Attention Deficit Hyperactivity Disorder (ADHD) is a common neurological condition involving a developmental impairment of the brain’s self-management system. Characterized by inattention, impulsivity and hyperactivity, ADHD affects roughly 5-8 percent of school-age children with symptoms continuing into adulthood in as many as 60 percent of cases. 

Typically, ADHD symptoms arise in childhood. Some individuals don’t show significant symptoms until adolescence or later into adulthood, when the demands of school, jobs and families are greater. Some adults are diagnosed later in life when they recognize their child's characteristics in themselves.  

Although there is no single gene or gene variant yet identified to be a carrier of ADHD, at this point the complexity of ADHD is likely to be associated with multiple genes, each of which is thought to have a small effect on the development of ADHD.

Individuals with this neurological condition can be very successful in life; however, identification and intervention are keys to avoiding the consequences of school failure, family stress, relationship challenges, job failure, substance abuse and accidental injuries.

Diagnosing ADHD

There are three types of ADHD, according to the DSM-V, the “bible” of psychiatric diagnoses: Inattentive, Hyperative and Combined. You can take the above screening test to identify common ADHD symptoms in yourself or your child. To diagnose ADHD, a comprehensive evaluation is necessary by a trained and licensed professional, such as a school psychologist, social worker, nurse practitioner, psychologist, psychiatrist, neurologist, or pediatrician. 

Girls often go under the radar, as undiagnosed, Inattentive-type. They work hard to please and get good grades, hiding their anxiety to meet deadlines while churning out exeplary results. ADHD symptoms ebb and flow directly in proportion to estrogen levels. A growing number of women are those over 40, where lowering estrogen levels make focus and distractibility more challenging. 

There are other conditions that commonly occur along with ADHD, called "co-morbid" conditions. Most common are: anxiety, depression, learning disabilities, bipolar disorder, Tourette’s syndrome and conduct disorder. People with ADHD can also be identified as being on the autism spectrum, but individuals with ADHD can also exhibit autistic-type behaviors without qualifying for an autism spectrum identification. It’s important to be accurately diagnosed by a clinician who understands these conditions.   

What Are Executive Functions

People with ADHD typically have challenges with executive functions that are responsible for self-management, such as activating, organizing, planning, and sustaining focus on a task. They have a tendency to lack what is called "timesight" where their concept of time is now or not now, unless a deadline kicks them into gear. Another executive functioning challenge involves difficulty with holding onto several pieces of information and performing an action with that information, such as carrying out a chore or performing an assignment. This is known as "working memory." 

Executive Functioning Is Not Equal to Intellect

Executive functioning is not related in any way to intellectual ability. Time management, organization and planning are separate from intellect. 

This can answer: “My child’s so smart! Why can’t he remember his homework?” 

Or: “I know I’m not losing my mind. Where did I put my keys?”

Quick Tips:

• Establish homes for very important things. 

• Create landing zones for homework and backpacks.

• Break down projects into steps and look for success with one step at a time.

• Repeat/say aloud directions/sections of text for understanding

• Estimate times for small tasks and compare to actual times

Task Initiation and Completion

Fluctuation in performance according to situation is common to people with ADHD. Executive functioning challenges may not be noticeable when individuals with ADHD are involved with an activity that’s interests them.

This can answer, “How can my kid play video games for hours??”

People with ADHD can hyperfocus where they “get into a zone” and intensely zero-in on a dedicated task without noticing the passage of time. 

Quick Tips: 

• Transform a boring task to something you or your child are interested in, with meaningful rewards attached. For example, if your child likes trains, use trains for math problems or writing assignments. Use a train museum as a reward.

• Build in deadlines to produce urgency for motivation.

• When hyperfocus is involved, set timers to create short breaks for water, snacks and sleep.

Regulating Emotions

People with ADHD can experience happiness, criticism and frustration more powerfully than others. Managing these intense emotions is also considered an executive function. 

Because of the negative feedback they experience from peers, teachers and well-meaning family members, individuals with ADHD tend to understandably hear what’s meant as feedback as an assault on their character.  This morphs into ingrained, harsh internal dialogue and shame. Some hide this by being people pleasers to avoid the rejection. Others may fly off the handle in rage.

Quick Tips: 

• Help your loved ones identify their strengths and do your best to recognize yours as well. 

• Use the 5:1 rule, with five positive comments to one with constructive feedback. A positive comment could be, “Your enthusiasm brightens my day” or “I appreciate the way you pitched in today.” Constructive feedback can be, “It’s helpful when you put a lid on your bowl in the microwave so it doesn’t splatter.”

• Try to include a positive feedback comment at the same time as the constructive feedback: “We appreciate it when you feed the dog. It would great if you can let him out too.”

• Keep a gratitude journal to track what you’re appreciative of in yourself. 

ADHD is a neurological condition involving the brain's self-management system. People with ADHD can lead happy and productive lives. Identification and intervention are key to unwrapping their gifts.

[References: CHADD, Parent to Parent, 2008; ADDITUDE Magazine, ADHD Myths and Facts, Fall 2013]

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