By Jerry Morris, PsyD, MsPharm, MBA
MB (Marc Braman, MD, MPH):
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 in the brain working.
JM (Jerry Morris, PsyD, MSPharm, MBA):
That’s well said. In fact, we have pretty clear scientific evidence now that there are genetic loadings in all of us for certain things, and that when we are brought up in a stressful, abusive, chronically insecure environment, it throws many of these genes that are maladaptive in modern and civilized worlds, but were probably pretty adaptive in the jungle. I told a lady in therapy the other day, I said, “You know, now listen, your paranoia and your tendency to really withdraw into a very safe area, almost like a cave in your home, was probably very adaptive when we were back in the jungle and there were signs that there was danger.”
It was certainly adaptive, when you grew up in a home where you were beaten and abused and… So I understand your genetics and how that abuse has thrown those switches, so that that’s become one of your paramount traits that’s expressed. However with therapy, you’ve learned to challenge those thoughts that trigger those impulses and feelings and say, “I’m not in the jungle anymore and I’m not being beaten and I’m in a safe marriage and environment.” And so now you can go out to the Walmart and shop, you can volunteer at the kennel, you’re doing a lot more things.” And I said, “Bravo. You understand genetics and genetic switches and you understand the need to modify the expression of those things.” So yeah, that’s how it works.
So you were mentioning before we got into this session that there was a big formal report based on a lot of really good science by a lot of researchers, outlining what was best treatment based on this newer, better understanding of how genetics and environment work. Can you cover that briefly for us?
Sure, there is now a publication with one of the government agencies. The agency that does all of the protocols for scientific interventions and treatments for doctors nationally. They’ve put out their summary of the science and the recommended protocols based on science for Attention Deficit Disorder. It’s called “Attention Deficit Hyperactivity Disorder: Effectiveness of Treatment in At-Risk Preschoolers; Long-Term Effectiveness in All Ages; and Variability in Prevalence, Diagnosis, and Treatment”. Now that’s mouthful but what it basically does is a great guide that summarizes all of the science about what works and what we should expect to use to treat attention deficit disorders and families with Attention Deficit Disorders. It’s put out by the Agency for Healthcare Research and Quality, it’s put out at www.ahrq.gov and it’s an excellent review and this agency does great work to inform all of we doctors about what works best and what we should be using with certain disorders.
What is first line, second line, third line treatment that is most effective based on the best science?
Okay, the best science right now recommends on the short haul, a combination treatment with psychological interventions, family interventions and education, and there are various forms now, even manualized treatments available for professionals to use in these areas that have shown effectiveness and medications to get quick and early control of some of the symptoms. Now in the long run, the highest rated and most effective treatments are the family interventions and the psychosocial interventions. They really have the most power of effect or magnitude of effect in the research, and that’s made clear in their protocols that they recommend now.
Excellent. So, consistent with the rest of lifestyle medicine, essentially, positive, constructive, healthy relationships are your foundational treatment or foundation for good health.
That’s exactly right and I would add one little sidecar to that, that people who are immersed in positive and effective and healthy relationships, they also channelize themselves and those with them, into positive effective environments, institutions and activities, so that the context is also important.
Excellent. So relationships, the foundation of effective treatment for Attention Deficit Disorder and good lifestyle medicine. Thank you, Dr. Morris.
Thank you, Dr. Braman.
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 www.ahrq.gov Contract No. MME2202 290-02-0020. AHRQ Publication No. 12-EHC003-EF.