but to better help them. 35%
never finish high school.
Adults with ADD suffer from poor school/work performance related to
- deficient sustained attention, reading, paperwork, etc.
- easily bored by tedious material
- poor organization, planning, anticipation
- procrastination until deadlines imminent
- trouble working in confined spaces
- grabbing opportunity
- impulsive decision making style
- cannot work well independently
- don't listen to directions
- frequent impulsive job changes
- often demoralized
- putting aside things for now
On the positive side:
- sometimes people worry over nothing
- people sometimes conjecture a future which never happens
Sometimes the gut response is the best response. People with ADD are
often passionate in a world lacking in passion. They experience a wider
bandwidth of the spectrum of emotions - including anger and love. Many
people appreciate the arts because they bring back emotion that's been
lost. Perhaps talking to yourself all the time isn't good. You can
incubate fear and negative emotion from too much self-talk. Some people
are very successful because they take risks.
On diet fads:
- Megavitamins/orthomolecular stuff (kid's lives are not ready for this)
- Sensory integration therapy (not developed for ADD)
- Chiropractic (utter nonsense)
Take home lesson: don't extend anything beyond what it was meant for.
On other therapies:
- Ocular/auditory exercises (ridiculous)
- EMG biofeedback/relaxation (muscular biofeedback) and neurofeedback
(costs $3-6 k/yr results are not lasting)
- Cognitive therapy (not always best as ADD is not a skill or knowledge
ADD is a problem of doing what you know to do. Time is not given for
common sense one has to emerge. What we want for people with ADD is for
them to perform what they already know. The hope is that they will be
able to do it with less prompting/reward necessary. The self-control is
in there, but it's difficult to call upon it. a person has to be ready
for treatment. 1988-90: Church of Scientology launches its campaign
against Ritalin, which Barkley calls 'safer than aspirin.'
Teach compensating skills - long term therapy is not usually necessary.
How to be an effective ADD parent or ADD adult:
- Become an executive. Do not abdicate responsibility. Professionals
can help but you have to make the final call. Stay informed so you can
call the shots.
- Be scientific. Read widely to discover the truth in a world of fad
therapies. Truth has several characteristics. Truth emerges from
available information. Truth converges from many sources. Experiment.
Maybe this and that will work. Don't get stuck. Don't think that this
medicine has to work this or that way.
- Be principled - centered. When you act, follow the rules - don't be
reactive. The '7 Habits of Highly Effective People' work well with ADD:
- Be proactive - take charge and stop whining. Cut the crap. Go ahead
and grieve, but get through it and accept things as they are. Grief
should lead to acceptance. You can then go about changing things
- Begin with the end in mind. Think about your funeral - what would you
like them to say? This is an excellent idea for any situation. How do
you want this to turn out? Keep that in mind and it will help you
persevere. If you see the end you will know what to do.
- Put first things first. You cant do it all at once. Prioritize. Is
having your kid make his bed all that important? Making a bed is not a
great predictor of success - tidiness is not all that important; spending
quality time with your family is.
- Think win/win. What will they get out of this? Make sure the person
you interact with feels they have won something.
- First understand, then be understood. What is on their mind? Listen,
then take your perspective into account.
- Synergize. More gets done when working together - how can you both
get things done together?
- Find renewal. Look for sources of satisfaction, note them, and return
to them on occasion. Your kids don't need or want you to be a martyr.
ADD people don't like being around martyrs. So take care of yourself and
Above notes compiled and edited by Dan Diaz (BL275@cleveland.freenet.edu)
Modified January 9, 2003