CHAPTER 10
Amanda took her seven-year-old son, Jack, to see her GP one day. She had been getting a lot of reports from his teachers that he had been very disruptive in class, was settling poorly in his work and had been falling behind the rest of the class. One of Jack’s teachers suggested that he might have ADHD and that he should see a doctor to have the situation assessed.
Depending on what part of the world you live in, Attention Deficit and Hyperactivity Disorder (ADHD) is diagnosed in anywhere between 1 in a 1000 and 1 in 10 children—boys more often than girls and in developed countries more than under-developed countries. In parts of the world where it is most common, like some states in the United States, it is probably the product of environment and upbringing, along with a tendency to over-diagnose the condition by attributing many behavioural or domestic problems to ADHD.
Research has shown that parents of children with ADHD have poorer quality family life, less parental warmth and higher depression and anxiety.[1] High parental stress and more inconsistent and hostile parenting are also associated with a greater chance of ADHD in the children. This doesn’t mean that parents whose child has ADHD must be ‘bad parents’ but it may mean that the pressures, stresses and inattentiveness in parents are likely to manifest themselves one way or another in the children, and ADHD may be an increasingly common one. Time-pressured, frazzled and stressed parents may be a symptom of the society we have created for ourselves. It’s all a part of an overheated and overly fast world.
ADHD isn’t just about parenting, though. Research supports the view that a number of chemicals and food additives increase the risk of ADHD, and a healthy whole-food diet reduces the risk. The sometimes necessary but largely superficial response to the problem is to put an increasing number of children on amphetamine-like drugs, rather than address the underlying issues.
What we call ADHD may in fact be just the tip of a very large iceberg. Underneath the bit of the iceberg above the waterline where we see and name ADHD is a much larger bit pushing it up—that is, the whole community. It would seem that we have created for ourselves a world that is conditioning us to have shorter and shorter attention spans and leave many of our children vulnerable to attention-related problems. IT, media, upbringing, genes, lifestyle and environment all play a part, but more of that later.
An article from the Harvard Business Review coined the term Attention Deficit Trait (ADT).[2] ADT—the tendency to have an attention that is constantly flitting—is a newly recognised neurological phenomenon and is a response to a hyperkinetic environment. Hyperkinetic is a way of saying highly paced, frenetic activity or, in more colloquial terms, everyone running around like chickens with their heads cut off. Put up your hand if your workplace is like this. Now put it down again because everyone around you is probably thinking you’re a little strange for sitting there with your hand in the air.
The modern work and home environment is not only too fast-paced for too much of the time, but within it we are generally trying to deal with too much sensory and mental input. ADT can be controlled by engineering the environment and by taking greater consideration of our emotional and physical health. Suggestions by workplace experts include a range of strategies outlined in Chapter 19 on the workplace.
Working memory is another term for short-term memory, which is our immediate memory of what’s happening currently. It’s like the information on the desktop of our computer that we’re working with at any given time. A more technical description is the ‘structures and processes used for temporarily storing and manipulating information’.[3]
The specific part of the brain responsible for working memory is largely the prefrontal cortex—the bit of the brain behind our forehead. It is, as has already been said, the area of the brain most involved in paying attention. It’s well known that ADHD is associated with impairment of the areas of the brain involved in and activated by attention regulation, and this is why improving working memory helps to increase IQ and treat ADHD at the same time. It also explains why, even for people without ADHD, we perform more poorly—say, in exams—when under stress. A reduced working memory capacity leads to a pronounced increase in reaction time and errors.[4] If performance pressure harms our ability to succeed by harming our working memory capacity, one can only imagine what effect it has on a well-intentioned child trying to perform under the gaze of a well-intentioned adult putting pressure on the child to get the right results.
Excess television has a negative effect on our capacity to pay attention, particularly for developing brains that need the direct engagement of the senses with the physical world to establish the connections they will need. Watching football on television, for example, is a totally different experience to playing it. Watching it requires no skill, creativity or engagement, whereas playing it demands attention. Children who watch higher levels of television by the age of three are significantly more likely to display attention problems at the age of 7,[5] let alone the higher risk of sleep problems and obesity. We were not evolved to live our life vicariously through a screen, even if it’s a 52-inch LCD screen.
How much TV is too much? Most experts recommend no more than two hours a day of ‘screen time’ (television and computer time) for a child. With the average child in a developed country now having four hours of screen time a day, we have gone a little too far, but it’s not an easy thing for time-poor and exhausted parents to find the time to spend with their children on other activities.
Other forms of media such as music can also have both positive and negative effects on a child’s development and behaviour. Very fast-paced or aggressive music can produce more fast-paced and aggressive children—it’s like we’re winding up their little springs from an early age.
Whether or not we’re aware of it, the kind of leisure activities we engage in have an effect on our state of attention and therefore our memory and performance. Passive leisure activities that lull us into a state of inattentiveness are not helpful. Number one among passive leisure activities is TV watching. Whether it causes dementia is a very hard question to answer definitively.[6] Just as not using our muscles leads to us not developing them in the first place, or their wasting away, not engaging attention means that capacity wastes away.
Alzheimer’s Disease (AD) is also associated with problems with the prefrontal cortex and memory centre of the brain. According to research on the long-term effect of television viewing on the brain: ‘For each additional daily hour of middle-adulthood television viewing the associated risk of AD development increased 1.3 times. Participation in intellectually stimulating activities and social activities reduced the associated risk of developing AD.’[7] Those who have less than average diversity in leisure activities, spend less time on them and practise more passive activities (principally watching television) were nearly four times as likely to develop dementia over a 40-year follow-up compared to those who rated higher than average on these factors.[8]
Then to all of the above we add Information Technology (IT). This is probably the main source of multitasking. Multitasking is probably something of an illusion or misnomer. What we’re actually doing when we seem to be multitasking is task-switching. Computers can multitask; we can’t. Switching attention happens so fast that it appears we are performing multiple tasks at the same time, when in reality we’re switching back and forth between tasks.[9] Dr Clifford Nass from Stanford University had this to say about the performance levels of extreme multitaskers:
It’s not just kids who have problems with all this stuff. According to research, adult workers distracted by email and phone calls suffer a fall in IQ more than twice that found in someone smoking marijuana.[11] In other research, an increase in the amount of time university students spent instant messaging had the effect of increasing their level of distractibility in performing academic tasks, whereas the amount of time spent reading books reduced the levels of distractibility.[12] Russell Poldrack from UCLA concludes:
The illusion is that we can do many things at once. Well, yes we can but we just can’t do them as well as we think we can, although the reduction in our level of focus and performance isn’t apparent to us. Simple multitasking, such as walking and talking at the same time, may be fine, but complex multitasking isn’t such a good thing. Complex multitasking is where we are doing two things at once, both of which require a little more intellectual grunt, like driving a car and talking on a mobile phone at the same time. As has been previously mentioned, within 5 minutes of using a mobile phone while driving we are more than four times as likely to have a motor vehicle accident.[14] Although our aim in multitasking is to not miss anything, to have a fuller life and to be more productive, the reality behind the illusion is that all we get as a result of this habit is continuous over-stimulation, distractibility and a lack of fulfilment.[15] We actually become less efficient in task-switching, not better at it.[16]
Much of the above is the negative side of the coin. The positive side of the coin is not to believe that there’s nothing we can do about ADHD. Apart from having an expert assessment from a suitably trained health practitioner and considering what treatments might or might not be indicated, there is a lot more we can do.
In relation to mindfulness and meditation practices, it’s not surprising that meditation, which is attention training after all, improves attention in children and is therapeutic for ADHD—according to reviews of the research in the field.[17] Meditation helps to stabilise the areas of the brain, such as the frontal lobe, that are involved with attention and working memory. Although more and larger studies are needed, it looks as though meditation is probably as effective as the drug treatments for ADHD, but with positive side effects.[18] Meditation doesn’t just help children to pay attention better; it also helps to develop their ability to be less impulsive. That little window of opportunity as far as choosing whether to act impulsively, or even to act at all, opens wider the more we practise paying attention.
Obviously, despite the potential role of meditation, it will still be important for a child with significant attention or behavioural issues to be assessed by a suitably trained health professional. In some cases it may still be necessary for a child to use medications in the short- to mid-term and to use other strategies along with attention training.
Managing ADHD is as much about parents learning and setting an example at home as it is about the child learning new skills. A patient and loving hand will be needed because making a child feel stressed over their inattentiveness will make the problem worse.
Jack was assessed by a paediatrician, who confirmed ADHD. Between Amanda, her husband Colin and the paediatrician they decided that the problem wasn’t severe enough to warrant medications. They were given some advice along the lines mentioned above, which they put into practice. Amanda and Colin got as much out of it as Jack did.
Not so helpful
• Watch TV for many hours at a stretch while also working on your computer and trying to relate to your family.
Helpful
• Be a positive role model (but if we can’t be an example then at least we can be a warning!). As adults we need to be more self-aware, more able to self-regulate and more able to live attentively. There’s no point in telling a child one thing and then doing the opposite. The child will learn from what we do rather than what we say. Avoid complex multitasking. Gently encourage your child to attend to one thing at a time and to slow down. This includes managing the environment and IT usage—switching off the mobile phone, working on one activity at a time, reducing unnecessary stimuli and interruptions.
• Engage interest, not anxiety. The most compelling thing for the attention is interest and fascination. Making a child anxious about paying attention will worsen the problem, not relieve it.
• Practise performing one task at a time. Begin with priority one and do one thing at a time until it’s time to move on to something else. Take breaks when needed and provide variety both in what you do and how you do it.
• Practise mindfulness (attention regulation). Practise mindfulness meditation and mindful activities—that is, activities that require attention. Start with a few minutes and then gently increase the time when you are acquainted with the practice. Make it light by not forcing it on your child.
• Optimise the environment. Avoid fast-paced or aggressive music, gaming or other media such as films. Have soothing or slower tempo music in the background while your child is playing.
• Limit screen time. Limit leisure screen time (TV, computer and gaming) to no more than 2 hours a day on average.
• Engage in regular physical exercise and sports. This can be a great way to work off energy and engage attention in a healthy way, and is especially good when your child is interacting with other children in team games. Choose physical activities that your child enjoys.
• Eat a healthy whole-food diet. Give your child a healthy diet, including things like omega-3 fatty acids. Avoid food additives and colourings.
• Look after ourselves. We should all practise all of the above ourselves so that we’re coping as best we can and also so that we’re part of the solution and not part of the problem. Above all, be patient.