ADHD and the Nature of Self-Control

It was published by Guilford Press in 1997. It runs a little over four hundred pages. In 2005 a paperback edition was issued with a new afterword by the author, and the one in circulation today is usually that edition.

Russell A. Barkley is one of the most cited names in ADHD research. Taking Charge of Adult ADHD, which I reviewed on this site, is the guide he wrote for the general reader. This book is the theory behind that guide. Its intended readers are researchers, clinicians and graduate students.

The two must not be confused. If you open one and expect the other, you will be disappointed.

Barkley has books translated into Turkish, but I could not find a verified Turkish edition of this one. I am writing it under its English name.

The question the book asks

In the mid-1990s ADHD was thought of, as its name says, largely as an attention disorder. Barkley argues that this frame is not enough to explain the picture.

The observation is simple: children with ADHD can pay perfectly good attention in many situations. They can stay for hours in a game they love. Where they struggle is in situations where behavior has to be directed by something that will happen later, the moments when they have to break free of the pull of what is in front of them.

For this reason the book redefines ADHD as a developmental problem of self-regulation. Attention difficulties are treated as a product of this problem.

When I first read this sentence, I objected. In my own experience, distractibility does not look like such a secondary thing. Then as I separated out what the book means by "attention," my objection softened: the problem is not in the amount of attention but in who is managing it.

The model: one brake and four functions

At the center of the book is a hybrid model that Barkley also published as an article the same year. The table of contents runs in the same order: first the nature of attention, then the biological causes, then behavioral inhibition, neuropsychological views on executive functions, the model itself, and finally the application of the model to attention, motor control and life outcomes.

The cornerstone is behavioral inhibition. Barkley describes it in three parts: being able to stop a strong, habitual response; being able to interrupt a response that has already started; and, meanwhile, being able to keep interfering stimuli from getting mixed into the process.

Inhibition opens up a gap. In that gap four executive functions operate.

Nonverbal working memory. Holding in mind what has happened in the past and picturing the future. Barkley ties the sense of time to this. What came before, what comes after, how long is left.

Internalization of speech. The turning inward over time of the self-talk that is done aloud in childhood. Acting according to a rule, giving yourself instructions, asking yourself before doing something.

Self-regulation of emotion, motivation and arousal. Being able to get yourself moving when there is no reward in the environment. Holding back an emotion for a while instead of expressing it right away, and shaping it to fit the goal.

Reconstitution. Breaking behavior into parts and building new combinations. Solving a problem, wording a sentence differently, changing a plan.

The shared output of these four functions is that goal-directed behavior can be carried out with information held inside, however bright the stimulus coming from outside may be.

The model becomes clearer when I think of it with a concrete example. There is a piece of work due in three weeks. To start on it today, I need to keep those three weeks ahead alive in my mind, tell myself what to do, generate motivation for something whose reward is very far away, and break the work into small steps. According to Barkley, all of these depend first on being able to stop the hand reaching for the phone.

The matter of time

The most lasting idea in the book, I think, is its view of ADHD as a disorder related to time.

When inhibition is weak, behavior sticks to the now. The future does not weigh enough in the mind. Five minutes from now and five weeks from now stay almost equally abstract.

Here I put the book down and sat for a while. It felt as if what I had thought of for years as "I don't know how to plan" had another name. I did know how to plan. The future the plan belonged to did not feel real enough to me.

If you are looking for the academic root of the concept of time blindness, which circulates so much on social media today, this book is one of the important stops.

The distance between knowing and doing

The clinical consequence of the model comes from here too. When ADHD is treated as a lack of knowledge, the person is told what to do, and when what was told does not work, it is put down to the person's will.

In Barkley's framework the problem arises at the moment when the knowledge is to be used. This means that help has to be carried to the place and time where the behavior happens: external reminders, visible cues, intermediate rewards that shorten the delay.

This is the logic on which many method articles on the site rest. I gave a plainer account of it in the article on executive functions.

The closing of the guilt file

While reading this part I felt something shift, and I want to write about it separately.

In the willpower narrative, not being able to do something is a matter of character. You do not want it enough, you do not try hard enough, you do not care. In Barkley's model the same failure is the result of a mechanism: the brake coming into play late, the future staying faint in the mind, motivation not being generated from within when there is no reward outside.

The book does not write this as a consolation. Barkley's concern is to build a theory; he has no aim of comforting the reader. But the side effect of the theory was that it closed part of the guilt file I had been keeping on myself for years.

The same model also has a practical consequence. If the problem is that the future stays faint in the mind, the solution is to make the future visible outside: putting the clock where it can be seen, keeping the deadline on the desk instead of in a calendar waiting to be opened, dividing a big reward into small intermediate rewards. If the problem is weak inner speech, write the instruction outside. The book does not list these strategies one by one; but it gives the reasoning for why they work.

Motor control and life outcomes

The last chapters of the book apply the model to three areas: inattention, self-regulation and motor control difficulties, and then the long-term life outcomes of ADHD.

The motor control part seems odd at first glance. But it is consistent within the logic of the model: the fluent execution of goal-directed behavior, starting a movement, maintaining a sequence and changing it when necessary, is also a product of the same self-regulation system.

The life outcomes chapter, for its part, draws early a picture that is supported today by far more extensive data. It traces ADHD in areas such as education, work, relationships and accident risk.

In the afterword added to the 2005 edition, Barkley assesses the research directions up to that day and how his approach has evolved. I recommend that you do not skip this afterword; it shows in a short way where what the book said in 1997 stands in the author's eyes eight years later.

What is left out

The point that bothered me most about the book is whom the model does not explain.

Barkley was building his 1997 theory openly for the predominantly hyperactive-impulsive and combined types. He said that the predominantly inattentive type might have a different attention problem, and that this model might not fit that group.

This is hard to read. In adulthood, especially in women, the inattentive presentation is a very common picture. Someone who received their diagnosis with this presentation needs to know that, in one of the foundational books of the field, they are reading a theory that was not built for them. I covered this subject separately in the article on inattentive type ADHD.

Most of the research the book rests on was also done with children, and a large part of it with boys. This was the general state of the period; it cannot be counted as a particular flaw of the book. But it is something to take into account when reading today.

Looking from today

Twenty-nine years is a long time for a theory. One has to separate where it has held up and where it has worn.

The idea of a single core deficit has weakened. The 2005 meta-analysis by Willcutt and colleagues showed that executive function weaknesses in groups with ADHD are real on average but of moderate size, and that they are not seen in everyone with ADHD. So executive function difficulty does not look like a core that defines ADHD on its own.

Multiple-pathway models have come to the fore in place of a single pathway. Sonuga-Barke's dual pathway model placed delay aversion, that is, waiting for a reward being aversive in itself, next to the inhibition problem. Nigg and colleagues argued that ADHD can be reached by different routes. Barkley's model became one of the starting points of this debate but did not remain the only answer.

Barkley himself extended his model. In his 2012 book Executive Functions he rebuilt executive functions within a framework of daily life and evolution. In later analyses working memory moved to a more central position alongside inhibition. When reading the 1997 model, it is good to know that it was a way station.

The biological causes section has aged. The fields of genetics and brain imaging have changed a great deal since 1997. Its direction is right: the 2019 review by Faraone and Larsson, based on twin studies, gives heritability as about 74 percent, and the book also treated ADHD as a largely heritable picture. But I would not rely on this section for details.

The language of diagnosis has changed. The book was written in the DSM-IV era. In 2013 DSM-5 said "presentation" instead of subtype, raised the age limit for the onset of symptoms from 7 to 12, and lowered the number of symptoms required for ages 17 and over to five. The diagnostic discussions in the book predate these changes.

It also has a forward-looking side. Putting the self-regulation of emotion and motivation inside the model was something little done at the time. Today emotional dysregulation is discussed as an important part of adult ADHD. The book prepared the ground for this discussion early.

Reading it

To be honest, reading this book in one sitting was not possible for me.

The paragraphs are long, the sentences are loaded with terms, and behind every claim there are several sources. The abundance of sources increases the book's credibility and decreases its readability. I had noticed the irony of an ADHD book asking so much sustained attention from a reader with ADHD in Barkley's other book too. Here it is far more pronounced.

The method that worked for me was this: first read the middle chapters where the model is described. Once inhibition and the four functions have settled, go back to the attention discussion at the beginning and the applications at the end. Read the biological causes chapter as a historical document, after reading about the field's current state in a recent review.

If you want to get the essence of the book first from a shorter place, Barkley's theory article published in Psychological Bulletin the same year explains the same model in far fewer pages. The book is like an expanded and justified version of that article.

For whom

For those curious about the theory itself. For those who want to get to the source of the question "why do so many ADHD articles mention time and self-control." For psychology students and for therapists working with clients with ADHD.

I would not recommend it to someone newly diagnosed and looking for what to do. There is no practical one-page summary. It is not suitable for the emotional period after diagnosis either. The book's concern is to explain a disorder; it does not care what the reader is feeling at that moment.

To a reader diagnosed with the inattentive presentation I would also say to begin by knowing the limit above. Many parts of the model will still feel familiar. But knowing that the theory was not built for you will keep you from feeling lacking in the places that do not feel familiar.

Its value for me is this: it showed me where many ideas about ADHD that I take for granted today come from. It is also where I learned to separate which of them rest on solid ground and which on a proposal that was reasonable in 1997 but was later tested and changed.