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Integrated Christian Counseling

The Biological Basis of ADHD

Dr. Brian Campbell

 




Students:


As we learn about ways to integrate psychology and theology in Christian counseling, it is important to keep in mind that modern science is revealing that many (if not,
 all) psychological disorders have an underlying biological basis.  
The Christian counselor who wants to effectively help clients, needs to be aware of research regarding the biological and neuropsychological concomitants of psychological disorders.  Let's look for a moment at a disorder that has a proven biological basis..


How can our understanding of biology and brain chemistry be useful when considering a disorder such as Attention Deficit Hyperactivity Disorder (ADHD)?  Let's take a brief look and then I will tell you a funny story that takes you inside the Christian counseling room and allows you to see the impacts of underlying neurochemistry (and therapist-specific factors that influence counseling).


Although I was never diagnosed with ADHD as a child, I've come to realize as an adult that I certainly met all the criteria for this disorder when I was young.  I always knew that I was a very active child, but no one at that time had a label that would characterize the difficulties I sometimes had in school.  Not only was I a bit "hyper," I also had significant problems paying attention in class.  In fact, I have distinct memories of the teacher droning along at the front of the classroom as I stared out the window.  As she talked in a monotone, my mind drifted to the playground where I used to love playing kickball--now that was exciting!  At other times, I became fixated looking out the window at the janitor who was mowing the lawn outside the classroom.

 Fortunately, God gifted me with enough intelligence to "make it through" my school years.  In fact, I never knew I had ADHD until sometime after graduate school.  It was only then that I realized that the characteristics of my mind seemed to fit the relatively new diagnosis of "Attention Deficit/Hyperactivity Disorder."  At one point, I even had to convince my wife that I had the disorder.  However, once I listed the symptoms, I no longer had to convince her.  Over the years of our marriage, it certainly has been a struggle for us, as a couple, to cope with my disorder.  For example, I can't tell you how many time I have asked my wife:  "Honey, do you know where I put...?" or, "I can't find my...?"   As you may know, forgetfullness is one of the hallmarks of ADHD.

 

Recently, modern science has started to reveal some fascinating information regarding the ADHD brain and underlying neurological functioning.  For example, in ADHD individuals, there are areas of the brain that are chronically understimulated.  One of the chief characteristics of my brain is that I need a lot of stimulation and get bored very quickly.  This is a more-or-less chronic condition for me.  I can only focus on things when they are interesting or stimulating or when I'm  pressured and under stress.  As you might guess, this makes it extremely difficult for me to pay attention to my wife as she tries to tell me the details of a shopping trip to the mall.  She's learned to detect when I've stopped listening--my eyes sort of "drift away."

 

Although I have never taken medication for my ADHD, I certainly have considered it at times.  Many, many children are diagnosed with this disorder in our society (perhaps "over-diagnosed.)"  Some children benefit tremendously from selected psycho-stimulants.  Many adults also take medication for this disorder.  As a Christian counselor, you need to be aware of the biological basis of ADHD and keep abreast of the scientific research that is giving us new insights into this disorder.

 

Praying for someone with ADHD is important.    However, in addition to prayer, it is important to understand this disorder from a psychological/neurological perspective.  Remember, science is giving us information every day that helps us understand "God's work" (human beings).  Please don't ignore the valuable information that helps us understand how God made us and how we function.

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I'm writing a book on ADHD and I thought you might want to have a few laughs.  Here is a section that I worked on a while back.  I am writing this story to my children. 

 

 Flash!  People with ADHD are often very talkative.  One reason for this is that they find the rest of the people in the world boring and uninteresting!—just kidding, but I think you get my point!  As I mentioned above, when a conversation gets boring and I’m about to fall asleep, or take off to visit another planet in my mind, I sometimes just decide to provide my own stimulation in order to stay awake. 

 

In fact, I have been known to talk loudly and enthusiastically for five solid minutes—without ever taking a noticeable breath.  Once I get going, I’m hard to stop.  Even when your mother tries to discretely elbow me in the ribs, I can simply ignore this prompt and keep going.  I’m Jay Leno, or Socrates, and I’m on fire! 

 

.  .  .  Sorry, for a moment there I almost stood up on my chair and started pontificating.  I have to say, it sure does feel good when I am dominating the conversation.  It’s fun!  It’s exciting!  I’m so incredibly interesting and insightful (at least I think so).  I’m a legend in my own mind!

 

This loud, hyper-verbal behavior works great when you are talking to other people with ADHD.  You see, they also are bored and trying to stir up some stimulation, so it works out great.  It’s fun when you get a good verbal jousting match going.  It’s like having a fist-fight without throwing a punch.  It can be incredibly exciting! 

 

This is at least one reason why ADHD people argue a lot.  They don’t mind getting into a “dog fight.”  In fact, they have a distinct advantage when things get “hot” and stimulating.  After all, deep down they are hunters, and they don’t mind a good fight every once in a while.

 

Unfortunately, as a counselor, I have been known to dominate the counseling session with my clients.  I try not to do this, but it is very difficult sometimes.  In fact, my worst nightmare is having clients who don’t talk very much.  At times, it’s like watching wall paper to see if it is moving.  Nothing doing, there’s no life!  Now, let me describe a horrific experience!

 

I had a married couple who used to come to see me (more than 15 years ago), who were dead ringers for the elderly couple in a painting called “American Gothic,” by Grant Wood.  You probably remember the painting.  It depicts an older couple (farmers), standing and holding a pitch fork between them, with the most somber and expressionless faces you could ever imagine.  Well, my clients were just about as “emotionally dead” as the people depicted in the picture. 


 

Now, as a psychologist, I was certainly sensitive to their problems, and I tried very hard to help them, but from a stimulus standpoint, their combined stimulus value didn’t even register on the stimulus scale (if there is such a scale).  Our therapy sessions typically started with me asking them about their week.  I usually addressed this question to the older gentleman, while his wife sat next to him—motionless, with her hands folded, looking somewhere toward my bookshelf (but definitely not looking toward me). 

 

After posing my question to the elderly gentleman, I waited patiently for an answer.  I waited…and I waited…and I waited.  I saw him move a little bit, so I knew he was still alive, but no words were coming out of his mouth.  Finally, after I had travelled to another galaxy and returned back, he spoke up and said, “Hum….” 

 

That’s it!  I’m deadly serious.  All he said was, “Hum…”  That doesn’t even count as a word.  It was just some sub-vocal sound! 

 

I waited, and I waited, but still nothing!  I could feel myself starting to slip away.  I wasn’t going to be able to hang in there much longer.  I was slipping into a wormhole, into an entirely different space-time continuum.  In desperation, I decided to start talking.  I didn’t want to be rude and “talk over him,” but I quickly justified my actions by making the autocratic judgment that “Hum” really wasn’t a word anyway, so I could go ahead and “interrupt.”

 

So I tried again, this time with a somewhat more provocative question, hoping to stir up some emotion—or at least speed up the conversation a little.  “How have you been getting along with your wife?”  (I thought this question was particularly clever, because I was hoping it would get the man’s wife to flinch, and maybe look my direction).

 

Nothing…nothing at all!  Just complete and utter silence!  The wife didn’t move a muscle, and nothing came out of his mouth.  I’m dead, I thought.  I’ve just gone to ADHD Hell.  Or, was it just purgatory?  I’m a protestant; so I guess it was Hell—definitely Hell!

 

This agonizing scene went on for longer than I could ever imagine.  At one point, after what seemed to be a light year or two, I took a furtive glance at the clock.  I shouldn’t have done this.  Only five minutes of the hour-long session had elapsed. 

 

That’s it I can’t take it any longer!  I’m going to have to use my time-honored “squeeze your pen between your fingers and cause pain,” trick.”  Through experience, I had learned that this tactic would usually give me a few more minutes before I “checked out” completely, and my reticular activating system literally shut off my brain.

 

If that didn’t work, I would have to go to my final “desperation” tactic.  I would excuse myself to go to the bathroom.  Once I reached the bathroom, I would pretend to use the toilet, do a fake flush, and then start splashing cold water on my face.  In between splashes, I would look in the mirror above the sink and think to myself: 

 

Tell me again...Why was it that you decided become a psychologist?