To start with, yes, the family does exert a significant impact on how we develop. Family reactions to an ADHD child are known to play a significant role in the child’s development of self- esteem, as well as having a role in the development of certain secondary diagnoses, like Oppositional Defiant Disorder.  Multiple studies confirm this.  I refer inquisitive readers to Joel Nigg’s book What Causes ADHD? [1] and Barkley’s Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment [2]. These books are good amalgamations of the body of scientific research on ADHD.  When you look deeper, and aspire to find the facts, you will see that any familial role, outside of genetic inheritance, is secondary to the development of ADHD.  Research continues to point to differences in the brain as the precursors of ADHD symptoms, not problem parents.

For example, the ability to delay an impulse, or wait, is impaired in ADHD, and is, in fact, a diagnostic criterion.  Struggling with waiting, or impulsivity, is, in part, linked to a brain region called the caudate. We know this because when victims of trauma suffer damage to the caudate, impulsivity often appears in people with no prior history of this trait.  Research has also shown that many ADHD boys have irregularities in that part of the brain.  The caudate does not change shape because of the actions of one’s parents. There are gene variants strongly associated with caudate difference in ADHD boys as well.  This is just one of numerous examples that make a compelling case for differences in the structure, size, shape, and functioning of the brain as strongly underlying ADHD.

Further, it is well documented that ADHD involves the frontal dopamine circuits of the brain.  Numerous brain imaging scans have demonstrated this, and the most common medications for ADHD, the stimulants, are known to improve the way the brain metabolizes dopamine.  In addition, several variants of dopamine-involved genes are strongly associated with ADHD.  ADHD is a neurobiological condition.  As with any disorder, the way that parents deal with it does impact the way the child grows and develops.  If the parent of a child with diabetes becomes an overprotective hypochondriac, that child might have some secondary “symptoms” that were precipitated by his or her parents’ behavior.  That fact does not change the truth of the physical condition with which the child must cope.  Blaming parents is counterproductive.  What is needed is more awareness and education about ADHD.

One of the treatments for ADHD is medication and the above-mentioned Op-Ed piece asserts that children are being overmedicated.  There is no research to support that.  I can say, anecdotally, that I encounter more parents who fear medication and resist putting their children on it than I do parents who wholeheartedly embrace the practice.  I suspect that there are some children who take ADHD meds who should not be taking them.  This is part of a broader trend.  Many parents are guilty, for example, of insisting their children be put on antibiotics, even when there is no clear-cut symptomology that warrants it, a fact which is contributing to antibiotic-resistant strains of bacteria.  We still don’t have enough data to make an informed opinion about ADHD over-medication.  Obviously, these are powerful drugs, and parents should go into such a decision with great deliberation and awareness of potential side effects.  I am no great proponent of medication, but I have seen ADHD meds transform lives. 

I agree with Dr. Sroufe that medication is proving not to be a good long-term strategy for a significant segment of ADHD people.  Trying to find common ground, I believe that parent training, like that offered by groups like CHADD, is highly beneficial.  Few of us have the natural inclinations to effectively handle the atypical behavioral profile of an ADHD child.  Positive and productive responses can be taught, but those responses, as well-intentioned and executed as they may be, cannot reverse the symptoms of ADHD.  They can help to create a more well-adjusted child, and perhaps minimize some of the troubling secondary conditions that arise with the disorder.  Parents are not to blame.  They deserve compassion and understanding.  Most parents of ADHD children who I deal with have spent incredible energies trying to help their children succeed.  Dr. Sroufe’s article does not help them.  It only pushes them further into shame and inadequacy, emotional states that will certainly not help them or their children.

1. Nigg, J. (2006). What Causes ADHD?: Understanding What Goes Wrong and Why,

New York : Guilford Press.

2.  Barkley, R. (2006). Attention Deficit Hyperactivity Disorder: A Handbook for

Diagnosis and Treatment. New York : Guilford Press.

The following studies further back up the scientific claims I make in this posting.

Bidwell, L., Willcutt, E., McQueen, M., DeFries, J., Olson, R., Smith, S., Pennington, B. (2011). A family-based association study of DRD4, DAT1, and 5HTT and continuous traits of Attention-Deficit Hyperactivity Disorder. Behavior Genetics, 41(1): 165-174.

Depue, B., Burgess, G., Willcutt, E., Bidwell, L., Ruzic, L., Banich, M. (2010).  Symptom-correlated brain regions in young adults with combined-type ADHD: Their organization, variability, and relation to behavioral performance. Psychiatry Research: Neuroimaging Section, vol. 182 Issue 2, 96-97.

Durston, S., Hulshoff, P., Schnack, H.,  Buitelaar, J., Steenhuis, M., Minderaa, R. et al., (2004).  Magnetic resonance imaging of boys with attention deficit disorder and their unaffected siblings.  Journal of the American Academy of Child and Adolescent Psychiatry.  43(3): 332-340.

Swanson, J., Floodman, P., Kennedy, J., Spence, M., Moyzis, R., Schuck, S. (2000). Dopamine genes and ADHD.  Neuroscience and Biobehavioral Reviews, 24.

Tripp, G., Wickens, J. (2010). Neurobiology of ADHD. Neuropharmacology, v. 57 issue 7/8, p. 579-589.

Volkow, N., Wang, G., Fowler, J., Logan, J., Franceschi, D., & Maynard, L. (2002).Relationship between blockade of dopamine transporters by oral methylphenidate and the increases in extracellular dopamine:  Therapeutic implications.  Synapse, 43: 181-187.

Williams, N., Zaharieva, I., Martin, A., Langley, K., Mantripragada, K., Fossdal, R.,Stefansson, H., Stefansson, K., Magnusson, P.,  Gudmundsson, O., Gustafsson, O., Holmans, P., Owen, M., O’Donovan, M., Thapar, A. (2010). Rare chromosomal deletions and duplications in attention-deficit hyperactivity disorder: a genome-wide analysis. Lancet, 2010; DOI: 10.1016/S0140-6736(10)61109-9.

Yang, M., Ishii, J., McCracken, J., McGough, J., Loo, S., Nelson, S., Smalley, S.(2005). Temperament and character profiles and the dopamine D4 receptor gene in ADHD. American Journal of Psychiatry, v. 162, issue 5, 2005, 906-914.

Suicidal Ideation and Focalin

A few cases of suicidal ideation among teens taking the ADHD stimulant medication, Focalin, have prompted some experts to advocate putting a warning label on the drug. Before you throw your medication in the trash, there are a few things you need to know. During a 6-year period, there were 8 reports of suicidal ideation among children or adolescents who took the drug. Four of these appeared to be linked to use of the drug, since symptoms resolved once the medicine was stopped. The 4 patients were all boys and between the ages of 8 and 11. Approximately 1.8 million children had this medication prescribed over a 6-year period. So, while suicidal ideation is an incredibly serious issue, in this context it is also an incredibly rare one. No cases of actual suicide have been reported. What this situation does reinforce, however, is that many ADHD medications are incredibly powerful. Parents need to research side effects and watch out for them. Medicating your child should not be taken lightly.

Self-Control, Drug Addiction, and ADHD

A study in Science finds that cocaine addicts have abnormalities in areas of the brain involved in self-control. And these abnormalities appear to predate any drug abuse. Researchers discovered abnormalities in fronto-striatal brain systems implicated in self-control in both cocaine-dependent individuals and their biological siblings who have no history of chronic drug abuse; these findings support the idea of an underlying neurobiological component for stimulant drug addiction. This particular brain circuit seems to be involved in a lot of common disorders, such as ADHD, in which individuals struggle to control their response to stimuli that distract them . With this new evidence, the link between untreated ADHD and substance abuse becomes even clearer. Once again, research continues to mount that difficulties in ADHD derive from differences in the brain!

ADHD and Childhood Exposure to Anesthesia

Two recently-reported studies appear to show a link between the administration of anesthesia to children and an increased risk for developing ADHD. The data for these studies came from the Rochester Epidemiology Project. Researchers analyzed school records of children who were born between 1976 and 1982 in Minnesota. Out of the 341 cases reviewed in the studies, children with no anesthesia exposure or just a single exposure to anesthesia had ADHD at a rate of about 7.3 percent. Children who had two or more exposures had ADHD at a rate of 17.9 percent. Researchers also tried to adjust for other risk factors, such as gestational age, sex, birth weight, and comorbid health conditions. To put this information in context, ADHD risk appears to increase with numerous other experiential risk factors, including: fetal alcohol exposure, low birth weight, cerebral palsy, as well as early exposure to lead and other toxicants. Since ADHD is a neurobiological condition, it should come as no surprise that substances that impact the neurobiological environment carry the potential to play a role in the development of ADHD. However, these experiential factors are all rather uncommon. The greatest “risk factor” for developing ADHD is having a parent or sibling with the disorder.

The truth is that the traits of ADHD are, by and large, extreme forms of behaviors that almost all of us exhibit from time to time. Spontaneity is called “impulsivity” when it prevents us from getting along with others, or gets us into trouble. Imagination is called “short attention span” or “distractibility” when we spend so much time in our own world that we do not fulfill what is expected of us as students or workers in the here and now. Energetic people are called “hyperactive” when their behaviors become extreme enough to make others around them uncomfortable, and thus cause disruptions. So, ADHD behaviors are extreme forms of traits that have great utility. However, the parts of the brain responsible for channeling and harnessing the strengths of ADHD people do not function optimally. So while the average person might struggle to remember appointments or the location of personal items, these are daily and constant struggles for a person with ADHD. Genetic and cerebral differences underlie this reality.

Evidence continues to mount that ADHD can be correlated with genetic variants. Yes, variations in DNA seem to underlie the symptoms of ADHD. Many of the gene variants, or polymorphisms, associated with the disorder relate to the operation of norepinephrine and dopamine, two neurotransmitters involved in learning, attention, and memory, among many other important functions. A recent study found that children with ADHD have nearly 50 percent less of a protein that is important for attention and memory. Another study from last month found specific genes that are related to important aspects of the brain’s signaling pathways, in which the above-mentioned neurotransmitters are involved. The science continues to support one very important supposition: ADHD behaviors derive are associated with distinct and meaningful differences in the brain.

I could list hundreds of studies, but my purpose is simply to get you to consider the neurobiological and genetic underpinnings of ADHD. It is not a choice. It is not an outgrowth of laziness. It is simply the product of changes in the brain. The good news is that this “different” brain often has unique strengths and aptitudes that, with proper mentoring and guidance, can be used to great effect. We need to first offer ADHD people compassion, and from that place, we have a good shot at helping them. I urge you to approach ADHD first and foremost from a place of understanding.

He once joked that he was not a pirate, but simply provided shipping services for those engaged in piracy. I like to think that I have some insight into this man’s psyche because in my work I regularly encounter self-centered, neurotic, and antisocial computer and video game addicts.  They are mostly young men who dream of being able to while away their days plugged in to their video game interface and not have to worry about making a living, or developing the social skills that would allow them to have successful personal and professional lives.  Several young men who attend my cyber addiction groups sympathize with “Dotcom” and think he is being mistreated by the U.S. Government.  He has a $35 million dollar mansion with dozens of video game consoles and tricked-out easy chairs all through it.  He lives in a video game paradise, complete with hot women, decadent food, and frequent parties.  Of course young men without jobs, or underemployed,  who live in their parents’ basement idolize this overweight, self-indulgent, socially abrasive video gamer.  While his enormous wealth and his championing of so-called “Internet freedom” seem worthy of respect, a deeper look at his life will hopefully disabuse his admirers of their misplaced veneration.

As a teenager, Dotcom earned a reputation in his native Germany for cracking corporate PBX systems in the United States, and tried to parlay it into a career in data security. That effort led to his arrest on charges of using and selling stolen calling card numbers.  In 1998, Dotcom was sentenced to a probationary sentence of two years for computer fraud and handling stolen goods. According to a report by News Record, he had traded stolen calling card numbers he bought from hackers in the United States.  In January 2002, Dotcom was arrested in Bangkok, Thailand, deported to Germany, and sentenced to a probationary sentence of one year and eight months, and a €100,000 fine, the largest insider-trading case in Germany at the time. Dotcom also pleaded guilty to embezzlement in November 2003 and received a two-year probation sentence. There are numerous other examples of his early transgressions, but clearly these instances paint a picture of a man who does not like to do honest work for a living, and who spent countless hours playing video games—he was a top rated in the world for Call of Duty.  Rather, he likes to scam.

He certainly trumpets “Internet Freedom” but only because he has found a way to easily use the Internet to facilitate crime, for which he had heretofore engaged in with impunity.  This man is a serial criminal who shows no signs of letting up.  What is the alternative to arresting him?  Letting him continue to defraud more artists and creators?

Kim Schmitz and his cadre of fellow hackers are highly intelligent people.  I only wish that more of them could use their talents to really help humanity.  We need cyber geniuses to solve many of today’s problems.  Cyber adepts have recently been doing this with a “game” called FoldIt which allows players to help scientists help find cures for diseases, like HIV.  The world is moving inexorably in the direction of people like Kim Schmitz.  We have to watch out for this type of genius who is often misunderstood, even maligned, in school.  We must nurture this vast powerhouse of potential by making sure that these folks do not get swallowed up by the cyber world.  We must encourage empathy, connection, and compassion.  I have a lot of ideas about how to do that, but I would like you to share some ideas of your own.  Please join the discussion by posting a comment.

I have been meeting with the family once a week and I really feel like a diplomat from the U.S. State Department. Snarky comments, instantaneous dismissals, and hurtful sarcasm have made progress difficult. With help from a very cooperative assistant principal, however, we have begun to put into place a plan that already seems to be paying dividends.

First of all, Zach’s schedule has been changed so that his last class of the day is Learning Strategies. If he works productively in that class, he is rewarded at home. He has to pack his backpack with appropriate materials, do some homework during class, and get the teacher to sign his planner, verifying that he has met the targets of productivity and preparedness. If he shows this to his mother in the car, she says nothing about school, and he receives 60 minutes of video game time. If on that day Zach brings notes from other teachers regarding his productivity in their classes, he gets an extra 10 minutes for each note.

So far, relationships have been improving between Zach and his parents, as well as with teachers. He is using Learning Strategies quite effectively, a fact that has lessened the amount of work Zach must complete at home. This strategy is creative and involves coordination between family and school. The teachers regularly talk to Zach about video gaming time. Instead of scolding his behavior, they empathize with his wasting an opportunity to play his favorite game. Yelling at home has gone down 90%, according to Zach’s parents. I have great hope for Zach and his family and will keep you apprised of their progress.

Be willing to try new and creative approaches with your ADHD loved one. And by the way, healthy lifestyle choices do help ADHD kids succeed. Stay aware of current research and be willing to try new things. My next book, released this June, will offer 200 pages of creative solutions! It is called: Movers, Dreamers and Risk Takers: Unlocking the Power of ADHD.

Study Groups have provided me with the most amazing laboratory for experimentation. The wide variety of ADHD types I regularly encounter necessitates ongoing development of strategies. I still regularly run across new students who stump me, a situation which sends me back to the drawing board to develop fresh tactics. Innovation is a necessity in my work.

My strong suit is creativity, but I also have a secret weapon: I am not a family member. As parents and loved ones contemplate new methods and strategies, it is important to keep in mind that the ADHDer in your life may not take your suggestions. In fact, the strategies I recommend had often been suggested by parents or loved ones; the ADHD folks were just not willing to try them until they started working with me.

I have come to believe that if I let ADHD folks be themselves, fun and excitement will surely follow. I like to say that Study Groups create an ADHD-affirmative environment. Not only do we have serious fun, but we take fun seriously. I have a comedy notebook in the main study room and whenever someone comes up with a good joke, sight gag, or impersonation, we write in the notebook. Humor is treated as a precious asset. It is honored and appreciated. Learn to do this with the ADHDer in your life, and your relationship with him or her will likely improve.

You will find no better tool to interact with an ADHDer than having fun. The interaction will energize and build rapport in a way that you never imagined. Self-help guru,Wayne Dyer, said that “every problem has a spiritual solution.” With an ADHDer, almost every problem can be solved with fun. If you keep that in mind, you may revolutionize the relationship with the ADHDer in your life, and you may help him or her succeed in ways that were previously unimaginable. As you seek to come up with new strategies to help the ADHDer in your life succeed, remember that fun, humor, and excitement are catalysts that will make the process much more effective.

Check out this story about me and my ADHD STUDY GROUPS on Channel 4, NBC, news:
Educator Says Fun is the Key.

A recent study showed that the growing sedentary trend among our youth can be reversed. The study, published in Pediatrics, found that greater amounts of physical activity in young people correlate with decreased amounts of screen time. Researchers surveyed 5,685 households and 7,415 youngsters ages nine to fifteen. One striking feature of their findings strongly suggests that simply establishing limits with children leads to less screen time overall. The holiday vacation can be a time of sloth and indulgence. We all need a break, but it is important that you don’t let your kids disappear into the cyber world. Make them exercise. Link game time to other, healthier activities. Get outside and do things as a family. Sitting in front of a screen seems to be our default nowadays. Find ways to interrupt that pattern!

Better yet, buy video games that do that for you. Aerobic video games, like Dance, Dance Revolution (DDR), are a powerful tool. They train the body and mind, as well as enhancing overall coordination. Fitness-oriented video games attract and engage many of those who generally would not even think about exercising. I recommend that families augment their video game arsenal with these types of aerobic games, and, even better, play them as a family. The Wii gaming system is one I highly recommend because it has multiple aerobic options. Wii Fit, for example, provides a compelling combination of exercise and fun. Many of my cyber-addicted clients struggle with weight issues. Systems like the Wii Fit help beat them “at their own game.”

I recommend EA Sports Active NFL Training Camp for an active workout with a theme that will please and engage any sports fan. It’s like you’re actually in a legitimate NFL training camp, rather than sitting in your arm chair getting fat while you watch your team play on TV! For younger children, I recommend Nickelodeon Fit. The game is packed with 30 scientifically-developed and designed exercises that target a variety of fitness areas that are important for healthy physical development in children. Nickelodeon Fit is the perfect way for parents to ensure that their young children remain active as they are entertained by their favorite cartoon characters. This game helps set an early tone with children that exercise is important. Wii Sports and Wii Sports Resort offer dozens of game applications that exercise the mind and engage the body, and can be played with the whole family. By making use of some of these options, you help create balance for your children, and you might even find that family time is increased and improved. If you do not have the Wii, most game consoles come with aerobic options. Check them out.

If you have one of those youngsters who plays video or computer games to excess, buy yourself the present of parental control devices. You may need parental control software to monitor and control computer time, or in many cases, lock boxes might be more appropriate.  Family Safe Media offers a variety of tools to meet your specific needs. Check out that site! Don’t wait until you have a full-fledged video game addict. This upcoming vacation season would be a perfect time to try out some of these options and get a workable system in place before the stress and busyness of the school year is once again upon us.

Use this holiday season to help your children find balance and to encourage them to be more productive and responsible. The offerings of the cyber world offer parents powerful motivational carrots. Please step up and take full advantage. Happy Holidays!

Kevin Roberts is a recovering cyber addict who runs support groups to help other cyber addicts who struggle to get their lives back on track. His background is in education, and for the last thirteen years he has been an academic coach, helping different learners succeed in school and life. He is the author of Cyber Junkie: Escape the Gaming and Internet Trap (Hazelden 2010).

September 10, 2011:

Dear Kevin,

My addiction started 4 years ago when I started seeing advertisements for World of Warcraft on the internet and on TV, and even in school on shirts. So, Ii walked to the local Best Buy and bought my first copy of my World of Warcraft (WoW). I paid a mere $15 that night to start playing. It was an occasional amusement early, but became an addiction when my relationship with my ex-girlfriend started going south. The emotional turmoil of the unraveling of my relationship was hard to bear, a fact which sent me into logging more and more hours on the game. I started skipping school to go home and play WoW. My room started getting messier and became a gaming “lair.” I never left my room except to use the bathroom, get something to eat, or go to the store for snacks. Later, I bought the expansion to the game, which turned out to be one of the most serious mistakes of my life. I started getting deeper and deeper into my addiction, even lashing out at my family for no reason. My cyber addiction broadened into substance abuse, as I started on the path to drugs and alcohol. A year after my relationship ended, my entire universe revolved around WoW. I was always talking about the game. When i was away from it, my mind obsessed on my what I was going to do when I got back to it. I would say things to myself like, “I need to get home; a Raid is coming up and I need to be there. While I shunned contact with the REAL people in my life, I focused on cyber relationships with people on WoW. I was always in the game, and my ability to differentiate between the game and real life had greatly diminished. I stopped before the last expansion came out and woke up one day and was about to go on WoW. I don’t know why, but on that day, I paused and looked around me, looked at myself in the mirror and saw that my life had taken a turn years before for the worse. I fought my addiction with new friends in the real world. Family members allowed me to stay at their houses for a few days to sometimes weeks to help and support me. I’m now two year off of World of Warcraft and my addiction is still here calling me back, but I fight it by spending time with the ones I love and care about. One thing i have learned from my experience is we all have an addiction, and it will always be there, we just need to know how to fight it. We must help and support each other, and we must NAME the addiction. Simply by naming it for what it is, I have found, we begin to exercise some power over it. I was motivated to tell my story because someone else told her story on Kevin’s blog. Telling our stories holds great power.

Randy, thank you for telling your story. You have helped me continue to act with purpose and intention in my life, rather than waste my life in the throes of cyber addiction. I think you are a powerful person, and I see great things in your future.

Did you know that those with AD/HD who play more than one hour of Internet/console video games may experience intensified symptoms of AD/HD? Moreover, their school/work performance also suffers when they put in too much screen time. This problem becomes even more acute given the easy accessibility of games through the proliferation of mobile, digital devices.

Kevin Roberts began his computer gaming obsession in Angell Hall’s computer lab.  In the ten years following graduation from the University of Michigan in 1993, he racked up 14,000 hours of “recreational” game time.  He held down a job, but spent most of his free time in front of a computer screen.  Support and intervention from friends finally got him to control his cyber behaviors.

Kevin Roberts draws on personal and professional experiences with cyber addictions to take audiences deep into the world of the cyber addict, examining the issues that underlie compulsive urges.  Discussed are warning signs, tools to deal with this addiction, and strategies to ensure that the problem does not take root in the first place, especially with those with AD/HD who are at particularly high risk.

Kevin Roberts is currently an AD/HD coach, director of curriculum for the EmpowerADD Project, and a leader of support groups for those with cyber addictions. His clients include professional athletes, college professors, and teenagers.

The tendency for human life to play out through the cyber world is only intensifying. Social networking via Facebook, Twitter, and blogging continue to supplant face-to-face contact.  Human life increasingly relies on cyberspace. Even the sacred institution of marriage is following this trend.

While tabloids regularly feature titillating tales of internet dating gone bad, one man has sought to give a good name to cyber romance. Gary Hudston, something of a computer adept, has found a most intriguing application for a popular PC game. Through Portal 2, an action-packed, puzzle-solving game,  Hudston(with help) created a level modification that allowed him to propose to his soon-to-be wife while she played the game.   While some have scoffed at Hudston’s choice to not propose face to face, sources say that the bride-to-be marveled at her man’s uncommon creativity.  Cyber boundaries are being crossed and the exponentially-increasing pace of technologically-driven change shows no signs of slowing.  Hudston showed us that the boundaries of the cyber world have no end in sight.

Click on the video to see Hudston’s brilliant mind at work.