ADHD in 2014

Most people have some understanding of what is meant by Attention Deficit Hyperactivity Disorder (ADHD). However, some may not realize that this diagnosis relies on specific criteria and needs to be made by a medical expert- a doctor or psychologist. While it is true that all children can at times be distractible, impulsive and hyperactive, these behaviors are much more prevalent in a child with ADHD. For a child with ADHD, symptoms of attentional limitation, distractibility and/ or hyperactivity and impulsivity undermine his ability to be successful at school and home.

Contrary to popular belief, research shows that most ADHD children have one or two areas of particular interest, for example, reading or Lego, where they are able to demonstrate focus beyond their normal limitations. It is also true that parents often refer to their child’s ability to focus on video games as evidence of normal attentional ability. This can lead to the sometimes false assumption that the child is simply unmotivated or non- compliant when he is non attentive.

Research observing ADHD children while playing video games is also illuminating. Results shows that while ADHD children seemed to be attentively engaged while playing, their behavior was still not typical of children without ADHD. The ADHD children were found to still be more restless and less attentive, to make more mistakes and to shed more tears while playing their video games compared to the non ADHD children.

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ADHD is not a new disorder and was actually first described by a different name as early as 1910. Currently research shows that when the same criteria are applied, the prevalence of ADHD is 5% worldwide. ADHD is a global disorder that impacts around 5 % of all children. While boys are 3:1 more likely than girls to receive an ADHD diagnosis due to their more overt symptoms, it is probable that ADHD impacts girls and boys at the same rate.

We know that ADHD is not the result of poor parenting; rather, the main cause of ADHD is genetic. In identical twin studies, the identical twin of a person with ADHD symptoms is 70-90% likely to be diagnosed with ADHD. A sibling or parent of a child with ADHD is 25% likely to also have ADHD.

We also have discovered that ADHD is not only a childhood disorder, but that for many people ADHD persists through to adulthood. While the symptoms of impulsivity and hyperactivity may abate as the child matures into adulthood, an adult with ADHD adult can continue to struggle with organization and tasks such as prioritizing as well as initiating and following through on tasks.

Our conceptualization of ADHD has been improved as the result of more recent clinical studies, where children with ADHD are compared with non ADHD peers; newer brain scanning techniques and advances in neurological research.

ADHD is currently understood as a biologically oriented developmental disorder related to the rate of development of a particular region of the brain. That region of the brain, located in and around the frontal cortex area, can be considered as the brain’s CEO, that is, it manages the Executive Functions of the brain. The brain’s Executive Functions include directing attention, prioritizing tasks, exercising inhibition (i.e. the decision not to perform an action), and maintaining an awareness of time, including relevant information from the past as well as future goals, all while performing actions in the present.

Brain scanning studies have shown that for children with ADHD the physical development of the Executive Functioning region of the brain is delayed by about three years compared to the development in children without ADHD. It is important to note that the pattern of development is the same for both groups of children; it is the rate of growth that is delayed in ADHD children. Other research shows that by the late teen years this difference is no longer apparent; the development in this area of the brain in ADHD children has caught up with that of non ADHD children.

Other research has identified chemical differences related to levels of neurotransmitters in the prefrontal cortex region of the brain between ADHD and non ADHD children. Stimulant medication has been shown to remedy that difference.

Treatment of ADHD is multidimensional but should begin with setting up the child’s home and school environments so that he is better supported to be successful. It is important to remember that children with ADHD are limited in their ability to remain cognizant of their past experiences as well as their intended goals while acting in the present, and this seems to impact their ability to maintain focus. Therefore, it is important to provide frequent feedback to the child while he is attending to his task as well as to remind the child beforehand of what reward or privilege he will enjoy upon completing that task. Examples of other adaptations that will support success might include limiting the time required to stay at a task, scheduling predetermined short breaks, and providing a less distracting alternate work area where the child might choose to go to complete his school work. Research has found that ADHD children do not make use of “self talk” to direct and motivate themselves while performing a task. Cognitive behavioral therapy (CBT) can effectively help the child learn to use the important internal process of self mediation i.e. “self- talk” to self instruct, self regulate and self evaluate. The child might choose, for example, to adopt a mantra such as Just Do It to regularly remind himself to stay on the task.

For many children with ADHD, medication is a critical component of treatment, necessary to allow the child to effectively use important behavioral and cognitive behavioral tools. Research shows that stimulant medication in particular improves the academic work, behavior and social adjustment in the majority of children diagnosed with ADHD.

Children with ADHD face unique and significant challenges to success and without effective support often suffer low self esteem, discouragement, feeling of personal effectiveness and social difficulties. It is critical that the abilities and gifts of each child are recognized and celebrated. An ADHD diagnosis does not limit a child’s ability to prosper and to achieve his potential; however, the nurturance and support of adults who understand this disorder is essential to help a child with ADHD to thrive.

ADHD in 2014
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For over 40 years Nancy has practiced as a Registered Psychologist, specialized in assessing and treating children, adolescents and families. She has practiced with Denis Boyd & Associates since 1991; prior to that she worked in varied government and private programs.

Nancy supports children and teens who present with a range of mental health concerns including anxiety, depression, ADHD, adjustment, trauma, and family issues. She assists families and parents in their intentions to effectively support their children’s emotional development and well being.

Nancy graduated from the University of British Columbia in 1977 with her Master of Arts in Clinical Psychology. She is a member of the B.C. Psychological Association.

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