Move 5: Interview with Dr. Russell A. Barkley
The following interview of Dr. Barkley, an expert in the field of clinical child psychology, was conducted via email. Although Barkley stated that, “I will be brief in replying to these questions as some could warrant entire essays”*, his responses have proven to be very informative and useful in moving my Capstone project forward.
What prompted you to work with ADHD/ADD and with children specifically?
My mentor at UNC Chapel Hill was studying hyperactive (now ADHD) children. I loved the research and especially appreciated his fatherly advice and guidance. The more I read the more I was fascinated by this disorder, especially since it interfered with the development of self-control. I was also fascinated by what was going wrong in development to produce this condition and what it might say about how typical people develop self-control. The fascination remains to date. I also came to understand that the disorder was in my family and especially plagued my fraternal twin brother, now deceased, so I developed a personal interest as well but that came later.
*Barkley, Russell. Personal Interview. 15 Jan 2015.
What behaviors differentiate an active or defiant child from a child with ADHD or ADD?
It is not easy given that both disorders coexist in 65% or more of children with ADHD. But ADHD symptoms arise earlier than arguing, defiance, and refusal. So that can help differentiate the two. Also, defiance does not involve inattention, hyperactivity, or impulsivity that is chronic and cross situational as ADHD does. Defiance also involves refusal to do a direction or command whereas ADHD involves not being able to complete them due to the symptoms of inattention and poor self-regulation. If you look at the DSM5 symptom lists for both disorders, you can see they are not the same problems but they can frequently coexist. We now believe ADHD can cause oppositional defiant disorder because the former results in poor emotion regulation, especially for impatience and frustration and anger, and that is a set up for eventually learning defiance.
What are your views on behavioral therapy or treatments for ADHD/ADD?
Very helpful especially for younger individuals. The older the child the less effective are things like parent training. But school behavior management and special accommodations can help throughout formal school. And cognitive behavioral therapy concentrating on executive functioning deficits, like time management, organization, emotion regulation, can augment and improve the effects of medications. Typically a combined approach of medications, behavior modification, and accommodations is best.
Not for everyone with ADHD as milder cases may be able to be managed through psychological and educational methods. But 70-80% of cases will require medication at some points in their life course as the former methods are simply not as effective as the medications.
Do you feel that medication is absolutely necessary for treating ADHD/ADD?
It tells me they don’t know the research literature on the evidence for the effectiveness of the medications and their relative safety nor do they understand the substantial neurological and genetic etiologies of ADHD. Such an opinion is either formed simply from trade media articles that sometimes attack medication or from propaganda such as that issued by fringe religious and political groups rather than being founded on solid scientific evidence.
How would you respond to somebody that believes that medication has no place in the treatment of ADHD/ADD?
I think that the public holds a deep seated assumption about children and their behavior that involves viewing it as largely learned patterns of behavior. Thus if a child manifests ADHD, they have not been raised properly by their parents. This view see children largely as tabula rasas and parents as highly influential in determining their course of their personality, behavioral, and other development. So long as one holds to such an unquestioned assumption, then they will see ADHD as not serious, as learned behavior, and as arising from poor upbringing (parent bashing). Science shows the assumption is dead wrong and that genetic, neurological, and other developmental factors can have strong influences on people’s personality and behavior. But until the lay public comes to a more science based view on child behavior, many in it will continue to see ADHD is not valid, not serious, and medication not warranted.
A pity. But just as with psychosis, mental retardation, autism, and the learning disorders, all of which in earlier times were seen as learned behavior or due to poor upbringing, things can change in such public perspectives. My hope is that with continued dissemination of science on ADHD, the same will occur for it as well.
In your personal opinion, why do you think there is so much of a stigma attached to ADHD/ADD and the use of medication as treatment? What do you think has lead to such widespread ignorance of the disorders?
Read more of this move here:
