Not surprisingly, I have learned that having a website results in dozens of questions per month from parents and professionals. I have correlated these questions and in particular chosen those who answers are often elusive or simply unavailable from most clinicians. I have modified and enhanced some of the questions as well. Over the next six months my monthly articles address one question per month.
Question #1
Many parents and teachers report that although children with ADHD are not supposed to be able to pay attention, there are many activities or situations during which their attention span appears focused, if not even more focused than unaffected children. If ADHD is a problem of paying attention, how is this possible?
Answer
Problems sustaining attention are not the cause but one consequence of having ADHD. If you provide a child with ADHD with a roll of coins and bring him or her to an interesting arcade, that child “pays attention” quite well. In fact in some cases children with ADHD may sustain activities of interest such as computer games longer than unaffected children. What is it about the condition of ADHD that leads to this phenomena? The fact of the matter is that children with ADHD have trouble paying attention in only some situations. These are situations in which children must bring on line increased self-control and effort in order to remain attentive. Such situations are defined as repetitive, effortful, uninteresting, and usually not of the child’s choosing. When these situations do not provide immediate, frequent, predictable and meaningful payoffs or rewards for completion, children with ADHD struggle even further. Keep in mind that all of us struggle to sustain attention and effort in these types of situations.
What is it unaffected children do to function in these situations that children with ADHD appear unable or incapable of doing? The answer: self-regulate. Self-regulation or self-control must be brought online in these types of circumstances. Thus, when tasks are interesting and pay-offs valuable, research studies find that children with ADHD pay attention reasonably well. As tasks become more repetitive, less interesting and offer only delayed reinforcement, children with ADHD lose focus and sustained attention faster than others. Thus, it is not that children with ADHD have something unaffected children don’t have. It’s that unaffected children are maturing quicker in a skill that children with ADHD struggle to develop – self-control. In fact, in research studies, children receiving a diagnosis of ADHD possess the self-regulation or self-control of children approximately two thirds of their chronological age. It is not that their self-control isn’t developing, it’s that it is developing at a much slower pace.
Self-control allows human beings to think, plan and organize; to open a window as it were between experience and response; to not necessarily be locked into a first response when faced with problems; to separate thought from feeling; to carefully consider alternatives and to sustain effort and focus even in the face of frustration or boredom. Although the clinical term for the condition still contains the words attention and hyperactivity, it is increasingly recognized by researchers and professionals that these are consequences of delayed or faulty self-control. Even parents of children with ADHD are quick to comment that there are many situations or activities during which their children appear to pay attention quite well, even if while engaged in those activities their children respond thoughtlessly or impulsively.
As scientific research emerges defining problems with the development of self-control as the core deficit in children with ADHD, a better understanding of treatment is also developing. Medications used to treat ADHD do not necessarily improve attention. They increase self-control leading to sustained effort, focus, attention, impulse control and enhanced capacity to manage physical activity. Stimulants, in fact, do not reduce hyperactivity but stimulate a center in the brain that human beings use to govern and regulate themselves. It is for this reason that stimulants such as caffeine are popular in our culture because even unaffected individuals many derive some small benefits in regards to enhanced self-control from them. We now recognize, however, that while stimulant medication may reduce immediate symptoms of ADHD, the medication alone does not appear to contribute to positive long-term adult outcome for these children. Programs are being developed to help children during their formative years experience increased opportunities to learn and develop the self-control that is so essential and necessary to become a productive member of society. Presently, the programs that I like best have been developed by Dr. Myrna Shure. They appear at the end of this week’s installment.
