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What is Attention Deficit Hyperactivity Disorder (ADHD)?

 

The term ADHD (previously known as Attention Deficit Disorder or ADD) is used to describe a neurodevelopmental disorder with a recognised and persistent pattern of behaviour. ADHD begins at birth and in most cases persists to some degree throughout the lifespan.

 

When people think of ADHD they tend to think of overactive, noisy boys who are disruptive in class and won’t sit still. In reality, ADHD affects both sexes and all age groups. Also, hyperactivity is only one part of ADHD and may not be relevant at all for some children. When present, the hyperactivity often burns out by adulthood.

 

The core features of ADHD include difficulties with:

 

  • Keeping attention on the task at hand
  • Avoiding distraction
  • Getting started on tasks (procrastination)
  • Maintaining mental effort to get the job done
  • Remembering to do things
  • Losing or misplacing things
  • Being impulsive (acting without thinking things through)
  • Planning and organising
  • Making good use of time (including being on time)
  • Managing emotions such as frustration and boredom

 

A common presentation would be someone (male/female, child/adult) who has difficulty maintaining attention, is easily distracted and forgetful, may be somewhat restless and fidgety, is likely to act without thinking, and needs direction to stay on task and get things done. Some people may have occasional outbursts of intense emotion that are short-lived and usually triggered by frustration.

 

People with ADHD are frequently labelled as being lazy, which is unfair and unhelpful. In reality, people with ADHD often have to work twice as hard just to stay on track. Simple tasks that can seem easy to others can feel like a mountain to someone with ADHD. People with ADHD can become mentally tired from constantly trying so hard. But when they are really interested in a task they will hyperfocus and can excel. People with ADHD are often creative thinkers with a lot of energy.

 

Parents are also often blamed for their child’s ADHD. They are accused of not providing appropriate discipline. While some of the parents themselves may also have ADHD (often without knowing it) and may not always be consistent with their parenting skills, the reality is that children with ADHD are harder to parent, even for a parent who has excellent parenting skills and no ADHD. Children with ADHD typically don’t pay attention, they don’t remember things, they may be more active, and they typically act without thinking of the consequences, despite what their parents may have taught them. They are often less fearful of negative consequences because they do not consider those consequences at the necessary time. Not all children react the same way to parental instruction.  Parenting behaviour does not cause ADHD, although lack of parenting skills will not help the situation.

 

No-one chooses to have ADHD, just like no-one chooses their eye colour. But people with ADHD can choose to do something about their symptoms. If left untreated, ADHD can be a troublesome disorder that affects self esteem and interferes with relationships, education, and career progression. With support, ADHD can be an understandable but manageable frustration.

 

The role of executive functioning in ADHD

 

The mental functions required to organise, begin and complete a task can be thought of as our “executive functions”. Take a moment to think about how we succeed in everyday life. Each day we engage in a series of goal directed tasks or activities, from simple tasks like getting dressed through to more complex activities like completing an essay or a tax return.

 

Getting a task done involves recognising or remembering that the task needs to be done, paying attention to the task at hand, resisting distraction, finding the motivation to get started, making a plan if the task is complex, locating important tools or objects, persisting in the face of boredom or frustration, monitoring progress, and making changes as needed until the task is complete.

 

Just like the conductor of an orchestra, who directs musicians to start and stop playing, our “executive functioning system” tell us when and how to engage in particular behaviours. If the conductor of the orchestra disappears, the orchestra will have a hard time performing to a high standard. If our executive functioning system is not operating effectively, we will have a hard time completing necessary life activities in line with our goals and needs.

 

ADHD can be thought of as a neurodevelopmental disorder of executive functioning. Children and adults with untreated ADHD have persistent trouble staying on task. They find it hard to complete appropriate activities at the appropriate times. They find it hard to avoid distraction and to delay rewards. They can act impulsively and without proper planning. And they usually struggle to find the motivation to get started on boring or mentally challenging tasks.

 

ADHD remains very poorly understood by the general public, and unfortunately it is similarly misunderstood by most health professionals.