ADHD - more than Attention and Hyperactivity Disorder

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One of the biggest influences on my perception of ADHD, is the research and related findings of Russel Barkley. No wonder this site has so many references to his work and view on ADHD. With that said, credit is given to Dr Russel Barkley and this article represents then my interpretation of and understanding of his conclusions.

A Developmental Disorderadhd cartoon

ADHD is a developmental disability. What was supposed to develop on the same rate as in other people, did not happen in ADHD. The end result is that ADHD will, in most cases, behave inappropriate in relation to his/her age. As Barkley says, its not a "qualitative" difference, as if ADHD has something special, more than others, but a "quantitative" difference. ADHD has everything others have, but are probably a few years slow in terms of the create of development there-off. I have seen how an ADHD adult act and "operate" at an age of about 2 -3 years younger at the age of 22. Barkley refers to a 30% lower real age of an ADHD.

Building further on this developmental disorder, is the realisation that ADHD is a neuro-biological disorder. It is not something that happened or developed because of environmental factors, bad parenting, poor nutrition or living conditions (although these factors will indeed worsen the outcome of ADHD). It is a disorder that is mainly because of neuro-biological disorder.

By knowing this essential two facts, relieves parents and adult ADHD from the guilt of possibly causing this disorder. As mentioned above, environmental factors and social factors can indeed worsen the outcome of ADHD, which should drive parents and adult ADHD to improve the social, environmental and diet factors to at least, eliminate the worsening affect of these.

So what "development" was delayed?

1. Inhibition:

The first delayed developmental trait is a failure to develop an appropriate inhibition of your behaviour; also referred to as self-control or self-regulation disorder. Traditionally, and DSM-V officially refer to ADHD as an "hyperactive" disorder while Barkley is of the opinion that the hyperactivity is merely an outcome of the developmental failure - that of an inhibition deficit. Hopping around (physical hyperactivity), talking excessively (verbal hyperactivity), impulsive decision-making are all outcomes of the deficit in self-regulation and displays the inability to inhibit action. You see, ADHD cannot stop and think about an appropriate reaction which will contribute to their long-term growth. Therefore, its misleading to focus on the hyperactivity, because it is merely the outcome of the inability to inhibit control. The inability or deficit is the consequence neuro-genetics, not upbringing.

Another compelling reason why the focus on "hyperactivity" is not assisting the diagnosis and treatment of ADHD is the different outcome of hyperactivity over life stages. Yes, a child might "hop around" and act very hyperactive but in adults the outcome of hyperactivity is almost never hyperactive physically. In adults it presents itself rather in an internal restlessness, in a "quickness to anger, to be easily excitable, to have low frustration tolerance, to be easily angered by things around you, and to display your emotions much more quickly than other people do" (Barkley 2012). In other words, an ADHD has a developmental failure to regulate their emotions and provide an appropriate response. To explain it again with the qualitative-quantitative scheme; ADHD and non-ADHD experience the same emotion, frustrations and anger, but ADHD cannot respond appropriately; cannot inhibit the emotional outburst like non-ADHD do (this is quantitative differences). It is this inability to calm oneself and then adopt the appropriate behaviour for the moment/situation. And this inappropriate behaviour, is the trait which causes so much pain to ADHD in relation to broken relationships, impulsive decisions and/or anger, loosing of jobs etc. As Barkley puts it: ADHD express raw emotions; non-ADHD express moderated emotions.

2. Persistence:

Another developmental delayed trait is the failure to persist. Again, by diagnosing ADHD as an attention deficit, or refer to it as a pre-dominantly inattentive is confusing things. Inattentiveness is again the outcome of a deeper developmental failure - persistence. Let me explain: the persistence deficit refers to the fact that ADHD have difficulty in persisting towards the goal at hand, which then causes the inattentiveness, or that causes the perception by others that ADHD has an attention deficit. ADHD actually has a lot of attention - and maybe that is exactly the problem. ADHD attend to ALL impulses (the bird singing, the ambulance siren, the lawnmower while trying to listen to a lecture) and consequently attend to all those while the non-ADHD has the persistence in achieving the goal at hand - to block out impulses in order to achieve the goal of listening to the lecture. I hope that makes it clearer: ADHD is therefore rather a failure to direct behaviour in achieving a goal, to persist toward that goal, which requires the ability to resist distractions. So, ADHD is not an attention deficit, rather a persistence deficit!

Conclusion

Indeed I agree with Barkley when he said that the name of this order being "ADHD" may cause more harm and ridicule. Really, there are more serious issues our world than me just not being able to concentrate. But as he said; when we understand what this disorder really is - that of inhibition deficit, persistence deficit, self-regulation deficit, executive function deficit - only then will the necessary attention (pun intended) be given to ADHD and its "sufferers".

Knowing that it is a neuro-biological disorder and not one of social upbringing or the lack of social skills, is a profound insight. On the one hand, it acquits parents and adult ADHD of the guilt, of the self-inflicted "rejection" of being a "bad person". On the other hand, it puts the traits and consequences, and the seriousness of it, in perspective. And lastly, it stresses the point that: if you're child have ADHD, one of the parents will have ADHD because its a genetic disorder. So whether its the adult who get diagnosed as ADHD or a child, its imperative that other members be considered too. If I can relate this personally, when the clinician explained to us what might happen to my child, he was, in a sense, "telling my life story".

References:

  1. Barkley, RA; Murphy, KR; Fischer, M; (2010). ADHD in Adults: What the science says. The Guilford Press.
  2. Barkley, RA (2010). CADDAC Presentation
  3. Graphic credit

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