As a concerned parent, I often here the discussion at schools – does ADHD exist?
This question has nearly as many answers as there are people willing to voice an opinion on the subject. There has never been a consensus about the validity of the ADHD diagnosis in large part because researchers had, until recently at least, found no evidence of a biological cause. The question is further confounded by the fact that the criteria doctors use to diagnose the disorder are common behaviors that nearly all of us have demonstrated at some point: failing to pay attention to details, having difficulty waiting in line, and so on.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), a standard reference source published by the American Psychiatric Association, there are three patterns of behavior that indicate ADHD: inattention, hyperactivity, and impulsivity (difficulty controlling one’s actions).
Signs of inattention as outlined in the DSM-IV include:
- becoming easily distracted by irrelevant sights and sounds
- failing to pay attention to details and making careless mistakes
- rarely following instructions carefully and completely
- losing or forgetting things like toys, or pencils, books, and tools needed for a task
Signs of hyperactivity and impulsivity include:
- feeling restless, often fidgeting with hands or feet, or squirming
- running, climbing, or leaving a seat in situations where sitting or quiet behavior is expected
- blurting out answers before hearing the whole question
- having difficulty waiting in line or for a turn
Because everyone shows some of these behaviors at times, the DSM-IV contains very specific guidelines for determining when they indicate ADHD. The behaviors must appear early in life, before age 7, and continue for at least six months. In children, they must be more frequent or severe than in others the same age. Above all, the behaviors must create a real handicap in at least two areas of a person’s life, such as school, home, work, or social settings. A child with some attention problems but whose school work or friendships are not impaired by these behaviors would not be diagnosed with ADHD. Nor would a child who seems overly active at school but functions well elsewhere.
Many researchers are developing an understanding of how certain brain functions contribute to attention, and what interventions may work for some children. They catagorize attention as consisting of three control systems: mental energy, processing, and production. Some children experience problems with all of these attention systems, while others may show strengths and weaknesses in different systems.
Attention Control Systems and Signs of Attention Problems
A common misconception about children with attention problems is that they aren’t paying attention at all. But children who struggle with attention may actually pay attention to everything; their difficulty is deciding what to focus on and maintaining that focus. And since attention is a complex neurocognitive process, there are several areas where signs of struggle appear.
Mental Energy
The first attention control system, mental energy, regulates and distributes the energy supply needed for the brain to take in and interpret information and regulate behavior. Children whose mental energy is not working effectively may become mentally fatigued when they try to concentrate, or have other problems related to maintaining the brain energy needed for optimal learning and behavior.
What to Watch For:
- difficulty concentrating; may complain of feeling tired or bored
- does not seem to be well rested and fully awake during the day
- has inconsistent work patterns that negatively impact quality and quantity of work
- shows overactivity and fidgets – especially pronounced when sitting and listening
Processing
The second attention control system is called processing. This system helps a child select, prepare, and begin to interpret incoming information. Children who have difficulty with processing may have a range of problems related to regulating the use of incoming information.
What to Watch For:
- processes too little or too much information; can’t distinguish between what is important and what isn’t
- focuses too superficially or too deeply on information presented
- has difficulty connecting new information with information already known
- only pays attention to exciting information or highly stimulating activities
- ◦focuses for too brief a period
- has problems shifting focus from one subject or activity to another
Production
The third attention control system is production. This area governs output – including what children generate academically, behaviorally, and socially. Children with production control problems have a range of difficulties related to regulating academic and behavioral output. They may do things too quickly without thinking, planning, or previewing outcomes.
What to Watch For:
- fails to preview the effects of statements or actions or to predict the outcomes of tasks or activities
- has difficulty coming up with the right strategy or technique to accomplish a task
- does not monitor quality of work or the effectiveness of strategies
- does not use past successes and failures to guide current behavior, actions, or strategies
- is apt to do too many things too quickly and some other things too slowly
- has a poor sense of how time and how to manage it
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