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Nov 2

29m 2s

Episode Summary 13: What Is Neuroaffirmi...

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This is the third and final episode in our series on Dr. Russ Barkley's approach to ADHD. In the first episode, we looked at how ADHD gets diagnosed and why diagnosis rates keep climbing. In the second episode, we covered the medication research - including the largest ADHD treat ... Show More

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A while back I sat through an hour of Dr. Russ Barkley, a global expert on ADHD, walking through the statistics: more car accidents, more health problems, and a life expectancy he says is 7 to 13 years shorter, driven mainly by a lack of impulse control. When the hour was over, I remember thinking that if I had a kid with ADHD, I would be absolutely terrified. Right after that, I took a second training, Becoming a Neuro-Affirming Clinician, hosted by B. Lourenco. The difference between the two couldn’t have been more profound. Barkley starts with executive function and asks how to fix it. B. Lourenco asks why executive function is hard in the first place, and what we can do to support people with ADHD that might involve medication, but might not. In this conversation, B. Lourenco explains why she thinks ADHD starts with attention regulation, and what she says to Dr. Russ Barkley’s claim that impulse control drives that shorter life expectancy. We talk about Dr. Russ Barkley’s view that kids shouldn’t get any say in whether they take medication, and what a parent who desperately longs for quiet and predictability can do when their kid wants noise and novelty all day long.

Questions this episode will answer

What does neuroaffirming mean? Neuroaffirming approaches start from the idea that ADHD is one of the ways brains work, and that it has been around about as long as humans have. It takes out the shame, then looks for ways to adapt that fit how you work and for the strengths that come with ADHD. Does ADHD shorten life expectancy? Dr. Russ Barkley says it does, by 7 to 13 years, driven mainly by poor impulse control. B. Lourenco agrees that health outcomes differ but disputes the explanation, because a doctor who sees only impulse control can miss co-occurring conditions that affect health. Are kids with ADHD overmedicated? B. Lourenco says over-medication was real for a generation of kids: too many were medicated, and many were given too much. She also says medication helps a lot, but it doesn’t have to be the first or only tool. Should kids get a say in whether they take ADHD medication? Dr. Russ Barkley says no; the decision is the parent’s alone. B. Lourenco points out that this denies children’s autonomy. How can parents help children with ADHD? B. Lourenco shares two important ideas for a parent who is just starting to wonder: stop blaming and shaming yourself, because nothing is fundamentally wrong with you or your child. Secondly, build connections with people who will support you without the shame and judgment of the wider culture.

What you'll learn in this episode

Why B. Lourenco thinks ADHD starts with attention regulation in a nervous and sensory system that works differently, and why executive function struggles follow from that
Why ADHD traits were useful for most of human history, and what changed in the last few hundred years
What B. Lourenco says to Dr. Russ Barkley’s claim that impulse control drives a shorter life expectancy, and the co-occurring conditions a doctor can miss when that’s the only explanation
Why over-medication was real for a generation of kids, and where medication fits as one tool among several
What it can look like when a parent who wants calm and a child who wants noise and novelty both get to exist, including a mom break scaled to your child’s age
Two things B. Lourenco would tell a parent who is just starting to wonder about ADHD for themselves or their child

Want to hear the full conversation?

The full conversation with B. Lourenco is available to Sustaining Supporters of the show and to Parenting Membership members. In it, B. Lourenco walks us through PINCH, a practical model for motivating a person with ADHD to do things like getting out the door and doing homework, and why leaving things until the last minute can be a strategy, even if it doesn’t have to be your only one. We also look at the homework fight from a different angle, asking whether you value it or just think you’re supposed to, and why high school doesn’t have to take four years. B. Lourenco explains the social model of disability with her glasses analogy, and we get into how decisions our society has made about cars and the tax code create challenges for people with ADHD that have nothing to do with impulse control. And we talk about the risks of getting a diagnosis compared with the risks of going without one. The whole episode is available in a private podcast feed immediately after you become a supporter of the show. As a Sustaining Supporter, you’ll hear extended conversations like this one with the experts I bring onto the show, plus occasional bonus episodes with my own analysis that aren’t released anywhere else. If you’ve been told the problem is your child’s brain, and something in this episode made you wonder whether that’s the whole story, this is where you hear the rest of it. Click the banner to learn more. Jump to highlights 01:34 Introduction: Jen's contrasting experiences with Dr. Russ Barkley's ADHD training and B. Lourenco's neuroaffirming one 03:59 What's in the full conversation for sustaining supporters, and the start of the interview with B. Lourenco 04:31 What the dominant "executive function deficit" framing of ADHD misses 07:35 Why ADHD traits were adaptive for most of human history and fit less well in today's world 09:24 Responding to Dr. Russ Barkley's claim that impulse control drives reduced life expectancy 13:09 Does more control ever help? Driving, rules, and why structure people will actually use beats control 15:02 Jen's explanation of what "neuroaffirming" means, and how this shapes an approach to medication 17:44 Medication as a tool that doesn't have to be the first or only support 19:05 When a parent who needs calm and predictability has a child who craves novelty and noise: neither is wrong 23:21 B. Lourenco's advice for newly identified parents and parents of kids with ADHD: drop the shame and blame, and build connection 26:28 Jen's wrap-up: mom breaks, the missing village, and changes for the margins helping everyone