ADHD: MORE THAN ATTENTION PROBLEM

JULIE STECK, PH.D., HSPP

CRG/CHILDREN’S RESOURCE GROUP

WWW.CHILDRENSRESOURCEGROUP.COM

UNDERSTANDING THE NATURE OF ADHD IS CRITICAL TO

TREATING THE DISORDER

HYPERACTIVITY IS JUST THE

“TIP OF THE ICEBERG”

HYPERACTIVITY

• Hyperactive and impulsive behavior emerges first in those with Combined Type

• Inattention does not emerge until 2 to 3 years later

• With age, hyperactivity often declines but difficulty with inattention and inhibition does not

• Verbal impulsiveness more impairing in adulthood than hyperactivity

SYMPTOMS VARY DEPENDING ON SITUATION

BETTER

• Fun, exciting

• Immediate consequence

• Frequent feedback

• High interest

• Early in day

• Supervised situation

WORSE

• Boring

• Delayed consequence

• Infrequent feedback

• Low interest

• Later in day

• Unsupervised situation

ADHD IS . . .

• Not an input disorder

• A disorder of performance, not skill

• Not a matter of knowing what to do

• Doing what you know

• Responding more to stimuli than others do

• Paying more attention to task irrelevant information

ADHD IS . . .

• “Time blindness”

• Living in the moment

• Difficulty using knowledge of the past at the point of performance

• Inattention to mental events and the future

ACADEMIC DIFFICULTIES CAUSED BY ADHD

• Reading comprehension

• Written expression

• Speed and accuracy of math calculation

• Handwriting

• Listening comprehension

AREAS OF DEFICIT IN ADHD

• Inhibition

• Self-regulation

• Executive functioning

INHIBITION

• Inhibiting the dominant response

• Interrupting ongoing behavior

• Protecting the executive functions from interference/distraction

EXECUTIVE FUNCTIONS

• Working memory and recall

• Activation, arousal and effort

• Internalizing language

• Emotional self-regulation

• Planning and problem-solving

DEFICITS IN WORKING MEMORY

• Difficulty holding information in mind to guide one’s actions

• Poor at multi-tasking

• Difficulty using hindsight to guide actions

• Little use of forethought to plan/adjust

• Poor sense of time—cannot estimate time or plan over time

DEFICITS IN WORKING MEMORY

• More impairing with age due to increased volume and complexity of information

• Deficits also seen in menopausal women

DEFICITS IN ACTIVATION, AROUSAL AND EFFORT

• Procrastinates getting started on tasks not of their choosing

• Difficulty stopping preferred tasks

• Becomes sleepy/sluggish on non-preferred tasks

• Gives up easily

• Trouble maintaining effort once frustrated

POOR USE OF INTERNALIZEDLANGUAGE

• Delayed use of the “mind’s voice”

• Impairs ability to follow through on own plans

• Interferes with reading comprehension and written expression

• Impairs ability to contemplate events and own behavior

POOR EMOTIONAL REGULATION

• Emotions are not inappropriate but are made public

• Unable to keep emotions private and moderate them

• Difficulty with self-motivation

• Easily frustrated

DEFICITS IN PROBLEM-SOLVING

• Trouble taking an issue apart

• Difficulty planning and generating options toward a goal

• Poor verbal and nonverbal fluency

• Diminished flexibility in finding solutions

IMPLICATIONS FOR TREATMENT

• Need more positive than negative consequences

• Need more frequent consequences

• Behavioral treatment does not last once it is discontinued

• Information should be externalized

• Time should be externalized

IMPLICATIONS FOR TREATMENT• Long-term tasks should be broken down into many small

tasks

• Motivation should be externalized

• Allow/encourage manipulation of tasks to improve learning

• Expectations need to be decreased

“THE MORE YOU ASK FOR SELF-ORGANIZATION, THE MORE HE/SHE

WILL FAIL. AND YOU ARE THE PROBLEM. WHY DID YOU ASK?”

RUSSELL BARKLEY, PH.D.

TOP 10 THINGS TO KEEP IN MIND

• For individuals with ADHD, time is the enemy. If they are doing something they enjoy, there is not enough time. If they are to do something they don’t enjoy, they will procrastinate or just not do it.

• Individuals with ADHD have difficulty sustaining mental effort.

• They also have trouble remembering to do what they need to do when they need to do it.

TOP 10 THINGS TO KEEP IN MIND

• ADHD causes a 30% delay in the acquisition of skills requiring self-regulation

• The greater the requirement for self-regulation and organization across time and space, the greater the likelihood for failure

• An individual with ADHD performs well once and we hold it against them forever

TOP 10 THINGS TO KEEP IN MIND

• Those with ADHD live in the moment—they don’t reflect on the past to remember what happened last time or look to the future to think of the consequences of their behavior.

• ADHD causes individuals to have trouble stopping a behavior in the middle of a behavior.

• Most of what we know about ADHD is based on research on males but females with ADHD are just as much at risk for problems in all areas of functioning

BIBLIOGRAPHY

• Barkley, R.A. (1998) Attention-Deficit Hyperactivity Disorder Second Edition. New York, NY. The Guilford Press.

• Barkley, R. A. & Gordon, M. (2002). Comorbidity, cognitive impairments, and adaptive functioning in adults with ADHD: Implications of research for clinical practice. In S. Goldstein & A. Teeter (Eds.), Clinical interventions for adult ADHD: A comprehensive approach (pp.46-69). New York: Academic Press.

• Barkley, R., Murphy, K., & Fischer, M. (2008). ADHD in adults: What the science says. The Guilford Press.

• http://www.apa.org/topics/adhd/index.aspx

• https://www.youtube.com/watch?v=GR1IZJXc6d8

• https://www.youtube.com/watch?v=BzhbAK1pdPM&list=PLzBixSjmbc8eFl6UX5_wWGP8i0mAs-cvY

BIBLIOGRAPHY

• Froehlich, et al. (2007) Prevalence, Recognition and Treatment of Attention-Deficit/Hyperactivity Disorder in a National Sample of US Children. Archives of Pediatrics and Adolescent Medicine, 161 (9): 857-864.

• Mannuzza, S. & Klein, R.G. (2000) Long-term prognosis in attention-deficit/hyperactivity disorder. Child and Adolescent Psychiatric Clinics of North America, 9, 711-726

• The new CHADD information and resource guide for AD/HD. (2005) Published by CHADD.

• Wilens, T. ADHD and the SUD in Adolescents. Paradigm Magazine, Fall 2006.