What is ADHD disorder?
Updated: Oct 16, 2023
Did you know that 1 in 8 teenagers in the U.S.A. aged 12 to 17 have an ADHD diagnosis? That is remarkable considering the first diagnosis of ADHD was in 1987. If you have been letting ADHD slip under your radar until now, read on - it is not going away. It turns out it is an incredibly old problem (dating back to 1798) with a shiny new name.
What is ADHD disorder?
ADHD disorder is more usually called ADHD, Attention deficit hyperactivity disorder. and many years ago was known as hyperkinetic disease. It referred to a group of children who had mental conditions and were otherwise healthy and of normal intelligence.
According to the hunter-farmer hypothesis, humans can be classified into just two personality categories: hunters and farmers. Hunters are driven to ‘get the job done' and are adventurous by nature. They are bigger-picture guys who find any form of routine kills their creativity. Farmers, on the other hand, prefer routine (which need not necessarily be boring)! They respond well to a trade-off between focusing fully during working hours and leaving their work behind when they leave the office. This is grossly oversimplified, but you get the idea.
Each of us exhibits both farmer and hunter traits, and our predominant traits will dictate the type we are deemed to be. In modern society, pro-farmer working environments outnumber pro-hunter ones. The classroom is pro-farmer. For the vast majority of kids, this is conducive to their growth and development. Not so for the hunter-type kids. They aren’t able to sit on a chair from 9 to 3 and train their minds on a teacher. Like their adult counterparts, their creativity is stifled. It is they who will be diagnosed with ADHD.
The causes of ADHD are partly genetic and partly due to environmental factors. Brain scans of ADHD patients show clear differences to those of non-ADHD patients, so it does have a neurobiological basis. Scientists are only now learning just how many permutations and combinations there are of the growing list of signs and symptoms.
ADHD presents many challenges to students and their families, but these patients are often gifted in ways other students are not. Many genuinely consider it a blessing to have ADHD, once they learn how to live with it. It is a disorder that is hard-wired into the brain,
How you might recognise ADHD
Broadly speaking there are three main types and the commonest type is a combination of the other two. Phew! A clinical psychiatrist whose work I value gave a presentation on ADHD and I found his approach to be more enlightening. It comes from his experience of working with ADHD patients.
Easily distracted and/or hyper-focused.
ADHD is an inability to control and regulate attention. We would expect this causes themt o be easily distracted. Did you know that hyper focusing is also a problem for them. They can effortlessly spend four or five hours on the same task and it happens because of their inability to switch focus. Two sides of the same coin.
High grades and high IQ
Poor concentration ought to go hand in hand with poor grades; yet many kids have excellent grades. An ADHD student who also happens to have a high IQ achieves this by compensating for their lack of attention in other ways. For example, by studying excessively long hours or becoming a night owl, or forming informal study groups. Some older students self-medicate although that is another story.
Have you ever seen a teacher call a student out for not paying attention and ask them for an answer to a question? I know I have! Some ADHD students will still be able to answer correctly. They do so by thinking hard and figuring it out, reinventing the wheel, so to speak. But that is exhausting and eventually takes its toll. This strategy will surely fail as studies intensify.
Poor executive function skills.
These are the skills that enable us to stay focused and manage our time well. We are not born with these skills. We have to learn them and ADHD students find it much harder to develop them than other people do. In recent times it is becoming clear that the use of electronic devices is exacerbating this problem. Their ability to focus is intensified around technological devices.
Negative behaviour traits.
Socially, ADHD students can come across as disobedient, defiant and/ or forgetful. If you know someone who has ADHD you will no doubt be able to recall a time when you asked them to do something for you and they totally did not! They will tell you they forgot, and you might tell them “not to forget!” But theirs is not lazy forgetfulness. It is a result of being so easily distracted.
Class size can be a contributing factor too as ADHD students fare much better when they are given personalised support.
Is an ADHD diagnosis reliable?
Unfortunately, misdiagnosis is a major problem in the management of ADHD. A study of 50 pediatricians in the US revealed that only 50% of them knew what the (strict) guidelines were … Also, there is evidence that two out of five children’s symptoms improve over time to the extent they no longer have ADHD by the time they become an adult. That is good news, but further complicates the picture.
Unexpectedly, research shows that the student: teacher ratio in a class is known to influence the rate of diagnosis of ADHD. e.g. take two classes each of thirty students, say. One of the classes will have two teachers and the other class one. The class led by one teacher will contain double the number of diagnosed ADHD students than the class with two teachers: if there are three kids with ADHD in the two-teacher class there will likely be six kids with ADHD in the other.
We can ask how this comes about. Some ADHD students are disruptive. Then, if the most disruptive students are medicated the whole class will be brought back under control. It happens.
The incidence of ADHD increasing. Why?
Ignoring misdiagnosis, the incidence of ADHD is widely accepted to be rising. Psychology Today journal indicates this is a consequence of greater awareness of symptoms and of destigmatization of mental health issues. Still, we saw that ADHD is partly genetic and partly environmental. It is plausible that shortened attention spans have are impacting us all.
A report from Microsoft in 2015 was picked up by both Time magazine and the New York Times and it blew up the internet. It concluded we now have an attention span 1 second shorter than that of a goldfish! The headline turned out to be false but the long-term consequences of increased screen-time cannot be denied.
In the past, we entertained ourselves by reading a book, or watching a movie. These are long-form content and require longer attention spans. Today we are are choosing to subject ourselves to 1 minute YouTube video shorts and TicToc posts. We are actively training our brains to focus in short bursts. In the classroom this training is counterproductive.
Incidentally, there is nothing wrong with watching long-form content in video form. It is apparently short-form content that does the damage.
Managing ADHD
Once you have a diagnosis of ADHD how do you process that?
Short term
Many students have their lives transformed by treatment programs. The options are medication and/or cognitive behaviour therapy. Behaviour therapy is aimed at improving executive function skills and reframing the negative traits as positive ones.
Neither treatment changes the hardwiring of the brain. Rather they change the software. Both options have the same rates of success. So how do patients choose? Medication achieves results much faster than behaviour therapy. However, when therapy ceases the skills learned during behaviour therapy have a longer lasting effect.
Younger children are normally offered behaviour therapy first, though some families still prefer to take the medication route. The deciding factor can be time. Before we rush to judgement, consider a family where mum and dad are both professionals and two or three of their four children have ADHD. Undergoing behavioural therapy and reinforcing it at home would be enormous time commitment in comparison to that required for administering daily medication.
I am in no way offering medical advice, only reporting what I have learnt from my investigations. I am discerning and choose sources that have good standing amongst their peers, but it is still no substitute for professional advice. At best, it will give the uninitiated a basic vocabulary and working knowledge with which to begin a more meaningful discussion with the medics and educators involved in caring for an ADHD child. I am interested in teenage children because they are who I spend most of my time with. ADHD in adults and in younger children will be similar, but have a different slant on it.
Long term
An ADHD patients considering their future career path may be surprised to learn that having ADHD can actually be an advantage.
Bizarrely, teaching is often top of the list. There are many more options; Google it. Psych Central has a particularly insightful article which provides some background as to why certain types of work appeal to certain types of ADHD.
For more information, I recommend Dr K who is a Harvard psychiatrist with a special interest in the gaming community. He is an academic gifted with the talent of being able to provide detailed explanations without loss of clarity.
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