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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    Dr. Craig B. Wiener

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

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