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Archive for January, 2015

What is ADHD?

       “Now is the time to blow the whole lid off the model that merely identifies pathology and to replace it with the more accurate- and hopeful- model that not only acknowledges the problems but also seeks and identifies the strengths as well.” –Edward M. Hallowell, Driven To Distraction: Recognizing and Coping with Attention Deficit Disorder

         Attention Deficit/Hyperactivity Disorder, or ADHD, is the term applied to a cluster of symptoms related to executive function and impulse control.  There are many questions in schools about ADHD: “How should we support these students?” “Can we use our regular (punitive) behavioral system with students who have ADHD?” and even “Is ADHD a real thing?” I will address the first two questions further into this series, but for now I would simply like to address the third, which questions the validity of the ADHD diagnosis.

ADHD is indeed “real”. ADHD is a cognitive difference that is rooted in the way the brain holds, processes, and reproduces information in order to complete tasks. Adults and Children can be diagnosed with ADHD- it is not simply a pediatric condition.

ADHD is a disorder in settings where a person is meant to follow a prescribed behavior and system for generating work (school and office work, for example). The differences in working memory ability, behavioral self management, and physical inhibitions can be a real deficit in situations where a methodical way of thinking, organizing, and task-switching is expected. In some cases, ADHD can be an asset for people who have learned to use their different way of processing to generate creativity, ideas and work output, and to see solutions to problems that others perhaps cannot, at a pace and through a process that may seem inconceivable to the “normative” mind. Many successful adults with ADHD consider what was once a disorder to be a gift.

Some also wonder if ADHD is a new “trend” in diagnosis, saying that in past decades one just had to learn how to “deal” if one had difficulty with focus, memory, or sitting still (among other indicators- there are many). When considering that there are advances in neuro-science, developmental psychology, and behavioral psychology being developed even now, it is easier to understand that when “we were young” we were also living with misconceptions about differences in learning and behavior, and we have come a long way. What we understand and approach/treat as a disorder now may be understood as a valuable diversity of thought in the future – even in school, even in children.

For your information, and to anchor the discussion in fact, the following excerpt has been taken from the CDC website (see Works Cited). Please remember that only a trained health care provider such as a medical doctor, psychologist or psychiatrist, can diagnose or treat ADHD:

DSM-5 Criteria for ADHD

People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development:
  1. Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
    • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
    • Often has trouble holding attention on tasks or play activities.
    • Often does not seem to listen when spoken to directly.
    • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
    • Often has trouble organizing tasks and activities.
    • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
    • Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
    • Is often easily distracted
    • Is often forgetful in daily activities.
  2. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
    • Often fidgets with or taps hands or feet, or squirms in seat.
    • Often leaves seat in situations when remaining seated is expected.
    • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
    • Often unable to play or take part in leisure activities quietly.
    • Is often “on the go” acting as if “driven by a motor”.
    • Often talks excessively.
    • Often blurts out an answer before a question has been completed.
    • Often has trouble waiting his/her turn.
    • Often interrupts or intrudes on others (e.g., butts into conversations or games)
In addition, the following conditions must be met:
  • Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
  • Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities).
  • There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
  • The symptoms do not happen only during the course of schizophrenia or another psychotic disorder. The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
Based on the types of symptoms, three kinds (presentations) of ADHD can occur:

Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months

Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months

Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months.

Because symptoms can change over time, the presentation may change over time as well.

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Stay tuned for Part II of this series, a discussion about support for students with ADHD! Thanks for reading.

Works Cited

“Symptoms and Diagnosis.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 29 Sept. 2014. Web. 28 Jan. 2015. <http://www.cdc.gov/ncbddd/adhd/diagnosis.html&gt;.

Hallowell, Edward M., and John J. Ratey. Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood. New York: Simon & Schuster, 1995. Print.

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