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? In this article, Sam Goldstein, Ph.D., explains this paradox.
Problems sustaining attention are not the cause, but one consequence of ADHD. If you provide a child with ADHD with a roll of coins and bring her to an interesting arcade, that child “pays attention” quite well. In fact, in some cases, kids with ADHD may sustain activities of interest, such as computer games, longer than unaffected children do.
What is it about the condition of ADHD that leads to this phenomenon? The fact is kids with ADHD have trouble paying attention in only some situations. These are situations in which they must bring online increased self-control and effort in order to remain attentive. Such situations are 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 more. Keep in mind that all of us struggle to sustain attention and effort in these types of situations.
What is it unaffected kids do to function in these situations that those 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.
Research studies find that when tasks are interesting and pay-offs valuable, children with ADHD attend 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’s not that children with ADHD have something unaffected children don’t have. It’s that unaffected children mature quicker in a skill that kids with ADHD struggle to develop - self-control. In fact, in research studies, children with a diagnosis of ADHD possess the self-regulation or self-control of children approximately two-thirds of their chronological age. It’s not that their self-control isn’t developing, it’s developing at a much slower pace.
Self-control allows human beings to think, plan, and organize; to open a window between experience and response; to not 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 they respond thoughtlessly or impulsively while engaged in those activities.
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.
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 outcomes for these children. Programs are being developed to help kids during their formative years experience increased opportunities to learn and develop the self-control so essential and necessary to become a productive member of society. Presently, the programs I like best have been developed by Dr. Myrna Shure.
ADHD by other names and acronyms
While Attention-Deficit/Hyperactivity Disorder (ADHD) is the official term and acronym used by today’s mental health care professionals, it is sometimes referred to by other names and abbreviations. For example, it is sometimes called:
- AD/HD (with the “slash” in the middle)
- Attention Deficit Disorder (ADD)
- Attention Disorder
Dr. Sam Goldstein is a clinical professor of psychiatry at the University of Utah, a research professor of psychology at George Mason University and director of the Neurology, Learning and Behavior Center in Salt Lake City, Utah.
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