By: Gail Silverstein, PhD
Attention Deficit Disorder is a biologically-based disorder which makes it difficult to control impulses and regulate attention. Currently, there are thought to be three different sub-types of ADHD: the predominantly inattentive type, the predominantly hyperactive type/impulsive type, and the combined type. The most recent official diagnostic manual refers to all three as ADHD, rather than using the older term “ADD” to refer to the predominantly inattentive type. That format will be followed here. At one time it was thought that people “grow out of” ADHD when they reach adolescence. Now it is understood that while some people’s symptoms do improve dramatically in adolescence, more often ADHD is a lifelong disorder although the symptoms may change somewhat over time.
People with ADHD often have difficulty sustaining attention and are easily distracted. They tend to be disorganized and forgetful, are often late, and may frequently lose things they need. They may make careless mistakes due to a lack of attention to detail. They may plunge right into a task without regard for the directions. They often don’t follow through or finish things they have started or promised to do. If in school, they may not finish homework or other assignments and may not even know what the assignment is. Or, they may do the assignment and forget to turn it in or forget where they put it. They may not seem to listen when spoken to directly. Those with symptoms of hyperactivity/impulsivity tend to be fidgety, noisy, and have trouble sitting still, relaxing, or waiting their turn. They may talk excessively, blurt things out, and interrupt other people. They seem to be always “on the go”. In adults and older adolescents, some of the hyperactive symptoms may take the form of an internal feeling of restlessness. They may have trouble managing money and pile up debt, or may drive recklessly, getting a large number of speeding tickets or getting into many accidents. They may make decisions impulsively, without stopping to consider the consequences.
ADHD symptoms are most often seen in situations in which the person is required to do something they don’t want to do, especially if the task is perceived by the person as boring or tedious. Many parents think that their child cannot have ADHD because he or she can watch TV or play video games for hours. They then erroneously conclude that the child’s inability to focus on schoolwork or homework is
voluntary. People with ADHD do not have an inability to attend; they have an inability to regulate their attention. Due to biological causes, it is harder for the person with ADHD than for other people to inhibit their impulses to do something more interesting than the task at hand.
What Causes ADHD Symptoms?
Along with changes in the name of the disorder, there have been changes in the theories about what causes it. The most recent research indicates that there is a chemical imbalance in the frontal part of the brain and the basic problem is one of inhibition of impulses. This leads to several types of problems. People with ADHD often seem to act without thinking or fail to profit from experience. When asked directly, they can tell you what they should do or should have done. The problem is that they cannot inhibit their impulse to speak or to act long enough to remember what they know. They live in the present and attend to whatever is in front of them at any given time. Thus, the child listening to a teacher talk may be distracted by a bird flying outside the window or to their own internal thought processes and stop listening to the teacher. An adult may start out to empty the dishwasher and then notice that the kitchen floor is dirty and start to wash the kitchen floor but then notice a bill on the kitchen counter they had been meaning to pay, and while sitting down to pay the bill, decide to check their e-mail first, and then while waiting for the e-mail to load on the computer, remember that they had wanted to Google something, etc. etc. until suddenly the day is gone and the house is littered with tasks which were begun but never finished. Each of these tasks is perceived as equally important and the person is unable to inhibit the impulse to attend to each of them. People with ADHD generally have some weaknesses in executive functioning.
Executive functioning can be thought of as the types of tasks which an executive does in a company - organizing, planning, prioritizing, directing the company’s attention to certain areas rather than others, etc.
Diagnosis of ADHD
It can be tricky to diagnose ADHD because all of us exhibit some of the symptoms some of the time. Therefore, diagnosis becomes a question of evaluating the degree to which this particular person exhibits the symptoms relative to the average person of the same age and gender. To be diagnosed with ADHD, it is also necessary for the person to exhibit the symptoms in more than one situation. Since people are born with ADHD, it used to be thought that an ADHD diagnosis was not accurate if symptoms were not evident before the age of 7. However, the more current thinking is that some people, especially if they are bright and not hyperactive, can compensate for their ADHD tendencies so that they do not run into significant trouble until adolescence or even adulthood. Many adults are diagnosed for the first time when their children are diagnosed and they realize that they have similar tendencies. This is not surprising since ADHD tends to run in families.
Diagnosis is also difficult because there are a number of other conditions which have many of the same symptoms and can mimic ADHD. These include anxiety, depression, some types of learning disabilities, and some medical conditions. Neuropsychological testing can diagnose ADHD, describe its impact on this particular person, and document the presence of the disorder so that needed help can be obtained from schools and healthcare providers. This documentation may also lead to accommodations on the SAT, GRE, LSAT, MCAT, and similar exams.