Turning ADHD on Its Head
Brown says that the brain scan studies are one of the more dramatic pieces of research that are helping to document that there are differences in the way the brain chemistry operates in those with ADHD. However, he is also impressed by the genetic studies that document the degree to which it runs in families. The combined effect of these is that we are dealing with a biologically based disorder that in the past has been looked at as just "bad" behavior.
"The biggest shift in our understanding of this disorder is moving from thinking about it as a disruptive behavior disorder to the recognition that it is an impairment of the executive functions of the brain," says Brown. "Those are the areas that manage and integrate other functions in the brain and involve the ability to organize. It affects a person's ability to get organized and started on tasks."
Hinshaw is cautious about making many decisions based on this one study.
"If we have learned anything, it is that ADHD is a heterogeneous disorder and is still a very low-tech diagnosis based on symptoms," says Hinshaw. "There are undoubtedly people with a genetic vulnerability. There are also undoubtedly others with biological vulnerabilities such as low birth weight."
Both Brown and Wilens agree that ADHD is, in many ways, where depression was a few years ago. The concerns being expressed about using a drug to chemically control behavior are many of the same ones that surfaced when Prozac and other similar antidepressants first came out. Indeed, ADHD is seen by many as a form of behavior that people should just "get over" -- again, much like depression was viewed in the past.
"I think most professionals are past these concerns, and it needs to be put in perspective," says Wilens. "This diagnosis has more genetic backing than any other psychiatric disease at this point. These are arguments that have been leveled against a number of psychiatric disorders in the past and have been proven unfounded."
Many of these advances may help lessen the stigma currently associated with ADHD. They may also lessen the controversy surrounding the use of a controlled substance as the major form of treatment.
"A better physiologic understanding of the disorder, along with clear, objective measures discriminating people with this disorder from those without it, is only going to serve both the consumer and clinician in a favorable way," says Wilens. "Studies that show use of stimulants actually lowers substance abuse in these kids will also help in this regard."
Brown sees in the future an increase in awareness that this is a disorder that not only affects children, but can also be seen in teens and adults. There are indications that both consumers and clinicians are discovering that treatments can be effective at any age. He does see a need to develop better methods to diagnose the disorder in adults instead of using criteria based on studies in children.