"Diagnosis" once included an etiology, a core symptom complex, a treatment, and a prognosis. ADHD almost meets those standards; still there are some troubling inconsistencies with this as perhaps with other psychiatric diagnoses. "Sustained Attention" varies sharply with the nature of a task, a variability that is not sufficiently explained by the concept of a task being "interesting." Psych Adaptations promises both to explain the variability as well as boosting our current diagnostic power.
There appear to be significant differences between individual members of a culture in the extent to which each member expresses specific Psychological Adaptations. Indeed, one major benefit to forming alliances is to assure the balancing of individual differences so that a member who is a poor hunter but a skilled builder will not starve. Females and males form alliances; the two sexes appear to differ in a range of psychological adaptations for getting food, handling relationships, and for child rearing. Each appears to have a better chance for survival because of their partnership.
ADHD is moving (rapidly, I hope!) from the "watch them fidget" and "ask the teacher" models. Barkley's formulation (1997) offers the promise of a "within office" assessment of ADHD as well as an incredibly rich domain of relevant questions to ask about a particular client. That is, what is his skill with retrieving ideas and words, what is his planning ability, are the impairments in his sense of time and his self concept, is his emotional regulation impaired, and does he have a limited ability to analyze events and to develop alternative behavior strategies for solving problems? It will take a few years, but only a few, for these ideas to alter our diagnostic practices for the better.
We have yet to address the interaction of ADHD with Psychological Adaptations. My suspicion is that the Executive Functions will not be globally impaired; instead, deficits may vary sharply with the skill area (Psych Adaptation) under consideration. For example:
a) Dora is superb with child care and geographical directions. She does not need to recheck recipes when cooking. Yet, her ADHD is blatant in school situations.
b) George is skilled with animal care and engine repair. He meets all of the social and academic expectations for severe ADHD and mild ODD.
c) Martha has 3 children by 3 different fathers; she approaches even pubescent male standards for ADHD. Yet, she excels with personnel work, keeping track of office politics, and organizing family gatherings.
d) Kate is 62 and also exceed pubescent male standards for ADHD (1) She's a sterling gardener as is her 35 yo daughter who also has ADHD. Kate works in nursing where her concerns for safety keep her aroused and alert for patient harm; her daughter works in the plant business and does exceedingly well when dealing with plants rather than coworkers and papers.
e) Josie has pervasive traits of LD in conjunction with impulse and mood problems. She has to study with ear plugs because of noise sensitivity. Her ADHD errors have had pervasive impact on her career and social choices. Yet, she is a town "yenta," knowing the family tree for most of our 5000 residents, the names of all children, the divorces, separations, and affairs, and even the automobiles driven by each of us. People seem to "tell her everything," and she appears to forget nothing.
f) Jeanne (40 yo) exhibits many of the chaotic elements in her life that are thought to be a part of ADHD. Yet, she is a skilled animal breeder and talented with a variety of folk crafts. She will also spend hours in the rain, arranging rocks around her plants.
I hope as we move towards greater sophistication, we will assess our clients by Psychological Adaptations rather than by global estimates of Executive failures or attention lapses in school. (2) Such assessment should help our clients find arenas wherein they can "be themselves" in accord with Brian Goodwin's wise suggestion that evolution (life) is about finding a place to be yourself.
Barkley R (1997) ADHD and the Nature of Self Control. NY: Guilford.
1) ADHD standards are sometimes adjusted so that girls are compared with girls of the same age and adults are compared with adults of the same age and sex. According to some data, a 40 year old with as few as 3 of the inattention traits differs significantly from his peers.
2) A Psychological Adaptation Inventory is available for $2 (my cost) from email@example.com. It incorporates information about parents and grandparents as well.