Temperament, Depression, Class and Resilience
Within the first few weeks of life, infants show marked individual differences in their level of activity, their responsiveness to change in the environment and their irritability. Some clearly enjoy being touched and mold their bodies to the person holding them, while other stiffen and squirm and do less to adjust their bodies to another person. These mood-related personality characteristics are called temperaments. There is some evidence that temperament is one of the basic building blocks of the personality. Temperament appears to consist of inborn traits, but they can be modified by parental contact: there is actually a reciprocal relationship between child and parent. The child modifies the behavior and attitude of the parent.
It is commonly said that a child’s temperament is as fixed as handedness or eye color, but this is inaccurate: we have overwhelming evidence that temperament can be changed by environmental influences. This makes sense. In Healing, Meaning and Purpose, we discuss the implications of the new findings about genes in the brain: they do not so much determine behavior as predispose you to the way that you will handle the environment. An important questions is just how plastic is human temperament? To what extent can you overcome your genetic programming and early rearing? Some recent research has indicated that the environment of the first three years of life is not as critical to later development as we used to believe. But I think that it’s dangerous to read too much into this research. Early emotional deprivation may leave the deepest scars and also be associated with physical deprivation. If a developing brain is deprived of key nutrients, it is difficult to catch up later.
More and more research is finding key genes that contribute to temperament. There is important evidence from animal research that the temperament of infant female rats can predict life span in those who develop spontaneous tumors. It is difficult to extrapolate from that to humans, but it is a further demonstration of the incredibly subtle interactions between genes, the environment, behavior and physical illness.
Some important recent research has examined the impact of temperament on the clinical features of bipolar disorder and of ADHD and autistic spectrum disorders. As expected, people with ADHD reported high levels of novelty seeking and high levels of harm avoidance. Patients with autism spectrum disorders were low on measures of novelty seeking, they had little dependence on rewards and high harm avoidance. Cluster B personality disorders, the dramatic, emotional, or erratic disorders ones (antisocial, borderline, narcissistic and histrionic), were more common in people with ADHD and the other clusters A and C were more common in autistic spectrum disorders. This tells us that these tow clinical conditions can have some specific effects on the structure of temperament, and on the risk of developing specific personality disorders.
In a new study in next month’s issue of the Journal of Personality, Kati Heinonen and colleagues from the Department of Psychology at University of Helsinki, have found a correlation between adult pessimism and childhood temperament in low socioeconomic status (SES) families. It is no surprise to learn that children raised in higher socioeconomic groups have a more optimistic outlook on life. But this is what is interesting, and the thing that will launch a great many more studies. It was discovered that the effect of childhood socioeconomic status on pessimism tended to remain the same despite opportunities for socioeconomic fluidity. A person from a low SES childhood who moved upwards in status was less likely to be optimistic as an adult than someone from a high SES childhood who remained in a high SES environment. The inverse also held true, as people from a high SES childhood who moved downwards in socioeconomic status were more optimistic than those who remained in low SES. This indicates that children who had the chance to develop coping strategies during childhood and subsequently developed a sense of mastery and control that protected them in adulthood from the adverse effects of lower SES. By contrast children from lower SES backgrounds who are subsequently upwardly mobile may not have had the opportunities to develop those psychological resources. They are thus unable to benefit as much as possible from later experiences of success.
We already know that pessimism is related to physical and mental health, so this new study provides a critical link between socioeconomic status and long-term outcome. This is essential information for policy makers and for parents interested in helping children develop more effective coping strategies.
This research really proves that some of the excessive optimism of the self-help movement can sometimes be misplaced: just wanting something to be different does not make it so. If you had a lousy up-bringing in impoverished surroundings, it will make it more difficult to bounce back and learn essential coping skills.
More difficult, but not impossible.
Research on resilience has provided us with a great deal of information about developing mastery and coping skills in the face of being in a low SES, and we shall return to some of that work in the near future.
Technorati tags: Temperament Socioeconomic status Resilience Depression Attention deficit hyperactivity disorder Autistic spectrum disorders Personality disorders
An Online Resource for Attention Deficit Disorder
Regular readers will know that I am very interested in attention deficit disorder, and I have written a number of articles on it. (Just click on the Category over on the left hand side).
It a common clinical problem, thought to affect 5% of American adults and an even larger number of children. Yet there is even more to it, in that attentional problems may also be able to teach us a great deal about gender differences in the brain and in psychology. To say nothing of helping us learn methods for improving everyone’s abilities to concentrate, focus and pay attention, at a time when ever more objects and events are demanding our attention.
Additude magazine has as its mission statement "to provide clear, accurate, user-friendly information and advice for families and individuals affected by AD/HD." Even as a professional, I have found the quality of the magazine to be excellent, and they are certainly succeeding in their aims. They certainly do not focus on medication as anything more than one aspect of treatment.
If you are interested in ADD, I highly recommend this resource.
“Life is denied by lack of attention, whether it be to cleaning windows or trying to write a masterpiece.”
–Nadia Boulanger (French Conductor and Musician, 1887-1979)
Technorati tags: Attention Attention deficit disorder Gender differences
Understanding Attention Deficit Disorder as a Long-term Challenge
Regular readers will know that I am a huge advocate of natural and non-invasive methods of treatment whenever possible. But sometimes we reach an impasse, and the only option is to use pharmacological or other types of conventional intervention. But even then, it is a mistake to assume that physical treatment alone will be sufficient to help the individual and their family: it is only sensible also to address the psychological, social, subtle and spiritual dimensions of the person. And we must never lose sight of the positives: some people who have health challenges are transformed for the better, and some “illnesses” may carry gifts with them. I’ve talked about the creativity of people with bipolar disorder and schizotypy and the empathy and innovation that may accompany attention deficit disorder.
There is often a fine balance between the positives and negatives of an illness and the types of help that may be of greatest value.
I have just been involved in a common discussion at this time of year: a young person has quite bad attention deficit disorder (ADD). Since she started pharmacological treatment not only has she risen from being a failing student to getting all As and Bs, but the quality of her life has improved dramatically. Unfortunately, she has been told that she only needs to take her treatment when she feels that it is necessary to complete her schoolwork. Many healthcare providers continue to believe that ADD and ADHD are just academic problems. There is a very good new review article that discusses this misperception in some detail. Prescription patterns show that the majority of school-age children are only being treated from Monday to Friday, and from 7AM to 3PM. Why does this matter?
There is excellent and extensive research about the consequences of non-treatment, and most of it has nothing at all to do with school. If people with ADD and particularly with ADHD are left untreated, they are more likely to:
1. Develop substance abuse
2. Be involved in a serious accident
3. Engage in illegal activities
4. Contract a sexually transmitted disease
5. Have an unplanned pregnancy
6. Become separated or divorced
The article makes a point that we have often discussed with families: these consequences of non-treatment are events that primarily occur outside the school environment. So withholding medicine just when it is needed the most may be a risky business.
We are now seeing increasing evidence that successful pharmacological treatment reduces these consequences of untreated ADD/ADHD to the rates found in the general population. Simply using appropriate medications can protect people from adverse consequences of these problems both now and in the future.
I think that we should look at ADD in the same way that we look at an illness like diabetes. In diabetes, the high blood glucose and elevated lipids are not themselves the problem. They may cause symptoms, but the real danger lies in the long-term physical consequences of high glucose and lipids. It is these that can be so devastating to the person with the illness, causing the so-called complications of diabetes, such as retinopathy, kidney and heart disease.
Similarly ADD/ADHD may cause symptoms – such as problems in school – but it is the long-term consequences that can cause such problems. Children and adolescents, and for that matter some adults with both illnesses don’t realize that these are the main reasons for treatment.
There is a common myth that adults know that they need to take their medication, and so they do. Hands up anyone who has only taken half of a course of antibiotics!!
There is very striking study of adults with ADHD who were asked to do a simulated driving test while on and off their medicines. The people in the study rated their driving performance just the same whether they were on or off their medicines. Despite the fact that when they were off their treatment they were an astounding five “standard deviations” worse in terms of driving safety and responsibility! For people not used to looking at statistics this may not seem like much, but the difference is astonishing. You would not want to share the road with an untreated person with ADD.
We know that within the first three months of treatment 50% of children and adults will have stopped their ADD/ADHD treatment and most studies agree that by 18 months, the figure is around 80%.
We need to get the message out that:
- ADD and ADHD can create some nasty long-term problems if not adequately treated.
- For a host of reasons, most people will stop their treatment, so plan for it, and don’t just wait for it to happen.
- Adequate treatment consists of a lot more than giving medication and hoping for the best.
- People need psychoeducation.
- They need to learn coping strategies.
- The family needs to know how to help and how to deal with the problems that someone with ADD/ADHD may be causing them.
- And people need to know how and when to use medications and how to integrate them with non-pharmacological strategies.
Technorati tags: Attention deficit disorder Attention deficit hyperactivity disorder Substance abuse Treatment
Attention Deficit Disorder, Allergies and Membranes
There has been a long-running debate about the relationship – if any – between allergies and attention deficit disorder (ADD).
As long ago as 1991 a paper seemed to indicate that there were higher rates of hyperactivity in the parents of children with allergies as well as increased rates of allergies in children with ADD. Recently a study from New York seemed to show higher rates of allergic rhinitis in children with ADD. The problem with all this is that we are looking at two common problems and trying to sort out a genuine connection can be tricky.
I started thinking about this problem again, after a recent report that some children had symptoms of hyperactivity, inattention, attention-deficit/hyperactivity disorder, and excessive daytime sleepiness as a result of sleep-disordered breathing. But what was remarkable was the number who improved after they had their tonsils taken out. The tonsils are one of the first lines of defense in the immune system, which is why they so often become enlarged with infections, or for that matter in any kind of immunological reaction. Now I’m not much of one to take out tonsils unless there’s a really good reason, but it is certainly an important observation for anyone who has a child with behavioral or cognitive difficulties: he or she may not be sleeping properly.
I have seen quite a number of people who had physical and psychological problems, including headaches, depression and attentional problems, who turned out to have either allergies or environmental sensitivities, and when those were addressed, the symptoms resolved. I have also seen some people who followed the notoriously difficult Feingold diet with some success, even though the research doesn’t seem to be very supportive of elimination diets. And I’ve seen just as many people who got no relief at all from elimination diets.
I have just done a detailed literature review on the topics of allergy and attention, and I don’t think that we have enough evidence to suggest that everybody with attention deficit needs to see an allergist. But what this highlights is that not all people with attentional problems or hyperactivity have ADD. They may have attentional problems because of sleep disturbance, depression, anxiety, obsessive compulsive disorder and a range of other problems.
There is some exciting research indicating that one of the problems in many cases of ADD is a disturbance in the normal functioning of cell membranes. If that is correct, it may be that there are disturbances in the membranes of both neurons in the brain and membranes of cells in the immune system. That link is not entirely proven. But it has received further credence by the finding that some children and adults with ADD seem to show improvements of both attention and immune function when they take omega-3 fatty acids. I have recently been hearing some encouraging reports from people who have used the Omega-3 Formula made by Omegabrite (And no, I have no link with the company!)
Technorati tags: Attention deficit disorder Allergy Atopy Hyperactivity Tonsils Cell membrane Omega-3 fatty acid
More on the Multi-tasking Mess
I have written about the problems inherent in multi-tasking in a previous post on March 27th. But three things have prompted me to revisit the issue:
1. I had a very kind note from Professor David Meyer from the University of Michigan at Ann Arbor, whose work I praised in my previous post.
2. After the articles in Time and Newsweek magazines, there was a flurry of correspondence from young people saying that we should rejoice in their newly acquired abilities to multi-task. Some seemed to be suggesting that they were in the vanguard of a general and very positive cognitive restructuring in the younger generation. Though it is possible, what they all seemed to be missing was the full import of David Meyer’s work on the increasing numbers of mistakes that creep in as we multi-task, or Linda Stone’s important point about the downsides of continuous partial attention. At the risk of sounding like a reactionary, as I read some of the comments, and as I reflected on the manifest differences in the working styles of students, I kept wondering if some people no longer even realize the poor quality of the work that they are turning in.
3. I have mentioned before that data collected in Europe about the dangers of using cell phones while driving, has lead several countries to enact new laws to restrict cell phones use in cars. CNN has picked up on a report from the National Highway Traffic Safety Administration and the Virginia Tech Transportation Institute. They confirm what any experienced driver knows already: driving takes concentration and vigilance, and chatting on a cell phone, eating, drinking and applying makeup is not likely to be compatible with safe driving. Since moving to Atlanta, I have seen some extraordinary examples of drivers doing just about everything apart from concentrating on driving. The most extraordinary was seeing someone reading a newspaper while doing well over fifty miles an hour. And yes, I’ve also seen more accidents in Atlanta than I have in all my previous years of driving.
So I was thinking: if I could be King for a day, I think that the first thing that I’d do is ban cell-phones in cars except for emergencies. And then we’d stop having cup holders in cars. So it’s probably a good thing that we’ve stopped having Kings in the USA…
Technorati tags: multi-tasking, attention, continuous partial attention,
Further Evidence for Attention Deficit Disorder
You may think it surprising that I would even raise the question about whether ADD and ADHD exist. But when I was trained in the UK, there was still a lot of skepticism about the diagnosis, and there was the constant question about whether Americans physicians, educators and psychologists were simply using a medical label for an undesirable behavior, rather than it being a separate clinical entity. There are still some people – apart from Tom Cruise(!) – who cling to the notion that ADD is not a scientifically valid illness, despite the fact that treatment can transform lives. I recently received an extraordinary article claiming that there’s no scientific basis to psychiatry. Though written by a someone with a medical degree, I found at least twelve factual errors in the article, before he moved on to tell us how to use some natural methods for treating these non-existent conditions!
I have always been strongly opposed to turning natural life events and individual styles into new illnesses, something about which I shall have more to say on another occasion. But for all the people who claim that ADD does not exist, here is a video which helps prove that it does. To me it is even more convincing, because the work was done at my alma mater in London, and the research arose out of that skepticism.
Cell Phones and Relationships
In a recent post I commented on the dangers of multi-tasking, and cited Linda Stone’s excellent term “Continuous Partial Attention.” A little over three weeks ago, Marianne Richmond wrote an excellent post on "Attention: Giving it and Getting It" that discusses, among many things, the role of attention in our relationships.
I have just come across a study that supports everything that we have been saying. It was published in the Journal of Marriage and Family in December and examined cell phone usage over a two-year period in 1,367 couples from the Cornell Couples and Careers Study. Increased cell phone use was linked to increased distress and lower family satisfaction. Being constantly available blurs the boundaries between work and family time.
Be very careful that you are not becoming a slave to that device on your belt.
“The waste of life occasioned by trying to do too many things at once is appalling.” –Orison Swett Marden (American Writer and Founder of Success Magazine, 1850-1924)
Technorati tags: continuous partial attention, relationships, cell phone
Hyperfocus
“Success isn’t magic or hocus-pocus its simply learning how to focus.” –Jack Canfield (American Motivational Speaker, Author and Trainer, 1944-)
We have all been taught the importance of focusing to learn and to get jobs done. But there is also a problem that we call hyperfocus. This phenomenon has been known for centuries; in fact the Athenian Philosopher Socrates had it, and I’m going to put my hand up and admit that I have it too. When I am focused on a task I can easily become oblivious to the world and sit at my desk for many hours at a time without moving. I will not even hear the phone on my desk ring. And I have recently learned the hard way that sitting hunched over a hot computer for hours is not good for the spine. My chiropractor has given me strict instructions to break the spell of hyperfocus every hour and have a good stretch. (Thank you Teresa!). I’ve been giving that advice to other people for years, but doctors are, of course, the worst patients. Now my computer sends me a reminder every hour. Fortunately there can be an upside to hyperfocus, which I shall explain in a moment.
So what is hyperfocus? Interestingly, it is can be a feature of Attention Deficit Disorder (ADD). People with the disorder may not just exhibit distractibility, but may also have a tendency to focus very intently on things that interest them. The ability of a child to sit for hours playing complex video games does not at all rule out the diagnosis of ADD. I have known many people whose hyperfocus lead them to spend countless hours playing games or surfing the Internet, to the detriment of their relationships.
The real problem in ADD is not a short attention span; it is a poorly regulated attention system. It is thought that attentional problems are related to low levels of dopamine in key regions of the frontal systems of the brain, which is why people with ADD tend to be drawn to activities that provide instant feedback, and may also be part of the explanation for the disastrously high rates of substance abuse and impulsivity in untreated patients. Particularly in young people with ADD, they tend constantly to seek out things that are exciting and entertaining rather than schoolwork and chores.
So what to do about hyperfocus? I shall mention in a moment why, in its place, it can be helpful. But when it is interfering with things that have to get done, or causing other problems, here are some tips:
1. Use you computer’s alarm functions: I use a Macintosh, so I’ve been able to set up some fun distractions that come along once an hour.
2. Alarm watches: set the sound and/or vibration that it will be able to break through your hyperfocus. Experiment to find the decibels needed.
3. You can send yourself regular cell phone messages via email.
4. Most modern cell phones have good alarm functions that you can set to help yourself.
5. Kitchen timers are also very helpful.
Though there’s not a shred of scientific evidence to support it, I have also had some successes with the Bach Flower Essence, Chestnut Bud, in reducing unwanted hyperfocus.
I firmly believe that most problems contain their solution. Therefore I try not to fight hyperfocus, but to harness it. For a child with hyperfocus, learning that is active and physical is far more likely to be successful than book learning. Many entrepreneurs have hyperfocus, because they like working intensely on projects that give them a quick and enjoyable payoff. They often find it difficult to work in corporate America, if they have to work at someone else’s speed and at times laid down by another person.
“Successful minds work like a gimlet, to a single point.” –Christian Nestell Bovée (American Lawyer and Writer, 1820-1904)
Technorati tags: attention, ADD, hyperfocus
Partial Attention
“To do two things at once – is to do neither.” — Publilius Syrus (Syrian-born Latin Writer, 1st Century B.C.E.)
Just yesterday I was counseling a successful young businesswoman who was telling me that she was planning to buy a Blackberry to add to her cell phone, laptop, PDA and pager. I strongly advised her not to buy one. Not because I have anything against Blackberries: they are wonderful pieces of equipment, and some people cannot do their jobs without them. My suggestion was based on something else entirely: Overload. Apart from being in business, she is also a mother of a young teething child and the last thing that she needs is yet another device to occupy her attention.
So I was delighted by the remarkable coincidence that this week’s Newsweek magazine is carrying an important article by Steven Levy, reporting on the recent emerging Technology Conference in San Diego that took "The Attention Economy" as its theme. He described an issue that has been worrying me for several years and which I shall be addressing when I am interviewed for Success.com in a couple of weeks time. A former Apple and Microsoft executive named Linda Stone described the epidemic of continuous partial attention.
We have all been multitasking since before our ancestors came down from the trees, but she discussed the way in which people’s attention is now constantly being distracted by a host of new inputs: email, text messaging, instant messaging and a hundred other things. And think of those news broadcasts that since 2001 have regularly had more than one item at a time on the screen. Many people have learned to give only partial attention to the task before them. The downside of this is that the appearance of competent multitasking (“Look mom, I can do ten things at once!”) is an illusion. If you are only working on a project with 10% of your attention, it is going to take much longer to get it done, and errors are far more likely to occur. What if needed is intense focus on one thing at a time.
In a speech, Linda Stone said that I prominent cause of continuous partial attention is "a desire to live as a node on the network." Some people can manage several inputs very well indeed. I often have more than one screen of input open at once, and Bill Gates is able to monitor four active screens at once. But when I’m really concentrating on producing high quality material for you, gentle reader, I turn off all the inputs until I am finished. In fact, checking my email is a reward for having finished the job at hand. While there are many advantages to being in perpetual contact, the balance has tipped more toward distraction, and, as Linda Stone put it, “a sense of constant crisis.”
I am also reminded of the phenomenon of “Flow” made popular by the psychologist Mihaly Csikszentmihalyi. We feel that we are in a state of flow state when we are engaged in self-determined, goal-related, meaningful actions that are moving in the direction that we desire. Having our attention and energy pulled away from the flow is likely to interfere without ability not just to be productive, but also to enjoy life. There is, of course nothing wrong at all with being in continuous contact and communication with others people. But in order to be productive or to enjoy the moment, at some point you need to actually stop the conversation and focus on what you are doing.
Professor David Meyer from the University of Michigan at Ann Arbor is a research psychologist who has demonstrated that multitasking, far from increasing our productivity, actually makes us less productive. Some data from Europe has influenced lawmakers, after research indicated that driving and talking on a cell phone is a particularly bad multitasking combination that has been shown to cause even more accidents than drunk drivimg.
Remember the old saying: “If you chase two rabbits, both will escape.”
Technorati tags: attention, multitasking, Productivity, Work, Stress
Modafinil and ADD
The Washington Post has just reported that the FDA has turned an application from the Pharmaceutical Company Cephalon to have modafinil approved for use in children with ADD, because of worries about a potentially serious skin reaction called Stevens-Johnson syndrome .
This is a real shame: we need more options for treating children and adults with ADD, and although I am a huge proponent of non-pharmacological methods of treatment, the fact is that a lot of people simply do not respond to the methods that we currently have available, and some do not even respond to the medications that are available.
Modafinil had looked very promising: in December 1998 the FDA approved modafinil under the brand name Provigil for treating adults with sleepiness associated with narcolepsy. Its main mechanism of action is to inhibit the reuptake of dopamine in key regions of the brain, effectively increasing the amount of dopamine available. It has been used off-label for excessive daytime sleepiness and last year a study form the University of Pennsylvania indicated that it might help some cocaine addicts fight their cravings. It is an open secret that a great many students and academics have been using it for years to enable them to study and work longer. I remember an article from someone who was due to lecture in India, immediately after his arrival from the United States. He admitted to taking modafinil to help him get through the ordeal.
The application to use modafinil in ADD is not dead. The FDA has said that they want a 3000 patients study to assess the risk of Stevens-Johnson syndrome, and the company will discuss that with them. But it will inevitably mean delays.
