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New York Times, SundayReview | OPINION

A Natural Fix for A.D.H.D.

You may wonder what accounts for the recent explosive increase in the rates of A.D.H.D. diagnosis and its treatment through medication. The lifetime prevalence in children has increased to 11 percent in 2011 from 7.8 percent in 2003 — a whopping 41 percent increase — according to the Centers for Disease Control and Prevention. And 6.1 percent of young people were taking some A.D.H.D. medication in 2011, a 28 percent increase since 2007. Most alarmingly, more than 10,000 toddlers at ages 2 and 3 were found to be taking these drugs, far outside any established pediatric guidelines.

Some of the rising prevalence of A.D.H.D. is doubtless driven by the pharmaceutical industry, whose profitable drugs are the mainstay of treatment. Others blame burdensome levels of homework, but the data show otherwise. Studies consistently show that the number of hours of homework for high school students has remained steady for the past 30 years.

I think another social factor that, in part, may be driving the “epidemic” of A.D.H.D. has gone unnoticed: the increasingly stark contrast between the regimented and demanding school environment and the highly stimulating digital world, where young people spend their time outside school. Digital life, with its vivid gaming and exciting social media, is a world of immediate gratification where practically any desire or fantasy can be realized in the blink of an eye. By comparison, school would seem even duller to a novelty-seeking kid living in the early 21st century than in previous decades, and the comparatively boring school environment might accentuate students’ inattentive behavior, making their teachers more likely to see it and driving up the number of diagnoses.

Not all the news is so bad. Curiously, the prevalence of adult A.D.H.D. is only 3 to 5 percent, a fraction of what it is in young people. This suggests that a substantial number of people simply “grow out” of it. How does that happen?

Perhaps one explanation is that adults have far more freedom to choose the environment in which they live and the kind of work they do so that it better matches their cognitive style and reward preferences. If you were a restless kid who couldn’t sit still in school, you might choose to be an entrepreneur or carpenter, but you would be unlikely to become an accountant. But what is happening at the level of the brain that may explain this spontaneous “recovery”?

To try to answer that question, Aaron T. Mattfeld, a neuroscientist at the Massachusetts Institute of Technology, now at Florida International University in Miami, compared the brain function with resting-state M.R.I.s of three groups of adults: those whose childhood A.D.H.D persisted into adulthood; those whose had remitted; and a control group who never had a diagnosis of it. Normally, when someone is unfocused and at rest, there is synchrony of activity in brain regions known as the default mode network, which is typically more active during rest than during performance of a task. (In contrast, these brain regions in people with A.D.H.D. appear functionally disconnected from each other.) Dr. Mattfeld found that adults who had had A.D.H.D as children but no longer had it as adults had a restoration of the normal synchrony pattern, so their brains looked just like those of people who had never had it.

But in another measure of brain synchrony, the adults who had recovered looked more like adults with A.D.H.D., the M.I.T. study found.

In people without it, when the default mode network is active, another network, called the task-positive network, is inhibited. When the brain is focusing, the task-positive network takes over and quiets the default mode network. This reciprocal relationship is necessary in order to focus.

Both groups of adult A.D.H.D. patients, including those who had recovered, displayed simultaneous activation of both networks, as if the two regions were out of step, working at cross-purposes. Thus, adults who lost most of their symptoms did not have entirely normal brain activity.

What are the implications of this new research for how we think about and treat kids with A.D.H.D.? Of course, I am not suggesting that we take our kids out of school and head for the savanna. Nor am I saying we that should not use stimulant medications like Adderall and Ritalin, which are safe and effective and very helpful to many kids with A.D.H.D.

In school, these curious, experience-seeking kids would most likely do better in small classes that emphasize hands-on-learning, self-paced computer assignments and tasks that build specific skills.

This will not eliminate the need for many kids with A.D.H.D. to take psychostimulants. But let’s not rush to medicalize their curiosity, energy and novelty-seeking; in the right environment, these traits are not a disability, and can be a real asset.