ADHD / ADD
Dr. Russell’s book Taking Charge of ADHD is our key resource for citing ADHD material. It is noted as (TCA 2013) in the paragraphs below. We have also found Understanding Girls With ADHD by Kathleen Nadeau, Ellen Littman and Patricia Quinn to be very informative. It is noted as (UGA 2016).
In order to understand ADHD and ADD you need to understand executive functions. Executive functions are how we regulate our thoughts and actions. ADHD and ADD are disorders in which development of executive functions is atypical and therefore a person diagnosed with ADHD or ADD will display less self-control than what we would consider to be age appropriate.
ADHD is the commonly used acronym for attention-deficit/hyperactivity disorder.
ADD is the commonly used acronym for attention-deficit/hyperactivity disorder—predominantly inattentive presentation.
Dr. Barkley believes the name ADHD gives the wrong focus to the disorder. He suggests having it renamed Executive Function Deficit Disorder. (TCA 2013, pg. 47) By doing so, the emphasis would move away from the inattention piece most commonly associated with ADHD/ADD and would lead discussion to the underlying cause – a delay in developing executive functions.
AHDH/ADD and the Key Components of Executive Functions
First a quick review of Dr. Barkley’s six components of executive functions.
1. Self-Restraint or the Mind’s Brakes: I can pause my reaction.
2. Self-Awareness of the Mind’s Mirror: I can think and plan my reaction.
3. Self-Directed Imagery or the Mind’s Eye: I use hindsight and foresight to inform my reaction.
4. Self-Directed Speech or the Mind’s Voice: I use internal speech to think things through.
5. Self-Directed Emotions or The Mind’s Heart: I recognize how I feel about an event and consider the context.
6. Self-Directed Mental Play or The Source of Problem Solving and Innovation/Creativity: I can imagine possible reactions or create a new rule for an event.
A person with ADHD/ADD has difficulty accessing their executive functions and using those skills to give an informed reaction. The observable characteristics of ADHD/ADD are difficulty sustaining attention, high distractibility, and poor impulse control. What those behaviors mean is a person with ADHD/ADD has difficulty:
1. pausing their reaction in order to
2. think through their reaction by
3. suspending the ‘now’ to consider the past or the future and
4. using self-talk to think things through before acting by
5. recognizing their emotions in the moment or recognizing the context and
6. problem solving which reaction is the appropriate/successful one to give.
“ADHD is not primarily a disorder of paying attention but one of self-regulation…[It is a] disturbance in a child’s ability to inhibit immediate reactions to the moment so as to use self-control with regard to time and the future. That is, those with ADHD ultimately suffer from an inability to use a sense of time and of the past and future to guide their behavior. What is not developing properly in your child is the capacity to shift from focusing on the here and now to focusing on what is likely to come next in life and the future more generally. When all a child focuses on is the moment, acting impulsively makes sense. The child simply wants to do what is fun or interesting at the moment and escape from what is not reinforcing at the time, maximizing immediate gratification as much as possible. From the child’s perspective, it is always ‘now.’ But this can be disastrous when the child is expected to be developing a focus on what lies ahead and what needs to be done to meet the future effectively. That capacity is crucial to our ability as human beings to be organized, planful, and goal-directed, and it is directly dependent on how much control we have over our impulses.” (TCA, 2013 pg. xiii)
A person with ADHD/ADD is able to notice and pay attention to a message or to their environment. The conflict comes from not being able to sustain their interest, to hold the ‘now’ in mind long enough to think a reaction through well. A person with ADHD/ADD moves quickly into the next moment, and the next, and the next, with little ability to pause their thinking in order redirect their reactions to known positive or successful behaviors. “The problem does not seem to be only one of paying attention but also just as much one of sustaining inhibition. So it seems that all three problems thought to be primary symptoms of ADHD – inattention, impulsiveness, and hyperactivity – can be reduced to a delay in the development of inhibition of behavior and of persistence toward goals and the future more generally.” (TCA pg. 54)
The ADHD/ADD Brain
ADHD/ADD is not a condition of simple impulsivity or inattention. It is not something a child will “grow out of”. It is not bad parenting nor is it a sign of being immoral. It will not be solved by “more discipline, more structure, more limit setting, and less coddling” (TCA pg. 19, 20). It is not caused by eating sugar, food allergies, hormones, inner ear conditions, yeasts, or too much television. (TCA pgs. 86-94) Rather, a person with ADHD/ADD has physical and measurable differences to the prefrontal cortex of their brain. This part of the brain is not as large, as mature as is typical. This is also true of areas connected to the prefrontal cortex. These areas appear less developed and less active based on analysis of brain wave activity and blood flow patterns using PET, CAT, and fMRI scans, as well as EEGs. (TCA pg. 77) It may also be that specific neurotransmitters are lacking in an ADHD/ADD brain. Neurotransmitters are chemicals that allow a nerve cell to pass along information to another nerve cell. (TCA pg. 75) It is possible that a chemical deficit is a contributing factor in causing the disorder.
A child with ADHD/ADD will have parts of their brain not as active as is expected for their age. Less activity in the prefrontal cortex supports the theory of ADHD/ADD as a deficit of executive functions. An underdeveloped prefrontal cortex does not yet have the executive skills of “slow down and think it through”. Thus, we observe frequent and regular distractibility or impulsiveness in the child. Because parts of the brain are not as mature, ADHD/ADD children demonstrate behaviors typical for a child two or three years younger than their chronological age. (TCA pg. 75)
Differences Between Girls and Boys
ADHD children are inattentive with hyperactive and hyperreactive behaviors. Hyperactivity in boys tends to be of a more physical nature. Hyperactivity in girls tends to be more through hyper-verbalization and greater mood swings. (UGA pg. 11) ADHD children may show you they need support through demanding, arguing, fighting, resisting, or disrupting. (UGA pg. 207)
Children with ADD, which is ADHD without the hyperactivity, show quieter and more daydreamy behaviors. While these children appear as better behaved, they are just as impacted by their weak executive function skills. It is just less noticeable. ADD children will probably not show you they need support with large behaviors but they may tell you if you make a safe space for them to do so. (UGA pg. 207)
Current research is showing ADHD to present more in boys (but sometimes in girls) and ADD to present more in girls (but sometimes in boys). (UGA pg. 29) Brain based differences have been documented that support reasons for the differences in genders. However, human beings are complex and the authors of both of our reference books emphasize that the differences that have been found between boys and girls are not to be taken as rigid and fixed. All children are unique.
Some ADHD/ADD ‘Typicals’
- (TCA pg. 36-52) (UGA pg. 6)
- high distractibility
- difficulty deferring gratification
- difficulty controlling impulses
- greater risk taking
- impulsive thinking reflected in impulsive behavior
- difficulty following instructions
- poor organization
- weak social skills
- large emotional reaction
- difficulty ending one task and transitioning to the next
- regularly misunderstand instructions
- do their work inconsistently
- regularly takes shortcuts in their work
- difficulty sleeping
Living With An ADHD/ADD Child
Dr. Barkley suggest the following guidelines for adults supporting a child with an ADHD/ADD diagnosis. (TCA pg. 159-168)
1. Give your child more immediate feedback and consequences. ADHD/ADD children are in the ‘now’ and they need reminders in each of those “now” moments.
2. Give your child more frequent feedback. There is a just right spot for feedback frequency: not so often as to be irritating but often enough to make a connection.
3. Use larger and more impactful feedback. External rewards such as stickers, privileges, or hugs are more concrete and will help guide your child toward the goal of intrinsic motivation.
4. Use incentives before punishment.
5. Externalize time and bridge time where necessary. Your child will need to be explicitly reminded about the passage of time.
6. Externalize the important information at the point of performance. Say out loud the steps of the task or have reminder cards/charts visible detailing the necessary skills as your child is doing the task required.
7. Externalize the source of motivation at the point of performance. Feedback or reminders about incentives will be often needed to assist your child while they are completing a task.
8. Make thinking and problem solving more manual or physical. Get ideas on paper, make pictures, used materials the child can touch and move. This supports the distractibility element of ADHD/ADD.
9. Strive for consistency.
10. Act, don’t yak! Follow through with incentives, consequences, routines and don’t just talk about them.
11. Plan ahead for problem situations.
12. Keep a disability perspective. If you are overwhelmed or frustrated with your child’s behaviors remind yourself ADHD/ADD is a medical condition that needs extra supports.
13. Don’t personalize your child’s problems or disorder.
14. Practise forgiveness.
A Note About Why We Are Writing This
Children come into our lives with a spectrum of temperaments and quirks. That is what makes each of them unique and a joy to discover. Within that uniqueness are developmental milestones that are typical for children to reach when growing and maturing. While there are benchmarks for human development, the path towards them will be an individual journey for every child. Concern arises when a child is experiencing distress with their social connections or delay in their academic achievement. Making friends and learning things is what school is all about. If a child is having significant difficulty with either of these areas they will be unhappy. That is when adults step in and help problem solve. Only your family doctor can diagnose your child – teachers cannot and will not. However, ADHD/ADD is fairly common, 5-8% of the population has it. If your child is experiencing social or academic difficulties ADHD/ADD may be a contributing factor and it is worth being informed about it.
A Very Short Summary
1. ADHD and ADD occur when a child is unable to use their executive functions easily or well.
2. It is a developmental disorder not a problem with temperament.
3. A child with ADHD/ADD reacts to the moment with little thought to the future or without recalling useful examples from the past.
4. A child with ADHD/ADD knows what is happening in the moment but he/she moves quickly to the next moment without fully thinking through their actions or words.
5. There are observed and documented differences in the brains of children with ADHD/ADD.
6. ADHD tends to manifest more in boys. ADD tends to manifest more in girls.
7. A list of typical behaivors for ADHD/ADD is just a list. Every child is unique.
Websites For More Information
CHADD Children and Adults with Attention-Deficit/Hyperactivity Disorder https://chadd.org/
ADDA Attention Deficit Disorder Association https://add.org/
CADDAC Centre for ADHD Awareness, Canada https://caddac.ca/adhd/