Attention Deficit Hyperactivity Disorder (ADHD)
Attention Deficit Hyperactivity Disorder or Attention Deployment Hectic Differences?
Attention Deficit Hyperactivity Disorder (ADHD) is usually understood as a disorder where something is missing in a person. However, it is less stigmatizing to think of it as a difference. In explaining the nature of this disorder to children and their parents, I sometimes change the wording of the ADHD label to Attention Deployment Hectic Differences.
The most current theory about ADHD is that the problems for someone with ADHD are related to their ability to stay focused on one thing. Rather than not being able to pay attention, children and adults with ADHD can’t stop themselves paying attention to all the other events happening around them. For example, if you are talking on the phone, you are generally able to tune out the noise of the TV, the children playing in the background, the car going by on the street, and the airplane flying overhead. A person with ADHD may try to watch TV and to identify the kind of vehicles driving and flying by as well as trying to carry on the conversation and talk to the children all at the same time.
Similar problems occur in the classroom. Children with ADHD often try really hard to pay attention to their teacher. Their problem is that they are unable to stop themselves paying attention to the other things happening (e.g., a conversation in the corridor, the men working on the sidewalk, and the motor cycle driving by on the street).
Frequently, parents of ADHD children remark that their children are able to watch TV without a problem. However, the volume on the TV is often high and there is nothing to distract them from the TV. Also, researchers have found that children with ADHD do not watch TV the same way as other children; they are not able to get information from a TV program as effectively.
There was probably a biological advantage to having some people in a group who were distractible and who paid attention to everything. They would hear the saber-tooth tiger coming first. As there are not many saber-tooth tigers in today’s classrooms, this style of paying attention is not very helpful in the classroom.
What is ADHD? There is considerable evidence that ADHD is related to a lower level of activity in the frontal and pre-frontal lobes of the brain. One function of this part of the brain is to monitor one’s own behaviour and to make decisions about what to attend to. Self-monitoring also includes inhibiting behaviour (i.e., not throwing the spitball in class or starting a conversation with a friend). A child with ADHD will often misbehave and see themselves do it but too late to stop. Thus, they are hit with a double whammy – they misbehave plus they are aware of their inability to control themselves. They may come to believe (erroneously) that they are “bad.”
What treatments are available? There are a variety of options. Family therapy may help a family adjust to the stresses that are related to having a family member with ADHD. Social skills training may be useful for a child to help them get along better with their peers. Classroom management may help to reduce the potential distractions for a child. Insight-oriented therapy (cognitive-behavioural, EMDR, etc.) may help repair damaged self-esteem. There is some early evidence that Neurofeedback may be helpful. However, current research shows that it may take up to 40 weekly sessions to have an impact. Neurofeedback involves the use of sensors on the scalp to measure brain waves and then training the person to increase the more desired brain activity.
Another method of changing one's attention style is stimulant medication. This method is also the most controversial. People are reluctant to consider medication for their children or themselves. However, there is much misinformation about how these medications work. I offer some information about how these medications work in another article.
Cogmed Working Memory Training. I am pleased to offer a program that can help with attention and working memory issues. It has substantial research support. Cogmed was founded by Swedish Neuro-Psychiatrist Torkel Klingberg. Dr. Klingberg developed the Cogmed program to enhance a person's working memory capacity in an effective, efficient, and fun way. Through a computer training program children, adolescents, or adults complete a specific set of exercises in a 30 to 45 minute session -- five days a week for five weeks.
The program was originally developed for children with ADHD. However, it is useful with other groups. Adolescents and adults with ADHD have benefitted from the program. Older adults and stroke victims have also benefitted from the training. One of the strengths of the Cogmed program is that it is not offered to new populations without first obtaining peer-reviewed research support.
At the end of the program, trainees experience substantial improvements in working memory, decrease in attention and impulsivity problems, and better academic performance and/or work achievement.
I am the only clinic in Canada west of Ontario qualified to offer this program. Please see more detailed information on my web page devoted to the Cogmed Working Memory Training program.