Follows Directions: ADHD and Psychological Adaptations 051797

One of the DSM flags for ADHD is an inability to follow directions. Many young men, covered with Post-It complaints from teachers and mothers, have trekked through my office. Lately, I've asked several, who could not follow instructional directions well or were lost with Mom's chore list, "Can you follow directions to a new pizza shop?" Oddly, some say "Yes," others, "No." One of the young ladies is in academic trouble, "directions" is one of her issues. Yet, she never lapses with directions when caring for younger children.

Psychological Adaptations (PAs) are conceived as information processing systems, subject to evolutionary pressures, and targeted toward survival problems (See other postings for more definition.) Some of these PAs are likely old in our species calendar, others newer. It ought to be interesting to gather 30 ADHD preadolescents and separate their abilities to follow directions in a variety of situations thought to involve different PAs.

For example, Following Directions could be assessed for:

1) Geographic orientation (can they find the pizza shop?) 2) Following recipes 3) Child care 4) Gardening 5) Object assembly 6) Searching for lost items 7) Housekeeping lists 8) Academic tasks 9) Football drills 10) Machine repair 11) Treating an injury 12) Drawing 13) Making a friend. 14) Warfare (Nintendo!)

The scale might be "Does w/o directions," "Does with directions," and "Can't do with written/oral directions"

Some of these items (friends and academics) may be evolutionarily newer, and according to Pennington,(1) more easily disrupted than perhaps travel orientation or hunting routines (such as football drills). Some of them are traditional downfalls for ADHD children. (Cantwell, for example, once commented that social blindness, the inability to recognize other's feelings, is a regular difficulty.) Other domains are unassessed or felt irrelevant to school performance. And, in our culture, school is not usually questioned as a predictor of life success.

The current markings of ADHD (impulsiveness, hyperactivity, and poor sustained attention) may each show dramatic variation in different children as a function of task. Such variability has been rationalized in the past by saying, "They can do it if they're interested." Perhaps "interested" should be rephrased to mean "skilled."

Finally, there is relevance to another view of ADHD, one that is focused on Executive Functions. The Barkley Formulation of ADHD (2) suggests that impulsive behavior leads to relative impairments in language development and retrieval, planning, the sense of time, emotional regulation, analytic skills, and the ability to solve problems constructively. Barkley's model takes us from counting fidgets and call-outs to an analysis of events inside the child's head. Even if impulsiveness has a correlational and not a causative role in Executive Function deficits, Barkley's view is a refreshing and crucial step towards understanding the relevant issues in ADHD, issues that affect peer relations and recurring family and vocational difficulties.

Still, I know children and teens who are ADHD in school and many home tasks (3) yet like to sit and fish. Others at age 10 diagnose, disassemble, and repair 5 HP engines. Still others excel with lifeguard duties or babysitting.(4) I know one very bright 12 yo girl who wants to go hunting with her father. Both of them appear to have ADHD around the house. All of these tasks can require planning, analysis, and synthesis. All of them can involve time management. Thus, even the Executive Functions described by Barkley may interact with task specificity in some children. Given the possible interaction of ADHD traits with PAs, it should be fruitful to include them as part of an ADHD assessment. There is the theoretical interest to see which PAs do and do not have EF impairment even in the same individual and to determine if and how the profile of PAs strengths varies between individuals.(5, 6)

The applied interest, the altruistic one, is that the kids who escalator past me, wearing Post-Its as they enter and Diagnoses as they leave, will get a more helpful set of labels. Self esteem may have its biological roots; however, one cognitive trigger for higher self esteem can be that of knowing that you are better at some particular things. The PAs may provide some of that content.

NOTES:

1) Pennington B (1991) Diagnosing Learning Disorders, NY: Guilford)

2) Barkley R, 1993, A New Theory of ADHD, ADHD Report, NY: Guilford, NY: Guilford. See also, More on a New Theory of ADHD, ADHD Report, 4/94.

3) Barkley has recognized that teacher and parental estimates differ. His suggestion is that ADHD is more likely to be seen by the teacher even if the parents do not. But, even here, there can be sharp interactions with task specificity.

4) There are some ADHD children who are poor with Nintendo!

5) There is a definitional thrust by some (Barkow J, et al., 1992, Adapted Mind, NY: Oxford) that a true Psychological Adaptation must be present in every individual. The argument is that (a) PAs are a product of natural selection; (b) nonuniformity between people would result in the disruption of essential PAs during sexual recombination, (c) therefore, the keep the PAs intact along with our survival skills, each of us must have the same PAs. A supplementary argument is that thanks to culture and relative abundance of resources, there has been on competition between human groups for about 30K years. Given the assumed absence of selection pressures, we must all be the same.

6) Next, depending on your resources, separate male from female performance or compare oral vs. written instructions. Pool R (1994, Eve's Rib: Searching for the Biological Roots of Sex Differences, NY: Crown) cites findings that females usually prefer "landmark" directions whereas males often prefer relational directions to a site.

1999 Copyright, James Brody, All Rights Reserved

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