ADHD, laziness or both?

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I have a photo collection of fat cats on my computer. I’m certain that they have the ideal life. Rolling around, sleeping most of the day, getting petted, drinking milk, being fed by multiple households . Just thinking about how wonderful that must be makes me happy.

I’ve always considered myself to be a lazy person. The kind who sleeps in, never tidies up, watches a lot of TV, eats junkfood, would rather stay in than go out and someone who  always puts things off, ” why do it now? when tomorrow’s just as good”.  Sure there have been times when I’ve temporarily shaken off the laziness and applied myself. (training for the city to surf, programming assignments at uni, marathon cleaning sessions) but this isn’t the day to day me.

When I got the diagnosis of ADHD initially I was glad to have a reason for why I was constantly screwing up. I’m not proud of being a lazy person/underachiever. But over time a feeling has kind of sunk in, that the diagnosis hasn’t really changed much at all. While I do think I do have ADHD, I don’t think its solely responsible for my past failures. I think if you have ADHD then you have less self control/self regulation than the average person. But less self control isn’t no self control. Every day that I don’t apply for jobs and choose to eat pizza instead of cooking is a day where I’ve made conscious decisions to do those things. Bad decisions, but If I don’t take responsibility for them and blame it on ADHD instead that would just make me a  helpless victim of ADHD.

Laziness is a characteristic that’s probably been around since the start of human existence, you’d think natural selection would have eliminated it, but no. The greeks had some ideas on understanding its cause.

What causes the character trait of carelessness?  We can get 
   insight from Aristotle.  According to Aristotle a character 
   trait is caused by repeatedly doing some particular thing.  
   With repetition it becomes a habit, a character trait.  Take 
   the character trait of laziness as an example.  A person 
   acquires the character trait of laziness by repeatedly taking 
   the route of avoiding work, of repeatedly ignoring the voice of 
   conscience, intellect, prudence in regard to what he ought to 
   do.  He has developed the habit of taking the easy road in 
   regard to work.  He just avoids it.  By repeatedly doing this 
   it becomes a way of thinking, a way of dealing with life.  Now 
   a person who is careless, or negligent, is one who habitually 
   doesn't do the things he ought to do.  He is untidy.  The house 
   is a disaster, in total disarray.  He doesn't put anything 
   away.  What explanation can you give for this kind of behavior?  
   Could the explanation lie in that character trait that we call 
   laziness?  Could it be that he is just lazy?  Why doesn't he 
   put things away?  It is too much trouble.  He doesn't want to 
   go to the trouble of putting them away.  It is just too much 
   bother.  And there is a problem, an obstacle.  He doesn't know 
   where to put them.  He has accumulated so much stuff his 
   storage spaces are all full.  Nor does he want to go to the 
   trouble of figuring out the best way of solving the problem. 
   Of organizing and storing them, or where to store them.  That 
   requires the activity called thinking.  He is averse to that.  
   Thinking, analyzing, figuring things out is just not one of his 
   specialties.  It is too much trouble, too much work.  It is 
   just an activity he shys away from.  So when he changes his 
   clothes he just throws the old ones in a pile on a chair.  He 
   has no self-discipline.  He is impulsive.  He does whatever he 
   wishes.  He buys this and he buys that, whatever his heart 
   desires.  He has a whole lot of stuff and no place to keep it.  
   So his stuff is strewn all over the house in piles.  He is just 
   not a methodical person, never has been one.  His mind just 
   doesn't work that way.  Organizing things requires thought, not 
   one of his specialties.  He is not lazy in everything.  He is 
   not lazy in doing things he enjoys doing.  He has plenty of 
   energy for doing things that give him pleasure.  He can show a 
   lot of perseverance in doing things he likes to do, wants to 
   do.  But with regard to drab, mundane tasks that give him no 
   pleasure, he is very procrastinating, dilatory and foot-
   dragging.  He is impulse oriented, mood oriented, feeling 
   oriented.  He doesn't do what he doesn't want to do.  He just 
   habitually avoids doing things that he doesn't feel like doing.  
   It is a way of life for him.  Confusion and disarray don't 
   bother him at all.  It is a way of life.  He doesn't deal with 
   basic problems at their root.  He just lives with them.

And conversely …

   
   A type of person has something in him that the careless, 
   indifferent, negligent person doesn't have.  What is it?  It is 
   something inside himself that requires him to do the right 
   thing, the honest thing, the intelligent thing.  He has that 
   voice within that tells him how he ought to act - and he obeys 
   that voice.  He is a person who habitually obeys the voice of 
   Conscience, Reason, and Prudence within.  He does what he knows 
   he should do even though it may require a lot of work and be 
   hard.  He habitually takes the high road even though it may be 
   the hard road.  He is not daunted by difficulty.  He does the 
   right thing.  He is a person of integrity.  He has a self-
   discipline and moral strength that the careless person doesn't 
   have.  The careless, negligent person who takes the easy, lazy 
   path in doing things reveals a lack of integrity that will 
   likely reveal itself in other ways as well.

Taken from http://www.solitaryroad.com/a1025.html

Things to think about.

First double blind study shows neurofeedback no more effective than placebo- why this isn’t as bad as it sounds

Neurofeedback (NF) is no more effective than placebo in the treatment of ADHD symptoms show the results of the first double blind study to be conducted, one which made use of sham neurofeedback.

Previous studies have had control groups do cognitive exercises, to simulate a level of mental activity similar to that of NF training. However a better control group is one where every factor except the neurofeedback is kept constant. Here the subject undergoes NF training, however a computer simulated EEG is used instead of the user’s own, also known as SHAM neurofeedback. Thus it is possible to differentiate between the benefits of Neurofeedback itself, and other factors involved in the neurofeedback process (e.g. time spent with therapist, time spent focusing on task, clinical setting etc).

In this study even the NF practitioners were unaware of which group (test/placebo) the subjects had been assigned to. Typically reward thresholds are adjusted manually by practitioners, to make the training progressively harder as the subject improves. However as the practitioners were unaware of whether real or sham training was taking place, the thresholds were adjusted by computer software instead.

The study methodology was not typical in comparison to previous neurofeedback studies. According to a quantitative meta analysis of neurofeedback studies, the bulk of them  have involved either beta/theta training or SCP training protocols at specific sites. Instead in this study individualised training protocols were used.This training was designed to normalize deviations from normal QEEG. Sites to train were chosen by analysing QEEG, with the areas trained corresponding to the largest deviations.

Over a period of four months, both the control and test groups took part in 30 treatment sessions. At the end of the treatment period both groups made substantial improvements in reducing ADHD symptoms, and there was no difference in improvement between the NF and sham NF groups. When the subjects/parents were asked whether or not they thought they were given a placebo(SHAM NF) treatment, 75% of the NF group and 50% of the SHAM NF group thought they were given a placebo.

The fact that less than half the subjects/parents in the test group were aware that they were undergoing NF training shows that the computer set reward thresholds may have been set too high/ were improperly managed by the computer software. Or that there may have been a problem with the site selected for training. Typically a NF practitioner would have some control over training, (ability to change sites/ set reward threshold levels) however this wasn’t the case in this study, and the results show this. Because of this in a future larger study to be carried out by the authors, the reward thresholds will be set manually by a NF therapist.

Both those underdoing NF and sham neurofeedback were similarly uncertain as to if they were being given a placebo or not. While this shows that sham neurofeedback is a suitable placebo, i.e It’s not immediately obvious to the patient that they are not being given a placebo,  it also shows that there were problems with the NF training methodology as the subject should have been aware that they were undergoing NF (e.g. felt a sense of control) . The authors noted that they may have had better results if they had stuck to more popular NF methods such as (beta/theta & SCP training).

The result of this study seems to show that SHAM neurofeedback is beneficial. I won’t go as far as concluding that it shows that it’s as beneficial as neurofeedback, as based on what I think was improper Neurofeedback methodology I would say both the test and the placebo groups were given SHAM neurofeedback. So where is the benefit of SHAM neurofeedback coming from? Is it the clinical setting? the time with the practitioner? the effect of paying attention for a certain amount of time? In this case I’m going to go with the latter. I would say that SHAM neurofeedback is beneficial in the same way that meditation is beneficial. By focusing on one thing (e.g. breathing in meditation, maximising reward in NF training) for a certain amount of time, concentration improves, and this could be responsible for the reduction in ADHD symptoms. However I think neurofeedback may be easier than meditation for an ADHD person, as meditation relies on internal regulation, while neurofeedback relies on external feedback.

Summary

ADHD and EEG-neurofeedback: a double-blind randomized placebo-controlled feasibility study
http://search.proquest.com.ezproxy.slv.vic.gov.au/docview/855953055/13D17177F2155D86E50/2?accountid=13905
Study year:2011
Study Demographics:14 children (ages 8-15)
Five of 8 children in the EEG-neurofeedback group and 4 of 6 children in the
placebo feedback group were medicated with psychostimulants
Study Methodology:randomized double blind study, feedback controlled placebo
ADHD defined via DSM-IV-TR criteria.
control group n=6, active group n=8.
Type of neurofeedback training:Individualised protocols. Designed to normalize deviations from normal QEEG. Sites to train were chosen by analysing QEEG, areas trained corresponding to largest deviations.
“The aim of the EEG-neurofeedback training was to normalize power within specific frequency bands and at specific electrode sites”

Frequency of training: 30 sessions over 4 months, 2 sessions a week.
How outcome was measured: EEG signal measured after training, data supplementary.
Efficacy in the present pilot study was measured by the total severity of inattention and hyperactive/impulsive symptoms of ADHD according to the ADHD DSM-IV scale (DuPaul et al. 1998), rated by the investigator in an interview with the parents. Severity of the ADHD symptoms were rated (with a score from 0 to 3) before training, after 6, 10, 20, 30 training sessions, and 6 months after the end of the training period.
Results: 75% of children and their parent(s) in the active neurofeedback group and 50% of children and their parent(s) in the placebo feedback group thought they received placebo feedback training.Analyses revealed significant improvements of ADHD
symptoms over time, but changes were similar for both groups.