Overview
About Attention Deficit Disorder
Attention Deficit/Hyperactivity Disorder or AD/HD has become an increasingly popular label for people who seem restless and distractible, or have trouble remembering. Actually, there are many reasons for such behavior, and only some of them should correctly be labeled AD/HD.
This chapter begins by describing AD/HD. The next chapter addresses other conditions with some of the same symptoms that may be misdiagnosed as AD/HD. It is important to keep in mind that thoughtful people sometimes disagree about how AD/HD should be defined and treated. Thus, the content of this chapter represents both what most people agree are the appropriate statements about AD/HD, as well as the author’s own judgment. Where consensus is lacking, the author will try to make that clear.
What is AD/HD?
To begin, the name itself should be explained:
A = Attention, defined as the mind’s ability to focus on what the senses are telling it as well as on what the person is thinking about at the same time
- Most information people receive is through their eyes (visual reception) and ears (auditory reception); but people also take in information through their sense of touch, smell, taste, and intuition.
- As soon as information reaches the brain, the mind begins to interpret it, by relating what it is sensing to what it has experienced before. This, for example, is how we know whether we are talking to a friend or a stranger on the phone; or whether someone is grilling hamburgers or vegetables; or whether the letter “a” is a small or upper case symbol.
In order to act on sensory information and the meaning one gives it, a person must also hold this information in mind while forming and executing a response. This aspect of attention is often called Working Memory—i.e., remembering something while “working” with it.
D = Deficit, defined as a significantly reduced capacity to attend or focus, compared with the person’s general intelligence or demonstrated abilities in other areas.
H = Hyperactivity, defined as unusual levels of motor activity and restlessness usually combined with impulsivity and failure to learn from mistakes, as well as anticipate consequences.
D = Disorder, defined as persistent behavior (lasting more than 6 months) that undermines age-appropriate activity or interferes with normal life tasks.
Note that to date, the definition of AD/HD has been developed to explain behavior in children and adolescents. Definitions of adult behavior in this area are subject to ongoing research and debate.
Primary Problems Recognized in Adults
Most people familiar with this disorder in adults agree there are 3 primary areas of impaired functioning. Not all areas will be part of an individual’s experience with AD/HD, and not all of the symptoms associated with an area will characterize that individual.
1. Executive Functioning. The brain’s executive functions are those that control behavior--including paying attention, managing emotional responses, and planning and carrying out goal-directed behavior.
Executive Functions Impaired in AD/HD:
- Thinking ahead—organizing, planning, anticipating consequences
- Attention—concentrating, avoiding distraction, holding information in mind (Working Memory)
- Self regulation—staying alert, sustaining effort, controlling impulsiveness
- Emotion—managing frustration and modulating emotions
- Mental flexibility—adapting to change, set shifting
- Self monitoring—observing and regulating actions
2. Working Memory. This area is related to executive functioning but deserves its own discussion. It requires the ability to concentrate, avoid distraction, and hold information in mind while applying it to a learning or problem-solving task.
Signs of Working Memory Impairment:
- Forgetting instructions
- Forgetting what is read from one sentence or paragraph to the next
- Inability to benefit from vicarious learning
- Difficulty learning from past mistakes
- Poor sense of time
- Poor awareness of self
3. “Secondary” Symptoms. These are problems that develop because of impaired executive and working memory functions; they include problems that often co-occur with AD/HD symptoms.
Consequences of (1) and (2):
- Chronic lateness and forgetfulness
- Procrastination
- Chronic boredom
- Low frustration tolerance; anger
- Relationship problems
- Employment problems
- Learning problems (with or without a corresponding learning disability)
- Substance abuse or addiction
- Anxiety
- Low self-esteem, depression
General Considerations
With so many characteristics of AD/HD to consider, it is easiest to think of it as a developmental disorder, in which executive functions mature more slowly than expected. Adults who display symptoms of AD/HD should not be diagnosed with this disorder until behavior during their early school years is well documented and confirmatory.
AD/HD is also a neurobiological disorder, which means it results from abnormal brain structure and/or chemistry. There are two explanations for its origin, and experts disagree on the proportion of persons with AD/HD to assign to each source:
- AD/HD may be found among several members and generations of families, indicating it is likely an inheritable condition. It also tends to occur with other disorders such as learning disabilities, alcoholism and depression, which suggests some individuals are born with a biological disadvantage.
- AD/HD may be found among persons with no history of AD/HD in the family after they have experienced adverse circumstances during infancy and early childhood. This explanation is often linked to conditions that create insecurity and failure to develop trust. Thus, some individuals early in life may be disadvantaged socially and emotionally. A thorough and compassionate explanation for this point of view can be found in books by Dr. Gabor Maté, among others (see Resources).
CEU's Available for ABE Teachers
For more information about ADHD and to earn four CEUs, visit the FREE interactive, online course titled, “Teaching Adults with ADHD” available on the Minnesota Literacy Council website at: http://online.themlc.org/