Attention Magazine February 2022

Ari Tuckman, PsyD, interviews Russell Barkley, PhD

ARI TUCKMAN: How did you choose ADHD as your topic of specialization?

RUSSELL BARKLEY: I was an undergraduate psychology student at UNC Chapel Hill and realized that to go to graduate school I needed to do more than just get good grades. So I walked around the medical school child development and rehabilitation center and offered to give ten to fifteen hours a week of my time to any researcher who needed a free research assistant. As luck would have it, I was referred to a psychologist, Donald Routh, who had just received a grant to study hyperactive children as well as their medication response. He consented to let me help with his research, shortly after which I became his honors student in psychology, did my honors thesis with him, and worked on his grant. I was fascinated by the children I observed for him. And he served as an influential father figure to me over the next fifteen months, encouraging me to enter the field of child clinical psychology instead of developmental psychology, as I would have a better chance at employment once I completed graduate school. I took his advice, went on to Bowling Green State University for my doctoral training, and wound up working with a former student of his, the late Douglas Ullman, then on faculty. I chose to continue studying hyperactive children for both my master’s thesis and doctoral dissertation, publishing both studies as well as the related literature reviews. And I have stayed with the topic ever since. The disorder fascinates me as a window onto how typical human self-regulation may develop by studying when it goes awry, as it does in ADHD.

What was it like working on ADHD in the early days compared to now?

It was an exciting time, as many young professionals like me were moving into the topic to study thanks to their mentors, such as Carol Whalen (Steve Hinshaw was her student), Jan Loney (Richard Milich), Virginia Douglas (Susan Campbell), Rachel Klein (Howard Abikoff), Gabrielle Weiss (Lily Hechtman), Robert Sprague (John Werry), Marcel Kinsbourne (Jim Swanson), Keith Conners (Karen Wells, Jeff Epstein) and many others. Far less was known about ADHD then, and so it was much easier both to keep up with the new research being published as well as to make contributions to the field through one’s own research. With several hundred thousand papers now published and thirty-plus being published per week in journals, it is far harder to keep up with it these days, though I try, and more difficult to make unique contributions to the field.

You have always been a strong proponent of following the science when it comes to diagnosis and treatment. You have been a tireless researcher, but also an eager disseminator of empirically based information to researchers, clinicians, and members of the public. How do those two roles relate to each other?

For many clinical scientists, they are not related at all. Most clinical researchers concentrate on getting grants and publishing journal articles, as that is how they advance in their academic rank and status within their universities. Indeed, many condescend to or outright distain making efforts to disseminate their findings to the lay people with the disorders they are studying. It is seen as detracting from their career goals. But I was strongly influenced by the examples of Jacob Bronowski, who in the 1970s created the Ascent of Man series for PBS, then later Carl Sagan and his series on astronomy, and then Richard Dawkins and his popularizing of the theory of evolution through his many books.

So, whenever an opportunity presented itself, I gladly gave lectures to professionals, schools and educators, and lay people. I saw immediately how the findings from our research could help to change their lives for the better and do it faster than would be the case for the five to ten years it takes for journal articles to filter down and influence clinical practice and people’s lives. People were so eager for findings from recent studies that could improve their understanding and care of their loved ones with ADHD that I found it incredibly rewarding to provide such lectures to them. And then I decided that, besides writing books for professionals, I would write some for parents and families with children with ADHD, and later for adults with ADHD. I think my trade books have had a far larger impact on the lives of people than any journal article I ever published.

Looking back on a career spanning more than forty years, what would you do differently if you could?

Nothing major. I was fortunate to be able to follow my curiosity and explore new ideas about ADHD and usually was able to garner grant support to do so. I don’t think I would change a thing, given how incredibly fortunate I was to find work doing the things I found so meaningful in my professional life.

What do you see as the future of the field of ADHD? What should today’s researchers and clinicians be focused on?

There will be obvious benefits from all the studies being done on molecular genetics, the role of ADHD risk genes in building and operating brain networks and the behavior and cognition for which they are responsible. This is being coupled with neuroimaging to understand how ADHD risk genes impact brain functioning. But it will also likely lead to new and more targeted medications, assist with diagnosis someday (not yet), and maybe even lead to ways to prevent ADHD or at least mitigate its many impairments and comorbidities. I think those two fields—genetics and neuroimaging—are making the most headway right now in understanding etiologies of ADHD.

We have also identified within the population of those with ADHD a second disorder, previously called sluggish cognitive tempo, that is very different from ADHD but was lumped in with it in earlier years as ADHD was the only attention disorder diagnosis. But the discovery of this second syndrome, soon to be called cognitive disengagement hypoactivity syndrome, alerted us to the fact that there is more than one attention disorder and that it is quite different from ADHD. It is manifested by staring, mind wandering, daydreaming, mental confusion, and sometimes a sleepy appearance, along with reduced motor activity at times. I have been privileged to serve on a work group with the leading researchers in the field on SCT (CDHS), and we just completed a review of the literature this month that will be published in a journal early next year. It sets forth what we know and also directions for future research as well as renaming the syndrome to something less pejorative or offensive.

As you know, I think ADHD is a disorder of self-regulation and its underlying executive functions. So, I think adding more symptoms of those problems to our diagnostic criteria will help improve diagnosis, but also show us that the disorder is far more stable over development and that fewer people outgrow it than is currently the case in longitudinal studies that rely on DSM-5 and its childhood-focused symptoms. I also think it dignifies the disorder better than does referring to it as just an attention disorder, which many people do not find to be especially serious as a syndrome.

Russell A. Barkley, PhD, is an internationally recognized authority on ADHD in children and adults who has dedicated his career to widely disseminating science-based information about ADHD. Read more about his life and his many accomplishments at http://www.russellbarkley.org/about.html. Dr. Barkley fully retired from the profession of clinical psychology and neuropsychology at the end of 2021.

Ari Tuckman, PsyD, CST, is a psychologist and sex therapist in private practice in West Chester, Pennsylvania, a former member of CHADD’s board of directors, and co-chair of CHADD’s conference committee.