Is ADHD a disorder, or are people just different?
Written by Thom Hartmann & Vaudree Lavallee
The "Hunter in a Farmer's World" metaphor was first used in the original 1993 version of "ADD: A Different Perception" to characterize the life situations in which those with ADHD often found themselves.
The metaphor is now popularly used to refer to subsequent Thom Hartmann books many of which address the ongoing wounding of our children by those who still portray ADHD/ADD as a disease. "ADD: A Different Perception " has recently been called a "Just So Story," "mind candy," and "unreputable" by the editor and owner of a privately published subscription newsletter.(2),(12) The editorialist's surprisingly harsh front-page commentary is in response to a book that was foremost a story told by a father (Thom Hartmann) who wanted to find an alternative to what he considered an emotionally destructive story told to his son about the way his son's brain functioned!(16) Although initially flattered by all the recent attention Dr. Barkley has shown the earliest version of the Hunter/Farmer hypothesis, we find it tragic, self-serving, and blatantly unscientific that he would present it only in part, and that the part he'd choose was significantly misrepresented.
"ADD: A Different Perception" provided a more feasible (and substantially more accurate) reinterpretation of the widespread fable used by those who wish to depict ADHD persons as "deficient" and "disordered." In subsequent Thom Hartmann books and articles, more attention was directed toward building the skills and self-esteem of ADHD children and adults. These efforts have been widely embraced by many, but aggressively opposed by those in the ADHD circuit who responded to our call to keep ADHD children's egos intact with, for example, Barkley's Marie Antoinette-like retort , "If feeling good is the clinical goal, then why not just give them heroin ?"(2) In contrast to such unfortunate and derisive rhetoric, the Hunter/Farmer hypothesis maintains that self-esteem is not a drug used to pacify but a sword that can be used to fight off the evils of despondency and self-hatred, and to provide hope for ADHD children.
The Hunter/Farmer hypothesis presumes that, irrelevant of where one places on the ADHD continuum, one not only has weakness to be compensated for, but also ADHD-related strengths that we must nurture. Contrarily, Barkley and those who consider ADHD to have no value whatsoever promote an absolute acceptance of the "disorder" perspective and a total reliance on compensatory or defensive strategies, offering "authoritative" advice about how to "take charge" of such children.(4) Their disorder perspective assumes that there is one, single, superior (non-ADHD) way of behaving and being in the world, in all times and cultures, and that all other humans not so endowed are defective, lack creativity and have reduced intelligence (Barkley, Goldstein, etc.)
Barkley's recommendation that ADHDers be authoritatively controlled and taught to avoid pursuing new opportunities for themselves (stimulation-seeking/risk-taking),(2) however, is like telling an entrepreneur to quit looking for new market and business opportunities, an inventor to stop trying to see how things work (or how they could work better), or a hockey player to stop trying to scoring goals! Some ADHDers might be able to find contentment under the scourge of such defeatist (and possibly self-fulfilling) prophecies, but not without giving up many of their lives' hopes, aspirations, and goals along the way. The debate concerning whether ADHD is a disorder or a difference has considerable implications, not only for ADHD research, but also for those adults and children along the ADHD continuum who deserve more than a life spent only meeting the minimum threshold of their real potential.
Like the perpetually dueling Smothers Brothers, with their constant refrain of, "Mom always liked you best," the world of ADHD research and speculation often seems to devolve into acrimony around whose theory is most or least supportable (or which brother is superior: the ADHD one or the over-focused one). Unfortunately, in this process one of the early causalities has been accuracy. Because of Barkley's newsletter's wide circulation, it seemed important to provide readers a rebuttal, and to correct at least a few of his mischaracterizations of the genesis, reasoning, and details of the Hunter/Farmer metaphor.
In two recent issues of his for-profit newsletter, Barkley has editorialized that the Hunter/Farmer metaphor was "laughable" and "inconsistent with evolutionary theory" since, according to his (mis)interpretation of the Hunter/Farmer metaphor, he says it states that hunters have evolved into farmers rapidly over the past 10,000 years since the agricultural revolution. We are, however, more apt to agree with those who state that biologically humanity has evolved very little since our hunting and gathering days, (21) or that existing differences between populations are likely due either to founders effects (genetic differences among founding families, many who were immigrants) or to the differential "pruning" effects of nature, pestilence, culture, and rivalry.(20)
We have always suggested that the cluster of "Hunter genes" and the cluster of "Farmer genes" have been with us since the earliest dawn of the human race: neither "evolved" from the other. (Indeed, this spectrum of behavior is seen within species across the animal kingdom, from dogs and cats to chimps and the great apes.) There has always been a need, in all societies, for the "adventurous explorer" and for the "careful bookkeeper," whether it be hunting and then skinning animals, or planting crops and entertaining the planters. The core of the hunter/farmer hypothesis, in short form, is that in hunting/gathering societies those persons with the "hunting gene" are rewarded and have an increased the probability of procreation, and among agricultural and post-agricultural/industrial societies (such as today) the "farming gene" is celebrated and increases the social and procreative advancement of farmers.
All theories on human development, regardless of content, fall into two categories: those, such as the Hunter/Farmer hypothesis, that take the difference perspective and those, such as the executive functions model, that take the disorder perspective. The perspective one decides to incorporate into one's model or hypothesis has enormous implications concerning how one treats individuals and how one interprets their behavior.
For example, no one will argue that hunters do not exhibit extreme difficulty in reciting nonsense syllables in correct sequence, or that they do not have poor rote memories. The disorder perspective attempts to "cure" such deviancy by encouraging (or forcing) ADHD children to work harder on sequence and rote.
Alternatively, the difference perspective assumes that different people may need to utilize different techniques to achieve the same goals. The difference perspective presumes that there are different ways of remembering, and different ways of processing and organizing input. As an example, researchers indicate that, in contrast to the excellent rote memories possessed by Farmers, intelligent Hunters not only boast, but are also able to take advantage of their "superior" incidental memories.(9),(26) In other words, since Hunters are predisposed to scan their environments, they are more apt to record and then later utilize background information. Conversely, Farmers are more likely to think in terms of an object devoid of context.
The limit in scope of the disorder perspective is both its major asset and its greatest liability. It's easily grasped and propagates readily because it neatly compartmentalizes a complex range of variables, and appeals to the latent moralist in our culture and in each of us.
On the other hand, it ignores the fact that both people and environments are complex and variable, largely disregards the effects of context on performance, and overlooks evidence that human weaknesses in one environment often turn out to be powerful or even vital and adaptive assets in another.(10),(17),(20),(26) For example, rather than questioning the desirability of the "brick" factory-style school house with it's large class sizes and homogeneous instruction methods, the disorder perspective places blame for failure squarely on to the child .(22) Not surprisingly, the disorder perspective sees adaptation and disorder as two distinct categories, rather than two aspects of a single phenomenon .(2)
What is an Adaptation and is ADHD one?
An adaptation, according to Barkley, is something that appears in hindsight to have been "designed for some purpose" or to solve "particular problems." The human thumb is commonly considered an such an adaptation, although the real adaptation may be the human creativity that allowed us to find a use or two for this oddly positioned finger. Other inventions, such as handcuffs or the inside of jars, could be used to "prove" that the thumb may also be maladaptive in certain circumstances. Which is view of the human thumb is right? Probably all three. The thumb debate is but a small example of the importance of avoiding absolute statements in an evolutionary context. Likewise, Barkley has described the type of absentmindedness often experienced by persons with ADD/ADHD as proof of a mental "deficit," whereas other scientists view it as one of the "side consequences of a generally adaptive architecture that sometimes gets us into trouble."(23) As you can see, a disorder may not be the opposite of an adaptation, but its compliment.
The topics of evolution and adaptation were also explored extensively by Pinker(21) in a book that can best be described as an intelligent elaboration of Dawkin's selfish gene theory. Nonetheless, Barkley's use of Pinker's work to discredit adaptation in the Hunter/Farmer hypothesis is inappropriate since Pinker indicates that at least one cornerstone of the Executive Functions model, delay of gratification, may be maladaptive. Pinker proposes that not only is going for the quick reward more adaptive, but that risk-taking, another common hallmark of ADHD, is also more adaptive in the long run. In other words, defining disorder and adaptation as absolute opposites is a fallacy that's not supported by most evolutionary theorists and researchers.
In 1997 when Barkley first presented a variation on Strang and Rourke's 1983 Executive Functions model to explain ADHD , Barkely chose to incorporate into his model the existing body of literature of brain function, and to emphasize the similarity between symptoms of pseudopsychopathy (right frontal lobe damage) and ADHD. The right-frontal-lobe brain damaged individual has been shown to experience increases in motor activity, talkativeness, and a lack of tact and restraint,(19) symptoms commonly associated with ADHD. Animals with frontal lobe damage cannot to adapt new situations or environments, while humans with such lesions similarly experience extreme difficulties in situations requiring problem solving and unique solutions(19) . Because he assumes ADHD to be synonymous with this type of brain damage," Barkley(3) concluded, rather incorrectly, that persons with ADHD are also less capable of creative thought, and stated this hypothesis concerning ADHD and creativity explicitly in several of his writings.
If brain damage research had been used to build the Hunter/Farmer hypothesis, "ADD: A Different Perception" may have explored the difficulties associated with being a right-frontal-lobe-damaged individual in a world taken over by people with left-frontal-lobe-damage. Described in non-disorder (difference) terms, left-frontal-lobe-damaged "Farmers" could be seen as objective (rather than indifferent), exerting emotional self-control (rather than showing little overt emotion), able to show enough self-regulation to remain silent (rather than showing little or no verbal output), and speaking only when spoken to (rather than failure to initiate conversations). However, this silly analogy was never used in "ADD: A Different Perception," or any subsequent Thom Hartmann book or article for that matter, because Hunters are not right-frontal-lobe brain damaged persons, and Farmers are not left-frontal-lobe brain damaged persons: each are, instead, two end-points on a continuum of human variability.
To understand the role of brain pathology research in validating the Executive Functions model, we need to first determine what the Executive Functions model would look like without reference to brain damage. The Executive Functions model would still compare the more liberal and flamboyant ADHDers unfavorably to the more conservative and restrained "statistical norm." Americas "brick" factory-like schoolhouses would still be seen as the epitome of human civilization and accomplishment. And, like Phillip Rushton,(11) the Executive Functions model would still see a negative correlation between IQ and promiscuity. In summary, we would still have an ethnocentric (almost Aryan) commentary of genetic endowment differences.
Without these highly questionable (and, in the opinion of these authors, outright flawed) ideological underpinnings, however, what remains of the Executive Functions model is simply a theory of individual variation. The Executive Functions model tends to focus on post base-line variation in human response to environmental stimulation while ignoring important differences in how such stimulation may initially be experienced by the individual. We agree that after controlling for base-line differences between Hunters and Farmers, there may be important executive function differences among Hunters and among Farmers. Additionally, these "executive function" differences may turn out to be one among the many variables which help determine whether ADHD will produce an entrepreneurial success or a chronic criminal.
As the Hunter/Farmer hypothesis predicts, there are base-line differences in the ways individual Hunters and Farmers each experience and cope with depression, boredom, frustration and joy. However, these base-line differences do not fully explain why one Hunter (or Farmer for that matter) may or may not experience depression at a dysfunctional level. Instead, the Hunter/Farmer hypothesis suggests that it's the driving need or hunger for aliveness which animates most ADHD/ADD behaviors, and executive function is only a small (but significant) variable that determines how this need or hunger is satisfied (through socially adaptive means, such as a high-stimulation job in an emergency room, or socially maladaptive means like becoming a barroom brawler).
Seen in this light, Barkley's so called executive system may be nothing more than a fight or flight response mechanism, acting like a rubber band that exerts its influence at both ends of the ADHD continuum. Evidence which indicates that having a "happy temperament" as an infant is associated with improved prognosis for Hunters while some environmental factors, such as having experienced abuse, are associated with negative life chances(13) lends support to the prospect that the Executive Function model is a theory of within-Hunter variation rather than of Hunter/Farmer differences. To recapitulate, if one were to divide the population into groups based on individual differences in tolerance of (or desire for) novelty, the individuals in each group would still vary in both their tolerance of and their exposure to adversity or stress. Theoretically, those in each group whose threshold for stress has been exceeded may exhibit many of the cognitive difficulties associated with the so-called executive functions.
Researching ADHD Adaptation, and Self-Esteem
The myopic nature of the disorder perspective leads to narrow and incomplete answers. Previously, disorder perspective researchers seemed to believe that everything we needed to know about ADHD we could gain through a better understanding of the workings of methylphenidate. Now, Barkley(2) writes that we should only ask the purpose of the executive function system rather than consider whether there are also adaptive functions associated with ADHD-like behaviors. Although knowing a little bit more concerning methylphenidate, such as its effects during pregnancy, or concerning the function of executive control processes may provide some benefit, neither is an adequate replacement for a better understanding of humanity and its complexity throughout the ADHD continuum.
Some self-proclaimed empiricists appear to have difficulty with what they consider murky constructs, such as self-esteem, which are associated with subjective emotions. In contrast to the so-called ambiguousness of self-esteem, these "empiricists" appear more comfortable with the presumably more precise language used in the DSM-IV definition of ADHD, such as "often," "excessively" and "extraneous." Other researchers, however, are less predisposed to automatically dismiss clinical observations and case studies, and more apt to report trends and to design research studies so as to settle theoretical disagreements and uncover a wider range of truths. It is to these other researchers that we will now turn.
According to longitudinal ADHD research, a positive self-esteem is associated with resiliency, autonomy, and a sense of humor,(18) all factors that are known to boost the immune system and improve one's general physical well being in a wide range of studies. Conversely, low self-esteem is associated with the feelings of helplessness stemming from a belief that personal failure is due to unchangeable factors such as inherent inability or inferior intellect. (8)
Considering these associations between self-esteem and how one's life turns out, one should not be surprised that, when asked, many ADHD individuals indicate that what was most helpful to them while growing up was having an adult who believed in them,(18) or that ADHD children who have a good relationship with their grandparents fare better.(13) Whether they be parents, teachers, or clinicians, adults wield a great deal of influence over the self-concepts and performance of those children with whom they are entrusted. Often the single most significant variable in a child's life that will determine his or her success was the presence of an adult who believed in and supported the child.
Rosenthal and Jacobson were the first to show that experimental manipulation of teacher expectations may influence student outcome. The researchers informed teachers that the performance of randomly picked students was going to improve dramatically. These "spurter" effects were more pronounced in first and second graders and in students with whom teachers traditionally held lower expectations, such as minority students .(7) The question left unanswered by Rosenthal and Jacobson's research is how specifically did teacher expectation lead to changes in student grades.
Elementary school teacher Jane Elliot proposed that a teacher's expectations influence student performance through its influence on teacher behavior. She dramatically illustrated the power of self-concept by using eye color differences to explain the concept of discrimination to her students. She found that her students actually performed better at their assignments on the day when their eye color was deemed superior and worse on the day when their eye color was considered inferior.(7)
Researchers Becker, Place, Tenzer and Frueh(6) also found an association between teacher's impressions of and behavior toward various students when they exposed teachers to one of three taped conversations between a female librarian and a young girl. The second and third tapes were identical to the control tape, except that in one tape the child interrupted the adult, and in the other the child engaged in three acts of tangency. For example, when the librarian suggest French food as a possible topic, the girl in the tangency condition started talking about how she lost her tooth after biting into an apple.
As expected, teachers' perceptions of both student ability and the likeliness that the student would receive their help were lower in both the interruption and tangency condition than in the control condition. Not surprisingly, teachers described the child in the interruption condition as a "poor listener", and the same child in the tangency condition as having "poor attention" or being a "dumb blond." More needs to be known concerning the effects of these attitudes on teacher and student performance.
A more detailed look into the impact of self-esteem on both hunters and farmers may also benefit greatly from the body of research on priming and relational schemas (scripts).
Priming is a scientific term denoting any experimental or naturally occurring manipulation, which makes some memories or information more readily accessible than other information.(1) A priming stimulus can be anything -- a word, a picture, an instruction, a facial expression, or even an emotion. For example, what Weiss(27) refers to as "flooding" and what Hallowell and Ratey(14) refer to as "hyperfocusing on the negative" may just be the effects of priming combined with the interconnection of emotion and memory retrieval. Since ADHD questionnaires tend to focus on the negative aspects of ADHD, it is possible that the act of filling these questionnaires out immediately prior to task performance can call forth (prime) negative memories and emotions in ADHD participants that may influence task performance. The potential for priming to bias research results has not previously been explored in ADHD research. The failure of ADHD researchers to reduce the occurrence of this type of bias when designing studies is one of the ways in which many of the existing studies into ADHD and its outcomes are potentially flawed and altogether at odds with accepted scientific models.
In summary, we find the work of those who attempt to position ADD/ADHD entirely as a pathology, "a failure of evolution," or a character trait of "no value whatsoever," to be more rooted in thinly-veiled pseudo-morality and eugenics than in science. Vast bodies of literature -- as well as common sense and the positive personal experiences of millions with ADHD -- are conveniently ignored, overlooked, or dismissed. In Barkley's words we find contempt and a reductionist, mechanistic world-view that allows only for pathology and non-pathology.
By obsessively focusing on negatives and refusing to acknowledge any evidence of value in ADHD, anywhere, anytime, under any circumstances, the increasingly small circle of "pure pathology" advocates are bringing only pain, power-based relationships (between parents told to "take charge" of their ADHD children, as well as between professionals and their clients), and the most massive labeling, segregation, and ostracizing seen in our public schools since the early days of "separate but equal" education among the races.
There are those who are more concerned about the appearance of being a "good" parent or "good" teacher who may take comfort in the pronouncement that their children were "born with this problem" and that "you should neither assign blame to yourself or accept it from others."(4) Such fatalistic pronouncements serve only to release parents, teachers and researchers from their responsibility and guilt concerning their children's failures.(22) The wounding wreaked on millions of children by their being told they are brain-deficient and have a mental disorder, however, is largely ignored by the pathology proponents, as is the agony endured by other parents who read in Barkley's newsletter that their children's condition, "rather than representing an adapted evolved set of valuable qualities, reflects weaknesses in the evolution.. ."
It is time we set aside this one-dimensional "villain story" which focuses solely on "the burden of ADHD to affected individuals, to their families, and to society.., "(5) and on how ADHD is a "deficiency in functioning" which makes one "less capable."(2) Science doesn't support the absolute pathology model, common sense doesn't support it, and certainly any sincere hope for therapeutic outcomes and healthy children don't support it. It's time to stop the wounding, the finger pointing, and the critical, condescending tone used to refer to and address those with ADHD and their advocates. It's time to walk away from the doomsayers and look to the light of a new day and world where all children are valued for their unique gifts.
REFERENCES
(1) Baldwin, M. (1992). Relational Schemas and the processing of social information. Psychological Bulletin, 112, 461- 484.
(2) Barkley, R. (2000). More on evolution, hunting, and ADHD. The ADHD Report, 8, 2, 1-7.
(3) Barkley, R. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121, 65-94.
(4) Barkley, R. (1995). Taking Charge of ADHD: The Complete Authoritative Guide for Parents. Become an Empowered Parent - A World-Renowned Expert Tells You How to Help Your Child and Yourself!
(5) Barkley, R. (2000). Genetics of childhood disorders: XVII. ADHD, part 1: The executive functions and ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 477-484.
(6) Becker, Place, Tenzer and Frueh (1991). Teachers' impressions of children varying in pragmatic skills. Journal of Applied Developmental Psychology, 12, 397-412.
(7) Boocock, S. (1980). Sociology of Education - An Introduction, Second Edition.New York: University Press of America.
(6) Brooks, R. (1994). Children at risk: Fostering resilience and hope. American Journal of Orthopsychiatry, 64, 545-553.
(7) Ceci, S., & Tishman, J. (1984). Hyperactivity and incidental memory: evidence for attentional diffusion. Child Development, 55, 2192-2203.
(8) Ceci, S. (1996). On Intelligence - A Bioecological Treatise on Intellectual Development. Cambridge:Harvard University Press.
(9) Di Cresce, G. (2000). Rushton's racial link to IQ rapped - Prof. Dismissed as crank. The Winnipeg Sun, February 3, 4.
(10) Goldstein, S., & Barkley, R. (1998). ADHD, hunting, and evolution: "just so" stories. The ADHD Report, 6, 5, 1-4.
(11) Grizenko, N., & Pawliuk, N. (1994). Risk and protective factors for disruptive behavior disorders in children. American Journal of Orthopsychiatry, 64, 534-540.
(12) Hallowell, E., & Ratey, J. (1994). Driven To Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood. New York: Pantheon Books.
(13) Hartmann, T. (1993). Attention Deficit Disorder: A Different Perception.
(14) Hartmann, T. (1999). Whose disorder is disordered by ADHD. Tikkun, July/August, 17-21.
(15) Hartmann, T. (2000). Thom Hartmann's Complete Guide to ADHD.
(16) Hechtman, L. (1991). Resilience and vulnerability in long term outcome of attention deficit disorder. Canadian Journal of Psychiatry, 36, 415-421.
(17) Kolb, B., & Whishaw, I. (1990). The frontal lobes. In WH Freeman. Fundamentals of Human Neuropsychology -3rd Edition. New York.
(18) Nesse, R., & Williams, G. (1995). Why We Get Sick - The New Science of Darwin Medicine. New York: Vintage Books.
(19) Pinker, S. (1997). How the Mind Works. New York:Norton.
(20) Reid, R., Maag, J. & Vasa, S. (1993). Attention deficit disorder as a disability category: A critique. Exceptional children, 60, 198-214.
(21) Schacter, D. (1999). The seven sins of memory - Insights from psychology and cognitive neuroscience. American Psychologist, 54, 182-203.
(22) Semrud-Clikeman, M., Steingard, R., Filipek, P., Biederman, J., Bekken, K., & Renshaw, P. (2000). Using MRI to examine brain-behavior relationships in males with attention deficit disorder with hyperactivity. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 477-484.
(23) Schacter, D. (1999). The seven sins of memory - Insights from psychology and cognitive neuroscience. American Psychologist, 54, 182-203.
(24) Shaw, G., Brown, G. (1991). Laterality, implicite memory and attention disorder. Educational Studies, 17, 15-23.
(25) Weiss, L. (1992). Attention Deficit Disorder In Adults - Practical Help for Sufferers and their Spouses. Dallas: Taylor Publishing Company.
Copyright © 1999, 2000, 2001 by Thom Hartmann, all rights reserved.
