ADHD: Attention Doesn't Half Describe It
By: Mark Bertin
Dr. Mark Bertin is a developmental pediatrician and the author of The Family ADHD Solution. He attended UCLA School of Medicine, trained in general pediatrics at Children's Hospital Oakland, and completed fellowship at Albert Einstein School of Medicine. Dr. Bertin is an assistant professor of pediatrics at New York Medical College, on the editorial board for Common Sense Media, and on faculty for the Windward Teacher Training Institute. He also leads mindfulness based stress reduction classes, frequently for parents.
The starting point for The Family ADHD Solution and for attention deficit/hyperactivity disorder (ADHD) care in the real world is understanding that ADHD (and this includes ADD, which is now more accurately labeled ADHD-inattentive type) is a proven, often misunderstood medical disorder. When parents, teachers, or kids are lead to believe ADHD is fake or in some way just an excuse for a child's lack of effort, motivation or self-control, it leaves adults frustrated and confused, children wrestling with their own neurologic tendencies without guidance, and siblings caught in the middle.
We should be far beyond any debate about the reality of ADHD. It is real, and there are dozens of credible studies that prove it. When appropriately identified, ADHD is no different than any other medical condition. Where the problem occasionally arises is in getting an accurate diagnosis; ADHD can be hard to recognize in any individual. Instead of pouring effort into a meaningless debate about if ADHD exists at all, we can best support families by helping them understand what ADHD really is, and how to manage it.
ADHD is a poorly named condition. The stereotypical symptoms — lack of attention, hyperactivity and impulsiveness — merely scratch the surface. The parts of the brain implicated in ADHD also control executive function skills — abilities such as time management, judgment, organization, and emotional regulation. Executive function is kind of like the brain manager, responsible for supervising and coordinating our planning, our thoughts and our interactions with the world. The true issue with ADHD is one of executive function and as has been said by Dr. Russell Barkley and others, a more appropriate name for ADHD might be 'executive function deficit disorder.'
To guide families onto a better path, we need to stop debating the existence of ADHD and instead clear up misconceptions about it. When parents or teachers lose track of the fact that ADHD is a neurologically based deficit, kids get blamed for behaviors and choices not fully in their control. Understanding the neurology of ADHD allows us to recognize that a child's apparent misbehavior or poor motivation comes down to a concrete, skill-based difficulty with focus, staying on task, controlling emotions, or any other of a long list of life skills related to executive function.
Just as some people can draw, shoot a basketball, or pick up how to play an instrument more easily than others, planning, remembering and paying attention are innate abilities driven in large part by our genetics. Chronic issues with forgetfulness, poor planning, getting off task, leaving homework assignments behind, not listening when called, losing one's cool when frustrated ... all reflect deficits of executive function. You might choose to teach someone how to shoot a free throw, or a new way to keep track of their to-do list, but the skill will not materialize out of thin air.
You wouldn't say to a child with asthma, "Just try harder, stop wheezing." Likewise, expecting a child with poor executive function skills to 'pull it together' right now is unfair and sets up challenging, often unrealistic expectations. Instead, we must develop a compassionate and objective view of their true abilities, followed by detailed planning that both builds skills and creates strategies compensating for areas that remain difficult. We encourage appropriate behavior and hard work, but also must be aware that ADHD-related hurdles can get in the way.
Addressing the wide-ranging impact of ADHD on families starts with recognizing it as a medical condition affecting executive function. When we start to understand the full reality of the situation — that someone with ADHD has a true disorder affecting how they manage their lives — we can then make skillful choices about how we parent, how we teach, and how we can best manage other aspects of care. When we recognize the actual cause of ADHD and its far reaching symptoms, we can compassionately change our expectations while offering intelligent long-range plans that develop skills and make certain all children with ADHD reach their full potential.
Adapted from "The Family ADHD Solution" by Mark Bertin M.D. Copyright © 2011 by the author and reprinted by permission of Palgrave Macmillan, a division of Macmillan Publishers Ltd.