Dr. Craig B. Wiener
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Problems with the ADHD "inhibitory model" 

2/5/2013

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No one is debating that some people behave in ways that result in longer term problems. The issue is how to account for their atypical behaviors and is the ADHD “inhibitory model” believable. Let’s take the example of a person diagnosed with ADHD “blurting” out something inappropriate that leads to his getting terminated at work. The ADHD “inhibitory model” says that he wasn’t able to suppress those unacceptable behaviors because of his ADHD. His ADHD kept him from promoting his longer-term future success.

However, when a non-ADHD person does not act out inappropriately when upset with his boss, does he first have to suppress the angry response to remind himself that he could get into trouble, or does he immediately (when feeling threatened by his boss) respond with deference because he has been conditioned over time to do whatever it takes to keep his job.

Patterns of deference to those in authority in the workplace may develop in relation to what has happened during many years of socialization in particular situations and circumstances. The person who shows deference at work may come home and yell at his children (despite the fact that this also leads to longer-term problems), and the person diagnosed as ADHD may not “blurt out” at all when being pressed by someone to admit wrong doing. However, if ADHD prevents suppression and awareness of longer-term consequences, why doesn’t his ADHD prevent him from suppressing in that situation?

Many factors may come into play when accounting for whether a person is careful or behaving in ways that result in getting fired. For example, does the person behaving inappropriately have a history of others providing support or rescue when he gets into trouble, is he happier not working, does his boss trigger an intense unresolved problem, and is he accustomed to fighting back when others are difficult or insulting rather than conditioned to submit?

There is yet another important problem with the ADHD “inhibitory model.” If you have to suppress to identify longer-term problems and solutions, how do you (or your brain) know when to suppress? This dilemma renders the “inhibitory model” untenable. It would seem that people must already know that a situation is problematic when they pause, and that is what stimulants them to pause in the first place.Their  brain activation during the pausing interval reflects what they are doing. It does not establish evidence of a suppressing response.       

Rather than adopt the ADHD “inhibitory model”, let’s assume that people have immediate associations in certain situations (in relation to their learning history). Yes, unlike other animals, people may have associations about more distant events. However, these associations may occur just as immediately as associations about more current time events and do not require a pausing response to take place (e.g., seeing a store and immediately remembering items bought at the store many years ago, etc.). If or when a person is aware that a short-term or long-term problem exists, he or she might have a pausing response; it is not that the pause helps the person become aware.

Biological delay is not the only way to account for the fact that some people keep doing behaviors that produce longer term problems. Their history of living in the world might account for their actions quite well. For example, when a 12 year old female diagnosed with ADHD overheard that her therapy session was going to be scheduled on a Friday, she immediately protested because she had the time distant association that her appointment was going to interfere with the possibility of having a sleep over party. The debate in not about data, the debate is about the interpretation of data and the problematic ADHD "inhibitory model" is quite inadequate to account for the behavior of those diagnosed with ADHD. 

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Presentation: Helping Parents Nurture Self-Reliance and Cooperation in Children with ADD

1/30/2013

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I gave a "Grand Rounds" presentation at the University of Massachusetts Medical School for the Department of Family Medicine and Community Health. You can see the slides and hear the audio of the presentation by following this link. http://umasscipc.adobeconnect.com/p8l4wbze4fr/    The talk is an overview  of my understanding of the ADHD diagnosis and its treatment. 
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Problems Disciplining with Rewards and Punishments

12/9/2012

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Recently, I wrote a blog for "A Mom's View of ADHD" which addresses some of the problems associated with socializing a child with parent controlled rewards and punishments. Here is the link to the article. http://adhdmomma.com/2012/12/disciplining-with-rewards-and-punishments-by-craig-b-wiener-ed-d.html
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ADHD: The Three Fragile Pillars of Biological Causality and Why a Learning Model Makes Sense

11/1/2012

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Our first task is to dispel the belief that ADHD represents a fixed inherited neurological delay that forever keeps your child from showing good judgment. You may or may not know that this view is based on three research findings. (1) ADHD runs in families. Often identical twins are the same when it comes to ADHD, and there are genes that increase the likelihood of ADHD. (2) The brain biology of people with ADHD is different from those without ADHD. (3) Medicine works because it is correcting your child’s faulty biology.

So let’s examine each of these research findings.

(1)   ADHD is caused by genetics. 

There are plenty of people with ADHD who do not have the genes associated with ADHD, and there are plenty of people without ADHD who have the genes associated with ADHD. We expect ADHD to run in families. People in families have similar bodies and experiences, so they are likely to learn similar ways. This, of course, is most pronounced with identical twins.

(2)   Brain biology is different for those with ADHD.

The finding that ADHD brains are different only shows a correlation between people who respond with ADHD behaviors and certain kinds of biological patterns. It is reasonable to assume that doing ADHD behavior over time changes biological development just like what happens to muscle development when people don't exercise. 

(3)   Medicine works

We don’t know the cause of the problem just because medicine works. For example, alcohol might help a person to become more sociable, but that does not tell us why the person was not sociable.  

Yes, your child’s biology changes the probably of what he learns. For example, if he is agile, he may enjoy playing sports, and if he has a gene associated with ADHD, his probability of an ADHD diagnosis rises a few percentage points from 9% to 13.5%. However, much can happen along the way to alter the course of his development. His genes do not seal his fate. Identical twins are often concordant for ADHD, but does not tell us how different they might become when exposed to very different kinds of environments. Children with similar starting points can learn to live in the world in very different ways. Your child’s high activity levels and other problems do not doom him to a lifelong pattern of ADHD behavior. There are ways to get ADHD behaviors to stop. You just have to know how to do it.

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Impulsive behaviors  

9/13/2012

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Many people assume that individuals behave "impulsively" because they don't think enough before they act. However, the fact that people can improve upon their responses when they reconsider does not mean that people behaving well  think more before they act. For example, while some children continue to speak out without raising their hands in class, some children learn to raise their hands each time and they don't have to hesitate and think to behave acceptability. Only under very limited sets of conditions do any of us pause and consider to meet situational demands. Always remember, your child with ADHD rarely blurts out when you want him to admit wrongdoing. He learns to hesitate in that situation just like others who learn to raise their hands in class.   

Conclusion: Behaviors are called "impulsive" when they lead to mistakes (and we assume that the person could have performed better), but it doesn't necessarily mean that the mistakes occurred because of a failure (or inability) to stop and think.  
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The ADHD Gene?

8/25/2012

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Some researchers claim that a person's genes cause ADHD. The DRD4 gene with a 7-repeat allele has occurred more often in ADHD populations. However, as noted in the following article, this gene occurs in almost half of the population in the America's and it occurs in 20% of the population worldwide. Always remember, there are many people with ADHD who do not have the genetics associated with ADHD, and there are many people without ADHD who have the genetics associated with ADHD. Conclusion: There are many factors other than genetics that account for the occurrence of an ADHD diagnosis. http://tools.medicine.yale.edu/kidd/www/330.pdf 
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Understanding ADHD neurological research

6/16/2012

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Many respond to the research in the article below as if it shows that biological deficits give rise to ADHD behavior. However, the findings only show a correlation between children who respond with ADHD behaviors and certain kinds of biological patterns. We might just as readily assume that doing ADHD behavior over time changes biological development just like what happens to muscle development when people don't exercise.   http://blogs.edweek.org/edweek/inside-school-research/2011/02/studies_point_to_new_way_to_id.html
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Medication Trends

6/14/2012

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This is an interesting article about the current use of ADHD medication. Keep in mind, even if the medications are temporarily relieving school failure and other kinds of "suffering", there could be other ways to resolve those problems. Interventions that produce fewer side effects and better longer-term results. http://www.msnbc.msn.com/id/47751459/ns/health-the_new_york_times/#.T9SmvNVfFgt
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Five ways ADHD behavior is reinforced

6/7/2012

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1. Attention
2. Avoidance
3. Acquisition
4. Accommodation
5. Antagonism
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Understanding ADHD as reinforced behavior 

6/7/2012

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ADHD is something that your child does; not something that your child has.
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    Dr. Craig B. Wiener

    Dr. Craig B. Wiener has worked with individuals diagnosed as ADHD since 1980.

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