By Jerry Morris, PsyD, MsPharm, MBA

MB (Marc Braman, MD, MPH):
What is it about relationships that tends to contribute to or help cause, if you will, Attention Deficit Disorder?

JM (Jerry Morris, PsyD, MSPharm, MBA):
Yes. There is a saying in a lot of treatment agencies and it goes like this, “What goes around, come around.” And so, the parents themselves have to able to model what they want to be internalized in the child. Now, this goes way back to Freud in the late 1800s knew about introjection and object relations. But to put it simply, what it means for the parent to teach regulation of emotions, regulation of impulses, empathy, patience, focus, attention, and those kind of things, they have to be able to have them themselves and emulate them or model them. If you try to have a family dinner and you have an Attention Deficit Disorder and as will happen with people who are not well-refined in inhibition, they knock over the milk. If you overreact impulsively with your behavior or with too highly-modulated emotions, or if you are to unempathetic about what small hands trying to pass the peas do, occasionally it’s too heavy or unbalanced and they drop them, then that’s what the child starts to internalize and those are the neurons that grow that impulsive, inattentive, uncooperative side of the child.

Now if on the other hand, we can analyze the parents in these families and they’ll have different levels of problems themselves, and we’ll intervene with them to get them to be able to do these repetitions and model the very same traits that they’re trying to develop in the child. Now trouble is… Here’s what reinforcement schedules tell us in the psychological research. An intermittent or a variable reinforcement schedule is more effective at maintaining a trait or a learning than a continuous one. So, all you have to do to maintain inattention, selfish or reactive and impulsive behavior is one out of 10 times, be that way yourself as a parent. And that variable ratio schedule of reinforcement actually will not allow extinction of that behavior in a more significant way than if you do it a lot because you know, the animal’s always thinking, “Well, I had it right the first time ’cause see it’s still there”. The parental side is big. Yeah.

So in essence, what I think I’m hearing is that at least to a large degree, kids are being taught or are learning these attention deficit problems?

Yes. We know that now from some of the scientific societies that are making protocols and showing what works with these patients and these families, and it’s always a family component that’s essential to really scientifically validate interventions with ADHD now. And we know this too, we know that there’s a genetic loading in many of these disorders to cause people to be more reactionary and act out, but that these behaviors are literally throwing genes switches to either cause them to be manifest or cause them to be inhibited.

So, this gets actually into my next question, which is how much of ADD is genetic and how much is learned or from the environment? And what you’re just referring to with genetic loading, is that there may be a genetic tendency, but that what happens in the environment at a dinner table, with a family at school, is either bringing out that genetic tendency or changing it to a more functional, healthful way of living and being and the brain working.

Routine and ritual elements in family mealtimes: Contexts for child well-being and family identity. Fiese, B. H., Foley, K.,& Spagnola, M. (2006). New directions for child and adolescent development, 111, 67-89. doi: 10.1002/cd.156.

Adolescent and parent views of family meals. Fulkerson, J. A., Neumark-Sztainer, D., & Story, M. (2006). Journal of the American Dietetic Association 106(4), 526–532.

Family dinner meal frequency and adolescent development: Relationships with developmental assets and high-risk behaviors. Fulkerson, J. A., Story, M., Mellin, A., Leffert, N., Neumark-Sztainer, D., & French, S. A. (2006). Journal of Adolescent Health 39(3) 337–345.

requency of family meals and 6-11-year-old children’s social behaviors. Lora KR, Sisson SB, DeGrace BW, Morris AS (2014). F. J Fam Psychol. 2014 Aug;28(4):577-82. doi: 10.1037/fam0000014. Epub 2014 Jul 7.

Attention Deficit Hyperactivity Disorder: Effectiveness of Treatment in At-Risk Preschoolers; Long-Term Effectiveness in All Ages: and Variability in Prevalence, Diagnosis, and Treatment (2011). Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 Contract No. MME2202 290-02-0020. AHRQ Publication No. 12-EHC003-EF.

Jerry Morris, PsyD, MSPharm, MBA

Dr. Morris is former President and current Executive Director of the American Board of Medical Psychology. He has owned and operated mental health hospitals and community centers and has run residency-training programs. He has managed clinical programs that treat lifestyle related diseases and is a member of the American College of Lifestyle Medicine.

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