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.

ADHD And Disability Accomodation

As some of my readers may know, I worked briefly as an employment specialist for a non-profit company working with people with mental illness. One of my responsibilities was to work with employers on negotiating "reasonable accommodation" (as per the Americans With Disabilities Act) when it came to mental health disabilities.

I was no expert and frankly, was pretty well out of my league at the job, so I can't claim to have perfect advice in this area. But I still think it's a useful discussion to have and one I don't see many people with ADHD having.

What, exactly, are "reasonable" accommodations for people with ADHD on the job site?

Willpower and the ADHD Brain

If you're reading this blog and you don't have ADD, I'd like to ask you to do a little mental exercise with me.

Think back to when you were five years old and your parents told you to put your toys away after you finished playing with them. Remember the resistance you felt to this activity, how spirit-crushing it seemed to do this chore when you wanted to move on to some other fun activity, like playing outside. Remember the effort it took to accomplish this task, if you could even do it on your own (which you probably could not).

Now...think about that same task now, and how it would look to you as an adult. Why, it's only probably six or eight toys that just need to be placed in a bin or on a shelf. That's no trouble at all. You can do it in about 30 seconds without a second thought. You may even find it pleasurable as you're spurred on by thoughts of how nice the clean floor will look and how useful it is to have things organized. Think that's emotional maturity?

WRONG: your brain has changed! Where you were once a creature of impulse, you now have higher brain functions that numb out those childhood feelings of resistance AND give you rewards (dopamine, I think?) for carrying out the tasks that your executive functions set forth. What was once a great feat of willpower is now a very easy thing indeed.

For the ADD brain, however, this change does not take place, or it does not happen to the extent that it should. But because most people don't understand the neurology of childhood brain development, we don't experience an overabundance of sympathy and understanding in response to this limitation. Instead, we get lectured and shamed and blamed and goaded and most of all, told we need to "try harder." We deeply internalize these messages about our own inadequacy. For those of us who never get a diagnosis, we never examine them. Even for those of us that do, the guilt mechanisms are already well in place and are constantly reinforced throughout life.

If there's one thing I'd like to communicate to anyone who ever reads my blog, it's that ADD is a genuine disability. It's as real as any physical limitation, however much it may not be visible. Though it's important for all people with neurological disabilities and differences to advocate for themselves, I believe it's especially crucial for those whose disabilities are, themselves, exacerbated by the guilt and shame of being blamed for our troubles and/or not taken seriously.

So please, my friends...always remember that compared to what it's like for us? Your toys pick themselves up.