It appears that more recent research is showing that ADHD is clearly a neurological disorder and not a behavioral problem Although many parents believe that their children are being defiant, these children may not be able to control their ability to focus even with their best intentions. There are many issues related to this disorder and problems with attention are only one of them. One of the primary problems is that children have difficulty with impulsivity and frequently demonstrate poor social judgment.
ADHD is different from other disorders such as childhood depression and anxiety. According to Dr. Russel Barkley this is a developmental issue. Children with this diagnosis develop at a different rate from other children and suffer socially due to their inability to get along with others and use good social judgment. There is, however, a relationship between ADHD and ODD which often develops with children who have been diagnosed with this condition.
During world war one and two it was discovered that when soldiers were injured in the frontal area of the brain they often lost their ability to focus their attention and to self-regulate. It continues to appear that the prefrontal area of the brain is involved in ADHD and that stimulation of this area remains essential to improved focus. Stimulant medication such as cylert, dexodrine, and Ritalin had been used for years as a way of providing stimulation of this area to improve focus and attention. There are several areas of the brain which are involved apart from the pre-frontal area which also may respond well to medications when stimulants are not providing symptom relief.
Recent research seems to shift the focus of this disorder from being an attentional disorder to a problem which is more related to executive function. I was recently viewing a video by Dr. Barkley who is a foremost authority regarding the diagnosis and treatment of ADHD. My understanding of Dr. Barkley’s comments is that it is difficult for children diagnosed with this disorder to make changes in themselves. He states that changes need to occur in the environment for children to be more successful. It is important that parents provide what he calls a “scaffold” around them which immediately rewards positive behaviors and efforts. He states that with this diagnosis children need accountability to help them make changes in themselves.
Some examples of executive function are seen below.
· Organization and Planning
· Working Memory
· Task Initiation
· Impulse Control and Emotional Self Regulation
· Social Awareness
· Self Monitoring
Children with these challenges can focus on video games and certain activities related to their interest because these activities are immediately reinforcing. The child’s brain itself seems to respond to the immediate reinforcement of the activity and the improved focus and attention becomes automatic. This is not related to the child’s conscious desire to focus on the activity. Activities such as classwork or homework do not offer this type of immediate reinforcement, although reinforcement may be provided it is frequently not immediate.
Too often we become frustrated with our children and become emotionally reactive when they do not focus to our expectation. As we become reactive we begin to complicate the issue with excessive emotionality which only serves to make matters worse. It is difficult enough for the child to deal with a neurological disorder; we don’t want to contribute to them having an emotional disturbance as well. Dealing with any disability or disorder is likely to be emotionally taxing and we need to develop an ability to be patient and compassionate as we improve our ability to provide structure and improve parent/child communication.