Tilley Psychological Services

Attention Deficit/Hyperactivity Disorder

General Information

Myths about ADHD

Assessment

Treatment

 

General Information

ADHD (Attention Deficit/Hyperactivity Disorder) is a fairly common neurological disorder but is often misunderstood by the general public.  The common stereotype is of a child (usually a boy) who is hyperactive, impulsive, and cannot sit still.  This stereotype represents one type of ADHD, but there are different types and we are still trying to figure out what they are, and how best to treat them.  The other most common form of ADHD is the "Primarily Inattentive Type", which is characterized by poor attention, but not the restlessness.  People with this type of ADHD are often described as daydreamers who are easily distracted and have trouble maintaining their focus on anything.

 

The characteristic behaviours associated with ADHD are difficulty with sustained attention, physical restless (which in adults is often expressed as fidgeting or an internal sense of restlessness rather than hyperactivity), and poor impulse control.  There are a host of other difficulties, including difficulties with time perceptions, poor emotional regulation, trouble with perception of (or attention to) social cues, problems starting things, impatience, and problems finishing things.  In adults, anxiety and/or depressive disorders are common as the ADHD adult struggles to understand what appears to be incomprehensible.  In fact, when the neuropsychological deficits associated with ADHD are understood, the problems begin to make sense.

 

The part of the brain that is most often implicated in problems associated with ADHD is the prefrontal cortex, an area of the brain in behind the forehead, just above the eyes, although other parts of the brain are also implicated.  The prefrontal cortex is involved in what are known as "executive functions" - inhibiting behaviours, making choices, maintaining working memory, directing attention, planning and following through.  It is also involved in intelligence, personality, and emotional responses.  Think of the prefrontal cortex as being like the boss, or the teacher in the class - when it is not working, the other parts of the brain do not know where, when, or how to do their job best, and there is some degree of chaos.  (This is, of course, a great simplification, but you get the idea.)  In people with ADHD, some parts of the prefrontal cortex tend to be smaller, there is less blood flow to the area, and less electrical activity.  Usually, when a person is asked to concentrate, this area of the brain usually kicks into high gear.  However, when people with ADHD are asked to concentrate, the level of activity in this area actually often decreases, resulting in great difficulty directing attention.  In fact, I sometimes joke that the name for this disorder should be Directed Attention Deficit Disorder or DADD  (no, nothing to do with fathers - that's another story).  As a result, useless information (such as the scratching of someone else's pencil or the sensation of the seams on clothing) is not filtered out and competes for attention with useful information (such as the math problem being worked on, or the conversation coming from the spouse).

Top | Home


Myths about ADHD

  •  It arises from poor parenting or teaching:  ADHD is a neurological disorder (see Daniel Amen's website for cool pictures that demonstrate this nicely) and while environmental and behavioural modifications can have a very positive impact, there is no evidence to date that ADHD can be cured.
  • It is caused by food allergies or sensitivities:  Some people have food sensitivities that cause a host of physical and psychological problems, including attention/concentration issues.  Avoiding problematic foods for such people will certainly help to ease their distractibility.  However, food allergies do not cause ADHD.
  • Children grow out of it in their teen years: It used to be thought that children grow out of ADHD, but it is now known that they do not.  In the teenage years, there is often a lessening of hyperactivity and better control of attention arising from neurological maturation.  This results in a shifting of symptoms, but about 80% of children with ADHD continue to suffer negative consequences into their adulthood.
  • People with ADHD cannot pay attention at all, to anything:  Simply not true.  There is a quite common phenomenon in ADHD people called "hyperfocus".  It is my belief that this arises out of the same difficulty with directed attention that leads to high levels of distractibility - the frontal lobes cannot direct attention away from activities that are stimulating.  And, by the way, video games are very stimulating!
  • Problems with ADHD only arise in "boring" situations, like school or work:  One common story that I hear is about the child who absolutely loves Judo, or hockey, or dance, or soccer, or . . . whatever . . . but who is always distracted and gets into trouble because he/she cannot maintain attention during instruction.  Another one is about the adult who loves music but has gone years without playing their instruments because they lose focus.
  • ADHD is a "new" disorder that is caused by too much television, video games, etc.:  Although the term ADHD is new (it was first used in the 1970's), the characteristic difficulties were first described medically in the early 1900's.  The only difference is that for much of the early 20th century, the syndrome was considered a behavioural or personality disorder.  We may very well find out that children who have high levels of exposure to television and video games are not good at directing or maintaining their attention, or coping with boredom.  It is up to us, as adults, to teach them these skills.  This may require some role-modelling:  turn off the television, radio, MP3, cell phone, video game, or PDA, and actually pay some attention to your life, your spouse, and your children.  

Top | Home


Assessment

There is no particular test for ADHD, and in some people it is an easier diagnosis to make than in others. According to the current guidelines recommended by the Canadian ADHD Resource Alliance (CADDRA) a complete assessment should include both psychological and medical exams, although in uncomplicated situations one or the other may be sufficient. The process of assessment involves a ruling in of a typical pattern of development and behavioural/cognitive difficulties, as well as a ruling out of other possible causes. For example, there are a number of medical conditions (such as low iron, a thyroid problem, or a sleep disorder) that could cause inattention (and hyperactivity in children). As well, some psychological problems, including anxiety, depression, and post-traumatic stress disorder (PTSD) could cause symptoms that on the surface could look like ADHD.

A complete psychological assessment can often address the possible presence of other learning disabilities, in addition to other psychological conditions which could be causative factors or co-morbid conditions (occurring at the same time). As well, the results of the psychological assessment can be used in designing a treatment plan, including any modifications that may need to be made to the educational or work environment of the person with ADHD.

Top | Home


Treatment

 

Education:  It is considered vital that people with ADHD and those around them educate themselves about ADHD and how it impacts the processing of information. 

 

Practical Strategies:  There are many environmental supports and modifications that can be made to help the ADHD person be more successful. 

 

Exercise:  We all need exercise, and this is particularly true for most people with ADHD.  When circulation is improved in general, blood flow to the brain is also impacted.  Many people with ADHD, even those with the Primarily Inattentive Type, are often restless, and regular exercise can help to ease their restlessness, as well as help them relax and sleep better.

 

Relaxation:  This is a lost art in our culture, and people with ADHD often find it difficult to "turn off their thoughts" and relax.  Practicing relaxation can help them learn to focus and to deal with stress better.  Because of their internal restlessness, many people with ADHD enjoy Tai Chi and yoga as ways to relax.

 

Reframing:  Most people with ADHD have come to believe that they are "stupid", "lazy", "inept", "defiant", or a host of other pejorative terms.  For many adults, in particular, receiving a diagnosis is a relief, because it allows them to understand how and why they react the way they do.  Simply having this understanding and getting treatment is enough for some.  However, for those with accompanying mood disorders, anger management problems, or poor personality adjustment, psychological therapy with a therapist who has a thorough understanding of ADHD will be necessary to help them accept themselves, with all of the gifts and challenges of ADHD, and to optimize their functioning.

 

Medication:  ADHD is a neurological condition, and many people find that medication is very helpful.  On the other hand, some people find that medication is not particularly helpful - we do not yet know why some people respond better than others.  There are a variety of different medications used for ADHD, and they all have different side effects.  Nonetheless, for many people with ADHD, medication is an important part of an overall treatment plan.

 

A note on alternative therapies:  There are many people who claim that therapies such as acupuncture, Reiki, or some types of chiropractic can cure ADHD.  The date, there is no good evidence that this is true, although many people benefit from these therapies and general improvement in health functioning will likely contribute to improved frontal lobe functioning.  As well, there are an increasing number of herbal or naturopathic products that claim to treat ADHD.  These are helpful for some people, not for others.  Those that work, work because they have an impact on brain functioning.  Unless you are an expert in brain physiology, if you are going to try any of these supplements, please work with a qualified health practitioner to ensure that you are doing so safely.  

 

Top | Home

 

Contact me at 780-702-8905 or email linda@tilleypsych.com