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ADHD is a real diagnosis, but it can be confusing and hard to understand. To clear up the confusion, I will attempt to explain ADHD and its implications in simple terms based on the research of Dr. Russell Barkley, and answer questions such as, “How can my child have ADHD if he can play video games for 3 hours straight?”
Understanding Attention-Deficit Hyperactivity Disorder
Let’s simplify ADHD and explain it in one sentence: ADHD is a deficit in one’s ability to control impulses. Briefly, someone struggling with ADHD has a hard time controlling their impulses and paying attention to something when there is something else more stimulating in their environment. This can either be in their external environment, such as a noise outside, or it can be internal, like a stimulating thought.
The ability to control or “put the breaks” on an impulse has to do with a person’s executive functioning, which takes place in a specific part of the brain. Without getting too technical, someone diagnosed with ADHD struggles with poor impulse control and executive functioning deficits, which will be briefly described below.
Signs and Symptoms
ADHD can be diagnosed as hyperactive, inattentive, or a combination of the two:
For the hyperactive type, deficits in inhibition will affect multiple skills, including motor, verbal, cognitive, and emotion regulation. Some symptoms that might present in each of these categories are restlessness, excessive talking, interrupting, quick decision making, and dysregulation.
In addition, when it comes to motivation, immediate gratification is preferred and delayed consequences are discounted. In order for them to be most effective, rewards/positive reinforcement and consequences should be immediate.
For the inattentive child, inhibition deficits will result in poor persistence towards goals, tasks, and the future due to difficulty sustaining attention and action over time. Additional symptoms include, but are not limited to, distractibility, poor task re-engagement following a disruption, impaired working memory, and forgetfulness.
How is Attention-Deficit Hyperactivity Disorder Diagnosed?
Symptoms of ADHD mirror other issues, such as anxiety, and therefore can be misdiagnosed. It is imperative to go to a skilled professional to rule out other potential issues. The clinician will assess ADHD based on reports from the parents, school, and child.
It is important to understand that schools do not cause ADHD and are not to blame for a child’s diagnosis. In order to be successful in a mainstream school, it is essential for a student to have strong executive functioning skills, such as impulse control, planning, and organization, to name a few. Naturally, those suffering from ADHD who struggle with these skills will have a hard time in school. However, if someone ONLY struggles in school, that person does not have the disorder. The key characteristic of ADHD is poor impulse control, and without intervention, those who struggle with ADHD will also struggle in other environments which call for inhibiting impulse.
With the explanation of ADHD as a disorder of poor impulse control and executive functioning deficits, we can now understand why a child can sit and play video games for hours and still have the disorder. Although ADHD is a disorder that includes attention challenges, children with ADHD do not have difficulty paying attention. Rather, it is difficult for them to pay attention to something specific since their attention is impulsively drawn to another stimulus. Video games are highly stimulating and can take up an ADHD child’s attention even for a long period of time.
Since attention-deficit hyperactivity disorder is a disorder of performance and not skill, teaching skills to children who struggle with ADHD is an inadequate intervention. They know what they need to do, but they have difficulty actualizing it in the setting and moment.
Since the child has executive functioning deficits, the environment needs to be set up in a way in which these deficits are compensated for. Through behavioral intervention, the child is externally motivated to inhibit impulses and shift attention to the task at hand. Therapists trained in ADHD treatment collaborate with parents and schools to develop the behavioral intervention and oversee its implementation in the home and school environments.
Sometimes behavioral intervention alone is enough to help a struggling ADHD child be successful. However, in many cases, medication may be necessary. Medication helps by releasing the chemicals which activate the “breaks” for inhibiting impulses. Stimulants are often prescribed for ADHD, but there are other types of medications that can work just as well.
A common misconception is that medication will change a child’s personality. Medication should absolutely not have that effect. If a child taking a stimulant seems to be sedated or experiences other changes to his/her personality, it usually means that the prescriber needs to adjust the dosage.
Many parents worry about side effects. Side effects are a valid concern, but keep in mind that not taking medication for ADHD has academic and emotional “side effects.” I suggest trying the behavioral intervention first which may be enough to help your child. Otherwise, you may need to consider medication, at which point you can discuss concerns with the doctor.
In summary, ADHD is widely accepted as a disorder of poor impulse control with executive functioning deficits and will affect performance in multiple environments. The best treatment for attention-deficit hyperactivity disorder includes a behavioral approach with medication. Both the therapist and prescriber should be licensed clinicians who have experience diagnosing and treating ADHD.
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