Attention deficithyperactivitydisorder is a developmental disorderwith an age onset prior to 7 years. Children with ADHD have significantly lower ability to focus and sustain attention and also score higher on impulsivity and hyperactivity. Stimulants, such as methylphenidate, have remained the mainstay of ADHD treatment for decades with evidence supporting their use. However, recent years have seen emergence of newer drugs and drug delivery systems, like osmotic release oral systems and (...) transdermal patches, to mention a few. The use of nonstimulant drugs like atomoxetine and various other drugs, such as a-agonists, and a few antidepressants, being used in an off-label manner, have added to the pharmacotherapy of ADHD. This review discusses current trends in drug therapy of ADHD and highlights the promise pharmacogenomics may hold in the future. (shrink)
We used Nunez's physiologically based dynamic theory of EEG to make predictions about a clinical population of children with Attention DeficitHyperactivityDisorder (ADHD) known to have neuronanatomical abnormalities. Analysis of high-density EEG data (long-range coherence) showed expected age-related differences and surprising regional specificity that is consistent with some of the literature in this clinical area.
Sagvolden, Johansen, Aase, and Russell (Sagvolden et al.) examine attention-deficit/hyperactivitydisorder (ADHD) at levels of analysis ranging from neurotransmitters to behavior. At the behavioral level they attribute aspects of ADHD to anomalies of delay-of-reinforcement gradients. With a normal gradient, responses followed after a long delay by a reinforcer may share in the effects of that reinforcer; with a diminished or steepened gradient they may fail to do so. Steepened gradients differentially select rapidly emitted responses ( (...) class='Hi'>hyperactivity), and they limit the effectiveness with which extended stimuli become conditioned reinforcers, so that observing behavior is less well maintained (attention deficit). Impulsiveness also follows from steepened gradients, which increase the effectiveness of smaller, more immediate consequences relative to larger, more delayed ones. Individuals who vary in the degree to which their delay gradients are steepened will show different balances between hyperactivity and attention deficit. Given the range of ADHD phenomena addressed, it may be unnecessary to appeal to additional behavioral processes such as extinction deficit. Extinction deficit is more likely a derivative of attention deficit, in that failure to attend to stimuli differentially correlated with extinction should slow its progress. The account suggests how relatively small differences in delay gradients early in development might engender behavioral interactions leading to very large differences later on. The steepened gradients presumably originate in properties of neurotransmitter function, but behavioral interventions that use consistently short delays of reinforcement to build higher-order behavioral units as a scaffolding to support complex cognitive and social skills may nonetheless be feasible. Key Words: ADHD; attention deficit; delay gradient; exponential decay; extinction deficit; hyperactivity; impulsiveness; intervention; observing responses; self-control. Footnotes1000 Jeffrey Gray was the BBS Editor for this treatment. When he accepted Sagvolden et al. for publication, he invited Catania, who was one of the reviewers of the original submission, to prepare a precommentary. Com-mentators were then invited to respond to the Sagvolden et al. article, to the Catania precommentary, or to both. (shrink)
This paper examines two influential theoretical frameworks, set forth by Russell Barkley (1997) and Thomas Brown (2005), and argues that important headway in understanding attention deficithyperactivitydisorder can be made if we acknowledge the way in which human cognition and action are essentially embodied and enactive. The way in which we actively make sense of the world is structured by our bodily dynamics and our sensorimotor engagement with our surroundings. These bodily dynamics are linked to (...) an individual's concerns and felt needs, so that what she attends to in perception, decision-making, and action is partially constituted by her cares and concerns. What I call ?affective framing? engages the whole living body, and ordinarily contributes to attentional focusing, working memory, goal-formulation, and action-monitoring. However, due to affective framing deficits, subjects with ADHD find it difficult to focus their attention, kindle their motivation, and systematically simplify cognitive procedures according to considerations of relevance, salience, and context. Thus, what is impaired in ADHD is not simply a set of executive brain functions, but rather a range of bodily dynamics through which subjects engage with their world. For this reason, intensive behavioral intervention that engages the whole living body may be the most effective, lasting treatment for ADHD. (shrink)
Attention-deficit/hyperactivitydisorder (ADHD) is currently defined as a cognitive/behavioral developmental disorder where all clinical criteria are behavioral. Inattentiveness, overactivity, and impulsiveness are presently regarded as the main clinical symptoms. The dynamic developmental behavioral theory is based on the hypothesis that altered dopaminergic function plays a pivotal role by failing to modulate nondopaminergic (primarily glutamate and GABA) signal transmission appropriately. A hypofunctioning mesolimbic dopamine branch produces altered reinforcement of behavior and deficient extinction of previously reinforced behavior. This (...) gives rise to delay aversion, development of hyperactivity in novel situations, impulsiveness, deficient sustained attention, increased behavioral variability, and failure to “inhibit” responses (“disinhibition”). A hypofunctioning mesocortical dopamine branch will cause attention response deficiencies (deficient orienting responses, impaired saccadic eye movements, and poorer attention responses toward a target) and poor behavioral planning (poor executive functions). A hypofunctioning nigrostriatal dopamine branch will cause impaired modulation of motor functions and deficient nondeclarative habit learning and memory. These impairments will give rise to apparent developmental delay, clumsiness, neurological “soft signs,” and a “failure to inhibit” responses when quick reactions are required. Hypofunctioning dopamine branches represent the main individual predispositions in the present theory. The theory predicts that behavior and symptoms in ADHD result from the interplay between individual predispositions and the surroundings. The exact ADHD symptoms at a particular time in life will vary and be influenced by factors having positive or negative effects on symptom development. Altered or deficient learning and motor functions will produce special needs for optimal parenting and societal styles. Medication will to some degree normalize the underlying dopamine dysfunction and reduce the special needs of these children. The theory describes how individual predispositions interact with these conditions to produce behavioral, emotional, and cognitive effects that can turn into relatively stable behavioral patterns. Key Words: catecholamine; clumsiness; dopamine; hyperkinesis; hyperkinetic disorder; impulsivity; monoamine; neuromodulator; overactivity; pollutants; reinforcement; reward; verbally governed behavior; soft signs; variability. (shrink)
Notwithstanding the many strengths of the dynamic developmental theory, there remain challenges to be overcome before it can be incorporated into a true causal model of attention-deficit/hyperactivitydisorder (ADHD). These include the development of reliable measures of reinforcement delay gradients, the validation of shortened reinforcement delay as an endophenotype, and the integration of this pathway with other potential pathways.
Little is known about how children and adolescents conceptualize psychiatric disorders and psychiatric treatment. In the current study, children and adolescents diagnosed with Attention DeficitHyperactivityDisorder (ADHD) were interviewed about their understanding of ADHD and the medication used to treat their disorder. The participants were all taking Ritalin and ranged in age from 5 to 16 years. With increasing age, children improved in their ability to name their condition and the medication. Latency-aged children (...) often did not perceive Ritalin as helpful while adolescents recognized some value in taking medication. Some of the adolescents were also able to describe medication side effects. The implications of these findings for patient education are discussed. (shrink)
The Iowa Gambling Task (IGT) is the most widely instrument used in the assessment of affective decision-making in several populations with frontal impairment. The standard performance measure on the IGT is obtained by calculating the difference between the advantageous and the disadvantageous choices. This standard score does not allows the assessment of the use of different strategies to deal with contingencies of gain and losses across the task. This study aims to compare the standard score method used in (...) IGT with a method that analyses the patterns of staying and shifting among different decks across the 100 choices, considering contingencies of choices with and without losses. We compared the IGT performance of 24 children with externalizing disorders (Attention DeficitHyperactivityDisorder and Oppositional Defiant Disorder) and 24 healthy age-matched children. The analyses of the standard score across all blocks failed to show differences among children with externalizing disorders and control children. However, healthy children showed a pattern of shifting more from disadvantageous decks to advantageous decks and choosing more consecutive cards from the advantageous decks across all blocks, independently of the contingency of losses. On the other hand, children with externalizing disorders presented a pattern of shifting more from advantageous decks to disadvantageous ones in comparison to healthy children and repeatedly chose cards from the B deck across all blocks. This findings show that even though differences among groups might not be found when using the standard analyses, a different type of analysis might be able to show distinct strategies on the execution of the test. (shrink)
The Depue & Collins model is intended to explain a normal human personality trait: extraversion. In contrast, attention-deficit/hyperactivitydisorder (ADHD) is generally considered to be a type of psychopathology not found in so-called normals; however, the clinical and neurobiological research done on ADHD seems to amplify and support Depue & Collins's model.
Some commentaries suggest that the attention-deficit/hyperactivitydisorder (ADHD) theory of this condition does not explain enough. Because the theory includes parameters of the delay gradient that vary across individuals and developmental modulation of behavioral outcomes by different environments, it accommodates a wide range of manifestations of ADHD symptoms. Thus, the argument could instead be made that the theory allows too many degrees of freedom. For many purposes, behavior is better defined in terms of function (e.g., consequences) than (...) in terms of structure (e.g., muscle movements), so cognition is treated here as a variety of behavior rather than as a different category of phenomena. The commentaries are discussed in the context of these and other distinctions, including those between association and selection, between operant and respondent behavior, and between fundamental processes and those that are derivative. Other issues include: prosthetic environments, rapidity of developmental change, the concept of inhibition, the form of the delay gradient, and possible directions for experimental research. (shrink)
The dynamic developmental theory (DDT) has benefited from the insights of the commentators, particularly in terms of the implications for the proposed steepened delay gradients in attention-deficit/hyperactivitydisorder (ADHD). The introduction of modified memory processes as a basis for the delay gradients improved the links to aspects of ADHD. However, it remains unclear whether the hyperactive-impulsive and inattentive subtypes are separate subgroups or may be explained as different outcomes of the same genetic factors and thus explicable by (...) the same principles. The DDT suggests that altered reinforcement and extinction processes define an endophenotype in ADHD that can be related dimensionally to inattention, hyperactivity, and impulsivity. The relation between the suggested endophenotype, characterized by changes in basic learning mechanisms, and other endophenotypes characterized by delay aversion or response disinhibition, needs to be tested in future studies. (shrink)
The reinforcement/extinction disorder hypothesis (Sagvolden et al.) is an important counterweight to the executive dysfunction model of attention-deficit/hyperactivitydisorder (ADHD). However, like that model, it conceptualises ADHD as pathophysiologically homogeneous, resulting from a common core dysfunction. Recent studies reporting neuropsychological heterogeneity suggest that this common core dysfunction may be the scientific equivalent of a red herring.
Critics of attention-deficit/hyperactivitydisorder (ADHD) have repeatedly argued that there is no proof for the condition being symptomatic of an organic brain disease and that the current "ADHD epidemic" is an expression of medicalization. To this, the supporters of ADHD can retort that the condition is only defined as a mental disorder and not a physical disease. As such, ADHD needs only be a harmful mental dysfunction, which, like other genuine disorders, can have a complex and (...) obscure etiology. This article argues that such a line of argument fails to save ADHD as a valid diagnostic category. Given the general diagnostic logic of the DSM-IV and how ADHD has been defined in terms of everyday (male) child behaviors, there are compelling grounds to disbelieve that ADHD can be a true medical syndrome united by some type of harmful dysfunction. Indeed, strong logical and empirical reasons will be adduced to show that people may qualify for ADHD diagnosis without suffering from any type of underlying pathology. (shrink)
ADHD is a psychiatric disorder characterised by persistent and developmentally inappropriate levels of inattention, impulsivity and hyperactivity. It is known that children with ADHD tend to produce incoherent discourses, e.g. by narrating events out of sequence. Here the aetiology of ADHD becomes of interest. One prominent theory is that ADHD is an executive function disorder, showing deficiencies of planning. Given the close link between planning, verb tense and discourse coherence postulated in van Lambalgen and Hamm (The (...) proper treatment of events, 2004), we predicted specific deviations in the verb tenses produced by children with ADHD. Here we report on an experiment corroborating these predictions. (shrink)
This paper examines some of the moral panics around hyperactive children, the construction of Attention Deficit-HyperactivityDisorder, and the lure of Ritalin in turning kids identified as at risk into successful, productive individuals. Through a historicization of the child as a psychiatric subject, we try to demonstrate Ritalin's part in the uneven development of modern trends towards the pathologization of everyday life, a developing continuum between normality and abnormality, and an emphasis on the malleability of children and (...) the importance of environment in their upbringing. We conclude that Ritalin is a part of modernity's project of turning people into individualsâin this case, a kind of US transcendence fantasyâwhich, along with discourses and institutions, promises to transform young subjects and biocosmetically alter their futures. (shrink)
Use of medication for treatment of ADHD (or its historical precursors) has been debated for more than forty years. Reasons for the ongoing differences of opinion are analyzed by exploring some of the arguments for and against considering ADHD a mental disorder. Relative to two important DSM criteria — that a mental disorder causes some sort of harm to the individual and that a mental disorder is the manifestation of a dysfunction in the individual — ADHD’s classification (...) as a mental disorder is found to be contentiously value-laden. The disagreements spill over to reasoning regarding appropriate management, because justification for a drug prescription is in part predicated on the idea that the drugs manage mental disorders. These debates do not appear to be nearing resolution, so individuals offering advice, or trying to decide whether ADHD drugs are appropriate for themselves or their children, may find it helpful to compare the values underlying various perspectives with their own. (shrink)
This article provides an overview of (a) issues in definition and diagnosis of specific reading disabilities at the behavioral level that may occur in different constellations of developmental and phenotypic profiles (patterns); (b) rapidly expanding research on genetic heterogeneity and gene candidates for dyslexia and other reading disabilities; (c) emerging research on gene-brain relationships; and (d) current understanding of epigenetic mechanisms whereby environmental events may alter behavioral expression of genetic variations. A glossary of genetic terms (denoted by bold font) is (...) provided for readers not familiar with the technical terms. (shrink)
Pharmakologisches „cognition enhancement“ zielt auf die Verbesserung der geistigen Leistungsfähigkeit mithilfe von Präparaten, die primär als Medikamente eingesetzt werden. Der Beitrag befasst sich mit der ethischen Bewertung des Gebrauchs von Stimulanzien als „enhancer“ durch Kinder und Jugendliche. Am Beispiel von Diagnose und Behandlung der Aufmerksamkeitsdefizit-Hyperaktivitätsstörung (ADHS) werden die Schwierigkeiten der Abgrenzung von Therapie und Enhancement beschrieben und daraus auf verschiedenen Ebenen ethisch relevante Fragen bezüglich Cognition enhancement entwickelt. Diese betreffen z. B. die Wirkungen von Stimulanzien auf ein sich entwickelndes System (...) und eine mögliche grundlegende Änderung der Erziehungs- und Sozialisationssituation durch pharmakologisches Enhancement, aber auch das Problem der Normierung von Verhalten und der Einschränkung der Autonomie der Betroffenen. Die vorgestellten Überlegungen geben Anlass, Cognition enhancement durch Stimulanzien im Jugendbereich vorläufig kritisch zu beurteilen. (shrink)
Attentional difficulties, both at home and in the classroom, are reported across a number of neurodevelopmental disorders. However, exactly how attention influences early socio-cognitive learning remains unclear. We addressed this question both concurrently and longitudinally in a cross-syndrome design, with respect to the communicative domain of vocabulary and to the cognitive domain of early literacy, and then extended the analysis to social behavior. Participants were young children (aged 4 to 9 years at Time 1) with either Williams syndrome (...) (WS, N=26) or Down syndrome (DS, N=26) and typically developing controls (N=103). Children with WS displayed significantly greater attentional deficits (as indexed by teacher report of behavior typical of attention deficithyperactivitydisorder, ADHD) than children with DS, but both groups had greater attentional problems than the controls. Despite their attention differences, children with DS and those with WS were equivalent in their cognitive abilities of reading single words, both at Time 1 and 12 months later, at Time 2, although they differed in their early communicative abilities in terms of vocabulary. Greater ADHD-like behaviors predicted poorer subsequent literacy for children with DS, but not for children with WS, pointing to syndrome-specific attentional constraints on specific aspects of early development. Overall, our findings highlight the need to investigate more precisely whether and, if so, how, syndrome-specific profiles of behavioral difficulties constrain learning and socio-cognitive outcomes across different domains. (shrink)
As many as two million people in the United Kingdom repeatedly see people, animals, and objects that have no objective reality. Hallucinations on the border of sleep, dementing illnesses, delirium, eye disease, and schizophrenia account for 90% of these. The remainder have rarer disorders. We review existing models of recurrent complex visual hallucinations (RCVH) in the awake person, including cortical irritation, cortical hyperexcitability and cortical release, top-down activation, misperception, dream intrusion, and interactive models. We provide evidence that these can neither (...) fully account for the phenomenology of RCVH, nor for variations in the frequency of RCVH in different disorders. We propose a novel Perception and Attention Deficit (PAD) model for RCVH. A combination of impaired attentional binding and poor sensory activation of a correct proto-object, in conjunction with a relatively intact scene representation, bias perception to allow the intrusion of a hallucinatory proto-object into a scene perception. Incorporation of this image into a context-specific hallucinatory scene representation accounts for repetitive hallucinations. We suggest that these impairments are underpinned by disturbances in a lateral frontal cortex–ventral visual stream system. We show how the frequency of RCVH in different diseases is related to the coexistence of attentional and visual perceptual impairments; how attentional and perceptual processes can account for their phenomenology; and that diseases and other states with high rates of RCVH have cholinergic dysfunction in both frontal cortex and the ventral visual stream. Several tests of the model are indicated, together with a number of treatment options that it generates. Key Words: Blindness; Charles Bonnet; cholinergic; cortical release; delirium; dementia; dream intrusion; hallucination; Perception and Attention Deficit (PAD) model; schizophrenia. (shrink)
Synchrony, or the coordinated processing of time, is an often-overlooked yet critical context for human interaction. This study tests the relationship between the ability to synchronize rhythmically in a group setting with the ability to attend in 102 elementary schoolchildren. Impairments in temporal processing have frequently been shown to exist in clinical populations with learning disorders, particularly those with Attention DeficitHyperactivityDisorder (ADHD). Based on this evidence, we hypothesized that the ability to synchronize (...) rhythmically in a group setting—an instance of the type of temporal processing necessary for successful interaction and learning—would be correlated with the ability to attend across the continuum of the population. A music class is an ideal setting for the study of interpersonal timing. In order to measure synchrony in this context, we constructed instruments that allowed the recording and measurement of individual rhythmic performance. The SWAN teacher questionnaire was used as a measurement of attentional behavior. We find that the ability to synchronize with others in a group music class can predict a child’s attentional behavior. (shrink)
Individuals with autism spectrum disorders (ASD) are known to have difficulty with eye contact. This might make it difficult for partners to communicate with them face-to-face. To elucidate the neural substrates of live inter-subject interactions of ASD patients and typically-developed (normal) subjects, we conducted hyper-scanning functional MRI with 21 subjects with autistic spectrum disorder (ASD) paired with normal subjects, and with 19 pairs of normal subjects as a control. Baseline eye contact was (...) maintained while subjects performed a real-time joint-attention task. The task-related effects were modeled out, and inter-individual correlation analysis was performed on the residual time-course data. ASD–Normal pairs were less accurate at detecting gaze direction than Normal–Normal pairs. Performance was impaired both in ASD subjects and in their normal partners. The left occipital pole activation caused by gaze processing was reduced in ASD subjects, suggesting that deterioration of eye-cue detection in ASD is related to impairment of early visual processing of gaze. By contrast, their normal partners showed greater activity in the bilateral occipital cortex and the right prefrontal area, indicating a compensatory workload. Inter-brain coherence in the right IFG reported previously in Normal–Normal pairs during eye contact was diminished in ASD–Normal pairs. Intra-brain functional connectivity between the right IFG and right superior temporal sulcus (STS) in normal subjects paired with ASD subjects was reduced compared with in Normal–Normal pairs. This functional connectivity was positively correlated with performance of normal partners in eye-cue detection. Considering the integrative role of the right STS in gaze processing, inter-subject synchronization during eye contact might be a prerequisite for eye-cue detection by the normal partner. (shrink)
The use of Ritalin and other stimulant drug treatments for attention-deficithyperactivitydisorder (ADHD) raises distinctive moral dilemmas for parents; these moral dilemmas have not been adequately addressed in the bioethics literature. This paper draws upon data from a qualitative empirical study to investigate parents' use of the moral ideal of authenticity as part of their narrative justifications for dosing decisions and actions. I show that therapeutic decisions and actions are embedded in valued cultural ideals about masculinity, (...) self-actualization and success, as well as in moral conceptions of authenticity and personal freedom. I argue that this investigation of parents' moral justifications and dosing dilemmas raises questions about the validity of authenticity as a transcendent moral principle. Moreover, this study demonstrates that in order to be relevant, bioethical analysis of neurocognitive enhancement must engage with ground-up studies of moral principles and decision-making in context. (shrink)
Aims. Currently, methylphenidate (MPH, trade name Ritalin) is the most widely prescribed medication for attention deficit/hyperactivitydisorder (ADHD). We examined the ability of repeated MPH administration to produce a sensitized appetitive eagerness type response in laboratory rats, as indexed by 50-kHz ultrasonic vocalizations (50-kHz USVs). We also examined the ability of MPH to reduce play behavior in rats which may be partially implicated in the clinical efficacy of MPH in ADHD. Design. 56 adolescent rats received injections of (...) either 5.0 mg/kg MPH, or vehicle each day for 8 consecutive days, and a week later received a challenge injection of either MPH or vehicle. Measurements. Both play behavior (pins) and 50-kHz USVs were recorded after each drug or vehicle administration. Results. MPH challenge produced a substantial 73% reduction in play behavior during the initial treatment phase, and during the last test (1 week post drug), 50-kHz USVs were elevated approximately threefold only in animals with previous MPH experience. Conclusions. These data suggest that MPH treatment may lead to psychostimulant sensitization in young animals, perhaps by increasing future drug-seeking tendencies due to an elevated eagerness for positive incentives. Further, we hypothesize that MPH may be reducing ADHD symptoms, in part, by blocking playful tendencies, whose neuro-maturational and psychological functions remain to be adequately characterized. (shrink)
Despite general agreement that altered reward sensitivity is involved in attention-deficit/hyperactivitydisorder (ADHD), a wide range of different alterations has been proposed. We cite work showing abnormal sensitivity to delay of reward, together with abnormal sensitivity to individual instances of reward. We argue that at the cellular level these behavioural characteristics might indicate that dopamine timing is off in children with ADHD.
While there is an increased interest in describing attitudes of teachers, parents and peers towards students with special educational needs in regular education, there is a lack of knowledge about various variables relating to the attitudes of these three groups. The aims of this study are: (1) to examine which variables relate to the attitudes of teachers (N?=?44), parents (N?=?508) and peers (N?=?1113) towards students with Attention Deficit/HyperactivityDisorder, Autistic Spectrum Syndrome or a cognitive disability (...) in regular primary education and (2) to examine whether teachers and parents? attitudes affect the attitudes of peers. An attitude survey was used to assess attitudes and data were analysed by means of multilevel analyses. The variables found in this study relating to attitudes can be used as a foundation to develop interventions to change attitudes. (shrink)
Anomalous perception has been investigated extensively in schizophrenia, but it is unclear whether these impairments are specific to schizophrenia or extend to other psychotic disorders. Recent studies of visual context processing in schizophrenia (Tibber et al., 2013; Yang et al., 2013) point to circumscribed, task-specific abnormalities. Here we examined visual contextual processing across a comprehensive set of visual tasks in individuals with bipolar disorder and compared their performance with that of our previously published results from schizophrenia and (...) healthy participants tested on those same tasks. We quantified the degree to which the surrounding visual context alters a center stimulus’ appearance for brightness, size, contrast, orientation and motion. Across these tasks, healthy participants showed robust contextual effects, as indicated by pronounced misperceptions of the center stimuli. Participants with bipolar disorder showed contextual effects similar in magnitude to those found in healthy participants on all tasks. This result differs from what we found in schizophrenia participants (Yang et al., 2013) who showed weakened contextual modulations of contrast but intact contextual modulations of perceived luminance and size. Yet in schizophrenia participants, the magnitude of the contrast illusion did not correlate with symptom measures. Performance on the contrast task by the bipolar disorder group also could not be distinguished from that of the schizophrenia group, and this may be attributed to the result that bipolar patients who presented with greater manic symptoms showed weaker contrast modulation. Thus, contrast gain control may be modulated by clinical state in bipolar disorder. Stronger motion and orientation context effects correlated with worse clinical symptoms across both patient groups and especially in schizophrenia participants. These results highlight the complexity of visual context processing in schizophrenia and bipolar disorder. (shrink)
This essay considers the moral status of certain practices that aim to enhance offspring traits. I develop an objection to offspring enhancement that draws on an account of the role morality of parents. I work out an account of parental ethics by reference to premises about child development and to observations about parenting culture in the United States. I argue that excellence in parenthood consists in a dual responsibility both to guide children toward the good life and to accept them (...) as they are. I conclude that prenatal manipulation of healthy and normal characteristics in human offspring fails to balance the dispositional extremes of control and restraint to which many parents today are susceptible. I apply this account of good parenting to the challenging case of height enhancement for short but otherwise healthy children. Finally, I reply to objections, first, about the phenomenology of bearing normative obligations to people who do not yet exist and, second, about the moral logic of criticizing embryo selection in the context of assisted reproduction when we accept child selection in the context of adoption. (shrink)
abstract This essay considers the moral status of certain practices that aim to enhance offspring traits. I develop an objection to offspring enhancement that draws on an account of the role morality of parents. I work out an account of parental ethics by reference to premises about child development and to observations about parenting culture in the United States. I argue that excellence in parenthood consists in a dual responsibility both to guide children toward the good life and to accept (...) them as they are. I conclude that prenatal manipulation of healthy and normal characteristics in human offspring fails to balance the dispositional extremes of control and restraint to which many parents today are susceptible. I apply this account of good parenting to the challenging case of height enhancement for short but otherwise healthy children. Finally, I reply to objections, first, about the phenomenology of bearing normative obligations to people who do not yet exist and, second, about the moral logic of criticizing embryo selection in the context of assisted reproduction when we accept child selection in the context of adoption. (shrink)
The theory of mind (ToM) deficit associated with autism has been a central topic in the debate about the modularity of the mind. Most involved in the debate about the explanation of the ToM deficit have failed to notice that autism’s status as a spectrum disorder has implications about which explanation is more plausible. In this paper, I argue that the shift from viewing autism as a unified syndrome to a spectrum disorder increases the plausibility (...) of the explanation of the ToM deficit that appeals to a domain-specific, higher-level ToM module. First, I discuss what it means to consider autism as a spectrum rather than as a unified disorder. Second, I argue for the plausibility of the modular explanation on the basis that autism is better considered as a spectrum disorder. Third, I respond to a potential challenge to my account from Philip Gerrans and Valerie Stone’s recent work (Gerrans, Biol Philos 17:305–321, 2002; Stone and Gerrans, Trends Cogn Sci 10:3–4, 2006a; Soc Neurosci 1:309–319, 2006b; Gerrans and Stone, Br J Philos Sci 59:121–141, 2008). (shrink)
The statistics at least seem alarming. The production of Ritalin, an amphetamine derivative used for the treatment of attention deficitdisorder in children (and lately, in adults as well), has risen a whopping 700 percent since 1990. According to figures given by Lawrence Diller in Running on Ritalin, over the decade, the number of Americans using Ritalin has soared from 900,000 to almost 5 million -- the vast majority children from the ages of 5 to 12, though there (...) is a significant rise in Ritalin use among teens and adults as well. No comparable rise is reported in other countries, though a much smaller surge has taken place in Canada and Australia. In Virginia Beach, Virginia (perhaps the most egregious example), 17 percent of fifth-grade boys were taking Ritalin in 1996 to control behavior problems and improve school performance. (Boys on Ritalin 1 outnumber girls in a ratio of 3.5 to 1; when I was recently complaining to another mother about my own son's academic difficulties, she said simply, "Welcome to the world of boys.") Stimulants have been used to treat behavior problems in children since 1937; Ritalin itself appeared on the market in the 1960s to treat what was then called "hyperactivity" -- impulsive, disruptive behavior by children who just "couldn't sit still." In recent years, however, the root problem has been identified as "attention deficitdisorder" (ADD), either with or without attendant hyperactivity. Symptoms of ADD, according to the standard survey used in its diagnosis, include: "often fails to give close attention to details or makes careless mistakes in schoolwork," "often has difficulty organizing tasks and activities," and "often avoids, dislikes, or is reluctant to engage in tasks that require mental effort (such as schoolwork or homework)." Symptoms of ADD-H (the variant withhyperactivity) include: "often fidgets with hands or feet or squirms in seat," and "often has difficulty playing or engaging in leisure activities quietly." Ritalin, by most accounts, is remarkably effective in getting such children to settle down and pay attention, with resultant (at least short term) gains in parental sanity and academic achievement. The fear, stated quite baldly, is that as a society we are 1 drugging our children in ever-larger numbers to get them to conform to adult expectations.. (shrink)
“A dynamic developmental theory of attention-deficit/hyperactivitydisorder (ADHD) predominantly hyperactive/impulsive and combined subtypes” is a major contribution linking comparative psychology with clinical developmental neuropsychopathology. In this commentary, I place some critical remarks concerning the theory's explanation of sleep problems, inhibition, error monitoring, and motor control.
Attention-deficit/hyperactivitydisorder (ADHD) represents adaptation to defective neurotransmission – an adaptation seldom with benefit. The resulting behavioural style not only increases vulnerability to adverse experiences, but also creates a context in which encountering adversity is more likely. Furthermore, the fact that ADHD is a highly heritable condition increases the probability of a child with a compromised neurobiological disposition being raised by caregivers with suboptimal resources.
Diagnosable individuals, caregivers, and clinicians typically embrace a biological conception of attention-deficit/hyperactivitydisorder (ADHD), finding that medical treatment is beneficial. Scientists study ADHD phenomenology, interventions to ease symptoms, and underlying mechanisms, often with an aim of helping diagnosed people. Yet current understanding of ADHD, jointly influenced by science and society, has an unintended downside. Scientific and social influences have embedded negative values in the ADHD concept, and have simultaneously dichotomized ADHD diagnosable from non-diagnosable individuals. In social (...) settings insistent on certain types of success, the negative values associated with the diagnostic category are attributed to people in the dichotomized "ADHD" group. Devaluation, institutional restrictions on "success" definitions and endpoints, and limited options for achieving success jointly constitute institutionalized intolerance of ADHD. (shrink)
Sleep disturbances are common for children with attention-deficit/hyperactivitydisorder (ADHD) and are of great clinical significance. Brain dopamine plays an important role for both ADHD symptoms and sleep-wake regulation. We therefore suggest that one basic aspect of integrative brain-behavior relationship such as the sleep-wake cycle may certainly be addressed in a dynamic developmental theory of ADHD.
Previous research (Kielbasa, Pomerantz, Krohn, & Sullivan, 2004; Pomerantz & Segrist, 2006) indicates that when psychologists consider a client with symptoms of depression or anxiety, payment method significantly influences diagnostic decisions. This study extends the scope of the previous research to consider clients with symptoms of social phobia and attention deficithyperactivitydisorder (ADHD). Psychologists in independent practice responded to vignettes of clients whose descriptions deliberately included subclinical impairment. Half of the participants were told that (...) the clients would pay via managed care; the other half were told that the clients would pay out-of-pocket. Confirming previous studies, payment method had a highly significant impact on diagnosis such that compared to out-of-pocket clients, managed care clients were much more likely to be assigned Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) diagnoses. Ethical implications relate to informed consent, accuracy and truthfulness in diagnosis, and psychologists' integrity. (shrink)
This paper explores the ways in which foster children and attention deficithyperactivitydisorder (ADHD) intersect as social and medical categories. Through the method of interpretive biography based on the official case file, this paper shows how the experiences of violence and ADHD become linked in the child's life through the emotion of anger. In this way, it is possible to see how the power dynamics of the medical, educational and welfare systems lock the diagnosis with (...) its embedded meanings into the child's life. It is also possible to see how counter forces like a caring foster family can challenge medical and welfare authorities. (shrink)