The Neuroanatomy of ADHD and thus how to treat ADHD - CADDAC - Dr Russel Barkley part 3ALL
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All Comments (21)
Here are important ideas from this lecture for fellow ADHDers who might not be able to focus.
0:33: Three concepts to build the model
First concept - Inhibition: You have to stop and build a pause in your behaviour. Basically, stop and think before you act.
1:17: Three kinds of inhibitions that's impaired in ADHDers
1:20 a) Can't inhibit the urge to respond on the moment to an event. (impulsiveness)
1:29 b) Inability to interrupt an ongoing behaviour when it's time to do something else. (especially if the ongoing behaviour is rewarding)
1:50 c) Inability to protect working memory from distractions.
2:20 ADHDers don't perceive distractions any more than others. The difference is that they respond to them and go off task.
2:28 Once off task, they can't retain the goal and won't return to the task.
2:37 So it's a series of responding to irrelevant events in life which is why it is so hard to accomplish your goals.
2:40 To sum up ADHDers have an inhibition problem.
Second concept: Self regulation
3:45 We self-regulate to change a distant consequence. We try to alter the future, not the now.
4:34 All deferred gratification requires self regulation.
Third concept: Executive function
5:31: Definition of executive function: The action to the self designed to change you so as to change your future .
5:51: We have five executive abilities.
6:53: The executive abilities are path dependent, meaning they require the previous on to develop. Think of it like a pyramid.
7:06 Boring technical terms, name dropping and some boasting.
8:07 Executive functions can be describes as actions to the self.
8:30 Role of non verbal working memory:
8:41 Humans have the best system for holding images in the minds.
9:49 You recall past events through images.
10:32 1st executive function: Stopping
10:32 2nd executive function: Reimage the relevant past.
10:37 3rd executive function: Speech to the self.
10:48 4th executive function: Emote to yourself.
10:51 5th and highest executive function: Planning, problem-solving, and simulating multiple possible responses.
11:27 Manual play leads to mental play.
11:54 Children begin to speak to others then themselves loudly then speak in their mind.
15:03 Athletes can improve their performance just by visualizing. They use the same brain as they'd if they actually performed.
15:14 When you speak to yourself you activate the speech part of the brain. And since it's the same system, you can't speak to yourself as well as others.
15:37 So rather than calling it internalization, you should call it privatization.
17:03 Chart of development of inhibitions.
17:29 Most people develop all executive functions by 30. ADHDers lag by 30-40%
18:02 So you learn self management and by extension you think about the future instead of the now.
18:36 Most 30 year olds anticipate 8-12 weeks into the future.
20:14 The frontal lobe's role was to keep track of favours. It's now used for vicarious learning.
21:13 ADHD kids can't use behaviour of others to modify their own behaviour.
21:39 ADHD kid lack hindsight, foresight, and anticipation of future events.
21:52 Adult ADHD is the consummate disorder of time management.
22:24 Until adulthood, language and instructions have little role in controlling the behaviour of an ADHDer. Because language cannot control motor function.
22:55 Adult ADHDers have a deficit in comprehending what they read, see, and hear.
23:10 Delay in morally governing behaviour.
23:22 We modify emotions which is the basis of self-discipline, persistence and motivation due to the emote to yourself executive function.
23:34 the ability to internalize are playing gives rise to the ability to generate multiple options when we are faced with the problem and if this system isn't working very well people tend to fall back on over learned outdated ineffective behavior.
23:43 the system also involves putting behavior together, to solve the problem stringing a sequence of actions together, so we should see that people with ADHD have a lot of trouble with problem solving in their mind with generating multiple possibilities for getting things done and then with following the one that most effective in doing so but we should also see that they have trouble stringing behavior together in a proper sequence and we will see this no better than in their speech.
24:25 Example of how ADHDers speak.
25:22 Adult ADHDers speech pattern include circumlocution and verbal wandering.
25:36 ADHD is not an attention disorder; it's time blindness. You're nearsighted in time.
25:50 Adults and kids with ADHD wait till the future is imminent.
27:12 ADD is actually IDD aka intention deficit disorder.
27:32 The back part of the brain acquires knowledge, the front part puts it together. ADHD separates these two as a meat cleaver. So no matter what you know, you can't utilize it like others. ADHD is a performance disorder. You can't perform the things you know how to do.
28:37 All treatment must be rooted at the point of performance aka the real world.
28:49 You have to restructure the environment to show what they know.
28:57 Teaching skills is useless because they won't be used.
30:00 Medication is required for most ADHDers (disagree with this one). The effects of medication is temporary.
30:59 Meds can be rephrased as neurogenetic intervention.
31:25 We need to tighten up accountability. Bring those consequences closer in time.
33:15 Externalize key pieces of information.
33:38 You can't hold things in your mind so write them down. Use an external resource to compensate for an internal problem.
35:21 Use external temporal guidance devices. (I personally recommend JIRA) Break the future into pieces and do a piece a day.
36:14 Social consequences can be motivating.
36:55 Use manual problem solving.
EDIT 25 April 2022: After a lot of hesitance, I finally went to a psychiatrist 4 months ago and started taking medication. I was prescribed the generic version of Strattera and it's made a huge, huge, huge improvement to my life. So if you're like what I was and averse to the idea of medication, please give it a shot, it might change your life.And if it doesn't you can always stop taking it. I believe I was reluctant to take medication because of all the societal stigma. I'm glad I overcame it and took help. Best of luck to all my fellow ADHDers.
I have never heard a non-ADHD person explaining ADHD this good.
My ADHD was far less impairing when I was a kid. I’ve never really had issues with things like reading comprehension or verbal skills. But the time blindness, the lack of time management skills, inability to organize… they’re crippling me in my career. I’m an attorney. Not being able to manage my time is a huge problem in a job based almost entirely on time management. I work slower to try to keep track of everything. And I work longer hours to make up for being slow or losing time down a rabbit hole.
This man literally lost his twin brother to ADHD. People that say he's being too negative are the same people who have hard time distinguishing what is actually true and what they believe is true. This man has done more than his critics to help people with ADHD. I have pretty bad ADHD and I'm glad I got on medications.
This guy is absolutely brilliant when it comes to the ADHD brain. I have learned so much from watching his videos. My son suffers from ADHD and because of Dr. Barkley's lectures I have been able to make sense of his behaviors. I think everyone who struggles with this, or knows someone who does, should watch his videos. You will have a lot more empathy for yourself and others by doing so! Amazing! I've learned a long time ago that I have to be my son's frontal lobe and that his environment has to be manipulated to get him to accomplish anything.
"ADHD is not a problem of knowledge, it never was. It is about how to use that knowledge". Please!! every doctor must watch this video. The German doctors I have visited say I had very good grades my whole life, so I do not have ADHD. Even though all the synthoms are there and that the “good grades” were achieved under a continued suffering :(
I nearly cried when I watched this.... it’s me completely and in every way (as someone who has struggled for over 40 years)
"Well, I'm working on it.. " every person with ADHD can relate.
This is my first time watching a video where I actually got a solution. This man taught me more about myself than I knew in all my years of experience of being in this body. So many points he made were so important but I won't be writing them because this entire video deserves to be watched again and again.
damn! as someone with ADHD hearing about normal memory is amazing! it's like you guys have superpowers! my memory is like a notebook with a couple sentences describing things I noticed and a few snippets of images and sound. I always thought memories in movies were poorly done because it's way too accurate but if that's what normal people experience I'm really missing out.
This dedicated man/physician has committed his life to investigating, studying,
analysing, and "connecting the dots" regarding ADD, ADHD and related topics.
His willingness to share and communicate his experience based findings and conclusions can, and does, make the world a better place, one person (and MD) at a time.
I am deeply grateful for him
Two of my wishes, one impossible, two possible: 1) I wish his information was available in the 50's. ADD/ADHD kids are 33% more likely to be physically and emotionally abused. 18% of abused kids are ADD ADHD. (I am confident the % is much higher due to non-diagnosis.)
2) I wish the key parts of his work were part of the curriculum for teaching credentials and part of the onsite training of teachers already working.
3) Respectfully, I see ONLY "glitch" in the many fantastic hours of his presentations. Regarding ADD ADHD people and their (our) failure to respond to heed to recommendations or urgencies, he says, "It's because it doesn't matter". It isn't that it doesn't matter to us, it's that "it doesn't register" or "sink in" (cognitively). I wish he'd use "register" vs. "matter".
THANK YOU DR. BARKLEY FOR YOU, YOUR WISDOM AND YOUR MESSAGE.
Joseph A Vargas PhD
Dr Barkley is absolutely fantastic! I have never, as a physician, felt like I grasped the essence of ADHD so well! Thank you Dr Barkley!!!!
This is incredibly interesting but I wonder if he could explain why some people with ADHD are actually excellent problem solvers - I'm one of them. Perhaps ADHD can be expressed as singular or more isolated executive functions misfiring while others work well, or even better than average. I do notice that as a higher executive function, problem-solving relies on previously learned information, so perhaps because ADHD children are so easily distracted by stimulating or peripheral information, some of them develop "out of the box" problem solving skills, effectively circumventing the standard path of executive function development and in fact applying their base level dysfunction to their higher functions. Again I have excellent planning skills, I just have trouble following through on those plans if they are remotely long-term. That again implies developed "advanced" executive functions but a deficit in basic ones. Perhaps the advanced functions develop semi-independently with a base level of basic functions. Perhaps it's more nurture than nature though too and because some ADHD people encounter problem-solving or planning requirements they kinda stack their points into those skills to the detriment of their basic ones.
I've gained more perspective in the first 20 minutes than I did seeing therapists and self treating for 20 years. I can only imagine how many people this is helping.
I’ve watched all this crying. I’ve never felt more understood. I had my diagnosis last week, I’m 36, almost 37 yo.Today it’s my first day under medication and I’m feeling great for the first time in a long time. I was so tired to be called promising but irresponsible, intelligent but not good putting things to practice, great but always late, unreliable, unfocused, lazy, slow, distracted… geez… I seriously don’t want to keep crying thinking of all the time and opportunities I’ve lost. But at this very moment I can’t stop feeling angry about everybody who kept saying I should just do more, double down, just focus, just this, just that as if it was just that easy and I was just lazy. I’m angry but also happy. Finally I know why and it’s a relief. I feel so much weight taken off of my shoulders… so much. Sry for the rant, but it was a big emotional day for me today.
Since diagnosis ~7 weeks ago at 31 I have been watching and reading everything I can to understand more about my own brain and how it's different. This is by far the most accurate description I have come across, and it also gave me chills with the serious tone of it all. As someone who very much struggles with the "am I making this up in my own head? Am I actually just lazy and looking for an excuse?" This helped a bit; both with validation, and the idea that even though I struggle to anticipate future consequences, I am still responsible for my behaviour and what I do to change it.
Validation. That’s what I got from this. I’m 50+ years old, my whole life I have fought, partly failed or failed, fought harder, partly failed, and fought harder to win again.
This guy pegged my issues and makes me realize I’m not nuts.
I have come up with many of his recommendations on my own. That feels good to.
But to me it’s about validation.
Wish I could get my wife to understand this about me.
me: can´t focus
also me: watches 40 min videos about neuroanatomy
I might have ADHD , at least I have ALL symptoms. I’m 72 years old male and living in a nursing home because of a spinal cord injury, I understand now why my life.was so disastrous, I still have symptoms which affects my life now. I came up with a theory of common sense where I step back and think of what are all the consequences if I do this. It took a year to learn it and use itI had to make it a habit and training learning on a iPad and the internet. I had to learn it step by step and slowly learn one thing at a time. This helped greatly, and excersizeing was very important even with a c5 c6 injury. I’m hoping to find out if I actually have ADHD and get what ever I need to settle my brain down. I was diagnosed with depression and on a antidepressant witch doesn’t do much if on it or off it.thanks to DR. Russell Barkley I understand a lot more about ADHD and how it controlled my life,
This man has explained the entirety of my life and its conflicts in 30 mins. My mind is completely blown.