Shirah Vollmer MD

The Musings of Dr. Vollmer

ADHD: Slowly Developing Brain

Posted by Dr. Vollmer on February 23, 2011

   “When is she ever going to grow up?” Arline, the mother of Jolie, age eighteen, asks me, with a tone of frustration, impatience and anger. “ADHD tends to cause a three-year lag in emotional development,” I try to explain to her in a flat tone to say that Jolie is going through a slower developmental trajectory than the average child her age. “Yea, but look at her,” Arline continues, “she is not motivated to do her homework. She is texting all the time. I mean all the time.” Arline continues with her frustrated tone. “I think you should use an incentive program for her to do her work, but at the same time, I think you need to understand that she is a late bloomer, so you need to have some patience with her development.” I try to explain in a way which is supportive to Arline and Jolie at the same time.

    Developmental change, the rate of development, is a variable in personality which is hard to contemplate because we cannot measure it. I imagine that the brain is developing, along with the other organs in the body, and as such, the DNA instructs this rate of development, as it does for height. Everyone grows at different rates, but most people stop growing around twenty. The rate at which people achieve their final height varies. Some people are done at twelve, whereas others are still growing in college. Girls tend to start their growth spurt before boys, and they tend to stop growing before boys as well. Brain development is probably similar. Girls mature before boys. In general, they reach their developmental milestones earlier. They develop speech sooner. Girls, in general,  are not smarter than boys, but a three-year old girl who has sophisticated speech seems smarter than a three-year old boy who is still speaking like a telegraph. Understanding that the brain is also developing at a rate which we cannot measure, but we can infer from the type of decisions the person makes, helps us understand that growth is in progress. With this understanding, intervention can be tailored to the person’s developmental, not chronological age.

    Arline looks at me and says “do you have children?” She seems to be trying to figure out if I have any idea about her parental frustrations, her worries, and her guilt. “I am happy to answer that question,” I say, “but tell me why you are curious. Do you think that if I have children, then I have a better idea of what it might be like to be concerned about how a child is eventually going to be independent, whereas if I don’t have children, then I would not be clued in to the feelings associated with having a child who is not responsible.” I ask, trying to guess why she is feeling so alone in our session. “Yea, I am not sure you understand how worried I am.” Arline says with deep feeling. “I am sorry if I have not conveyed my understanding, but I feel as if I do understand,” I say, trying to state that although she feels alone, I can feel, at least in part, her trembling anxiety over Jolie’s future. “I am going to think about this slowly developing brain idea, but right now, I don’t get it,” Arline says in a calmer voice. “Think about it,” I say, feeling like Arline is a bit more open, and perhaps more able to accept Jolie’s biology. “It is not easy being a mom,” Arline says with lightness. “Yep, I get that,” I say, mirroring her easy going tone. “There is a lot at play in helping a human being develop,” I say, stating the obvious, but feeling like I need to express the complexity of parenting. “More than I ever thought,” Arline says, allowing us to connect in a warm way.

4 Responses to “ADHD: Slowly Developing Brain”

  1. Shelly said

    Shirah, c’mon. An incentive program at 18? That is NOT going to work. What kind of incentive can Arline give her daughter? The keys to her car?

    • Yes, the keys to the car…etc. Incentives work frequently-they get us up and going. I agree that they don’t always work, but it is worth a try. Besides, what is the other option?

  2. Kristin said

    What did you mean when you said, “I am happy to answer that question”? Did you answer it, or were you simply trying to deflect the question? Do you think your personal life experience is ever relevant to your understanding of your patient’s experience? If so, wasn’t the patient’s question understandable and valid?

    • Shirah said

      I meant that there is a content answer, such as yes or no, but there is also, as I perceived, a hostility to the question. It felt to me like the question came from a place which implied that there is no way I was understanding her situation and therefore I was not being helpful to her. Of course, the question was understandable and valid, but it was also layered and angry. Perhaps that tone did not come across in this fictional blog.

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