Ego Depletion/Decision Fatigue: Some Helpful Reading

I've mentioned the concept of decision fatigue on this blog before, and how it relates to ADHD...but as a quick refresher, ego depletion is a new idea based on evidence psychologists are observing about human nature.

Basically, the new evidence seems to suggest that what we might call "willpower" or executive function (i.e., what those of us with ADHD seem to have so much trouble with) is a real, traceable neurological phenomenon related to our brain's metabolism. What's really important about this is that it means that phrases like, "mental energy," or "emotional resources" aren't just cute turns of phrase, they're speaking to a concrete biological reality.

So what depletes our willpower? According to the research, being tired, being hungry, having to make a lot of decisions, having to exercise willpower in the face of impulses, and feeling anxiety or social rejection.

I hope to see someone with real credentials dig into the question of ego depletion in a brain that already has limited executive function, but I don't expect many surprises there. I'd be willing to bet the strength of the ego has a lot to do with a person's dopamine levels. This is the sort of science that's going to blow a lot of holes in our ability to continue being judgmental about people's "character," but you won't see me crying any crocodile tears over that fact.

Anyway...here's some good reading on the subject:

Good ol' Wikipedia

A therapist's rundown about ego depletion and some advice.

Ego Depletion on the "You Are Not So Smart" blog

I came across this article today:

Unprecedented Reliable Data Proves That ADHD Is Overdiagnosed

So, to summarize, someone decided to go out and do research about the rates of ADHD diagnosis and test the common notion that ADHD is wildly overdiagnosed. They set out to determine whether therapists diagnose ADHD according to heuristic judgements (vague stereotypes of ADHD, basically) rather than established diagnostic criteria.

I have to say, I'm grateful that the reporters included the study's methodology:

"The researchers surveyed altogether 1,000 child and adolescent psychotherapists and psychiatrists across Germany. 473 participated in the study. They received one of four available case vignettes, and were asked to give a diagnoses and a recommendation for therapy. In three out of the four case vignettes, the described symptoms and circumstances did not fulfil ADHD criteria. Only one of the cases fulfilled ADHD criteria based strictly on the valid diagnostic criteria. In addition, the gender of the child was included as a variable resulting in eight different case vignettes."

The thing is, though, what's actually contained in those four case vignettes is important to the interpretation of this study. Presumably, at least some of the three "not ADHD" vignettes were chosen for the study because they did resemble ADHD prototypes. They were red herrings, in a sense.

But what about the opposite kinds of cases? What about cases that don't look like prototypical ADHD, but do fit the diagnostic criteria? I don't see how there could have been any room in this study's methodology to test those kinds of circumstances at all. That leaves us with no data about how often it happens that someone has ADHD, but gets told that they don't. So...if you're only testing prototypical cases, you cannot possibly be proving statistics of "over" diagnosis, only statistics of wrongful diagnosis...and even then, only one particular kind of wrongful diagnosis.