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“I prefer to distinguish ADD as attention abundance disorder. Everything is just so interesting . . . remarkably at the same time.” Frank Coppola, MA, ODC, ACG
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New Understandings of ADHD
Thomas E. Brown, PhD
According to a recent study by the U.S. Centers for Disease Control and Prevention, about 7.8 percent of children aged 4 to 17 years are currently diagnosed with AttentionDeficit/Hyperactivity Disorder (ADHD).This means that most teachers are likely to have in every class they teach, on average, at least a couple of students with ADHD. Clearly, it is extremely important for each teacher to have at least a basic grasp of what attention disorders are and what they are not.
Over the years, attention disorders have been known by several names. Currently, educators and medical professionals use different terms to describe this condition. Based upon federal law, educators use the terms ADD and ADHD to differentiate between students who are inattentive and those who are primarily hyperactive, respectively. Doctors diagnose students as having ADHD that is either predominately hyperactiveimpulsive, inattentive, or a combination of the two.Throughout this book, the term ADHD will be used. Information specific only to the ADHD inattentive type will be noted.
Understanding this disorder is not so easy.There are many widespread myths, and scientific understanding of ADHD has changed a lot over recent years. It is now clear that attention disorders are a much more complicated set of problems than was previously understood.
Several Different Types of ADHDThere are three types of ADHD:
ADHD and Executive Functions
Many still think of ADHD as essentially a behavior problem—students who are unwilling or unable to sit still, listen to the teacher, and follow classroom rules. But researchers now have recognized that ADHD is not so much a behavior disorder as it is an inherited problem in the development of executive functions, the management system of the brain.
One way of thinking about executive functions is to picture a symphony orchestra whose members are all very fine musicians. Even when the musicians are excellent, if there is no conductor, who can organize and integrate the efforts of the individual musicians in the same piece at the same time, the music will not be very good.
The problems with ADHD are not with those parts of the brain that would correspond to the individual musicians. The problems originate one level up in the management system that starts, stops, controls, and manages these activities, integrating them moment by moment to allow us to perform the tasks at hand. This management system is what is referred to as executive functions.
It is important to recognize that executive functions are not the same as intelligence. Some students who are extremely bright have significant impairment in executive function. And among those with average or below average intelligence, as measured by IQ tests, are many with adequate or better than average executive function.
The brain’s executive functions are not fully developed at birth.They gradually develop as the prefrontal cortex develops through early childhood and adolescence and into young adulthood. As executive functions develop, parents, teachers and others in the child’s life often expect the student to exercise an increasing measure of selfmanagement, from the simple tasks of dressing and selfcare to the more adult responsibilities of managing a high school courseload or driving a car.
One way of thinking about children with ADHD is that they are delayed in the development of their executive functions, unable to manage themselves at the same level as their peers. Students with ADHD often experience a roughly 30 percent developmental delay.15 For example, an 18yearold may have executive function skills that are comparable to those of a 12- or 13-year-old. Because this delay often has a profound impact on academic performance, parents and teachers must provide more supervision and support that is commensurate with the student’s developmental age rather than the chronological age.
Problems Show Up Early for Some, Later for Others
For some children, problems with ADHD are obvious very early in their development. As preschoolers, these children are extremely difficult to manage, primarily because they are unable to follow even the most basic directions and, if frustrated, are excessively quick to run off or lash out at other students. Such children are often unable to fit into preschool and daycare settings without specialized staffing and services.
Other children with ADHD may have much less extreme behavior problems. Their difficulties appear more in their academic work and may not become noticeable until third or fourth grade when more sustained attention and self-management is expected. Although some may speak out impulsively without being called on, socialize excessively, and be more restless than their peers, others may quietly withdraw and daydream their way through class each day. However, the primary difficulties shared by both groups of students can be seen more in chronic problems with disorganization of books and papers, the inability to complete work, or frequent failure to understand instructions quickly grasped by their classmates.
Not surprisingly, academic underachievement is frequently a hallmark of students with ADHD.These students are atrisk and most will experience major problems at some time in their school career. In one study of students progressing through the school system, 29 percent failed a grade, 35 percent dropped out of school, 46 percent were suspended, and 11 percent were expelled. Providing proper supports and accommodations should prevent many of these students from experiencing these failures.
The Science of ADHD: Inherited Problems in the Brain’s Chemistry
Although some media coverage suggests otherwise, there is now very strong evidence that ADHD is a neurobiological disorder, a problem with the brain and its neurotransmitters. After a review of the research on ADHD, the American Medical Association concluded that “ADHD is one of the best researched disorders in medicine, and the overall data on its validity are far more compelling than for many medical conditions.”
Differences in brain functioning have been shown in multiple imaging studies of people with ADHD compared to those without ADHD.Typically those with ADHD show less activation in critical areas of the brain when performing tasks that require concentration, decisionmaking, or selfcontrol. Some imaging studies have also found differences in the volume of specific brain regions in children with ADHD.
There is also strong evidence that the primary cause of ADHD is genetic, due not to any single gene, but to combined effects of a number of genes. Simply stated, ADHD runs in families. If a parent has ADHD, their child has more than 50 percent chance of having ADHD; for siblings of a child with ADHD, the risk is 32 percent. Environmental and perinatal factors can play a part, but twin studies have shown that more than 80 percent of problems with inattention, hyperactivity, and impulsivity are the result of genetic factors.Causes of ADHD are linked to chronic problems in the release and reloading of two specific neurotransmitter chemicals, dopamine and norepinephrine, that are crucial for effective communication in the management system of the brain.The brain of someone with ADHD apparently makes these chemicals, as does everyone else, but often it does not release and reload them effectively.This leads to significant inconsistency in the student’s ability to focus and get things done, especially if the task is not a high-interest activity.
- See more at: http://www.chadd.org/Understanding-ADHD/New-Understandings-of-ADHD.aspx#sthash.r12QYQ1G.dpuf
According to a recent study by the U.S. Centers for Disease Control and Prevention, about 7.8 percent of children aged 4 to 17 years are currently diagnosed with AttentionDeficit/Hyperactivity Disorder (ADHD).This means that most teachers are likely to have in every class they teach, on average, at least a couple of students with ADHD. Clearly, it is extremely important for each teacher to have at least a basic grasp of what attention disorders are and what they are not.
Over the years, attention disorders have been known by several names. Currently, educators and medical professionals use different terms to describe this condition. Based upon federal law, educators use the terms ADD and ADHD to differentiate between students who are inattentive and those who are primarily hyperactive, respectively. Doctors diagnose students as having ADHD that is either predominately hyperactiveimpulsive, inattentive, or a combination of the two.Throughout this book, the term ADHD will be used. Information specific only to the ADHD inattentive type will be noted.
Understanding this disorder is not so easy.There are many widespread myths, and scientific understanding of ADHD has changed a lot over recent years. It is now clear that attention disorders are a much more complicated set of problems than was previously understood.
Several Different Types of ADHDThere are three types of ADHD:
- ADHD Combined Type: Some students with ADHD have significant and chronic problems with both inattention and hyperactivity/impulsivity.
- ADHD Predominately Inattentive Type: Others have a lot of difficulty with inattention and not much trouble with hyperactivity or impulsivity; some of them sit quietly staring into space and daydreaming.
- ADHD Predominately HyperactiveImpulsive Type: Still others show little difficulty with inattention but have serious problems with excessive hyperactivity and impulsivity. Usually these students are very young children who are not expected to pay attention very well and who are likely to develop combined-type ADHD.
ADHD and Executive Functions
Many still think of ADHD as essentially a behavior problem—students who are unwilling or unable to sit still, listen to the teacher, and follow classroom rules. But researchers now have recognized that ADHD is not so much a behavior disorder as it is an inherited problem in the development of executive functions, the management system of the brain.
One way of thinking about executive functions is to picture a symphony orchestra whose members are all very fine musicians. Even when the musicians are excellent, if there is no conductor, who can organize and integrate the efforts of the individual musicians in the same piece at the same time, the music will not be very good.
The problems with ADHD are not with those parts of the brain that would correspond to the individual musicians. The problems originate one level up in the management system that starts, stops, controls, and manages these activities, integrating them moment by moment to allow us to perform the tasks at hand. This management system is what is referred to as executive functions.
It is important to recognize that executive functions are not the same as intelligence. Some students who are extremely bright have significant impairment in executive function. And among those with average or below average intelligence, as measured by IQ tests, are many with adequate or better than average executive function.
The brain’s executive functions are not fully developed at birth.They gradually develop as the prefrontal cortex develops through early childhood and adolescence and into young adulthood. As executive functions develop, parents, teachers and others in the child’s life often expect the student to exercise an increasing measure of selfmanagement, from the simple tasks of dressing and selfcare to the more adult responsibilities of managing a high school courseload or driving a car.
One way of thinking about children with ADHD is that they are delayed in the development of their executive functions, unable to manage themselves at the same level as their peers. Students with ADHD often experience a roughly 30 percent developmental delay.15 For example, an 18yearold may have executive function skills that are comparable to those of a 12- or 13-year-old. Because this delay often has a profound impact on academic performance, parents and teachers must provide more supervision and support that is commensurate with the student’s developmental age rather than the chronological age.
Problems Show Up Early for Some, Later for Others
For some children, problems with ADHD are obvious very early in their development. As preschoolers, these children are extremely difficult to manage, primarily because they are unable to follow even the most basic directions and, if frustrated, are excessively quick to run off or lash out at other students. Such children are often unable to fit into preschool and daycare settings without specialized staffing and services.
Other children with ADHD may have much less extreme behavior problems. Their difficulties appear more in their academic work and may not become noticeable until third or fourth grade when more sustained attention and self-management is expected. Although some may speak out impulsively without being called on, socialize excessively, and be more restless than their peers, others may quietly withdraw and daydream their way through class each day. However, the primary difficulties shared by both groups of students can be seen more in chronic problems with disorganization of books and papers, the inability to complete work, or frequent failure to understand instructions quickly grasped by their classmates.
Not surprisingly, academic underachievement is frequently a hallmark of students with ADHD.These students are atrisk and most will experience major problems at some time in their school career. In one study of students progressing through the school system, 29 percent failed a grade, 35 percent dropped out of school, 46 percent were suspended, and 11 percent were expelled. Providing proper supports and accommodations should prevent many of these students from experiencing these failures.
The Science of ADHD: Inherited Problems in the Brain’s Chemistry
Although some media coverage suggests otherwise, there is now very strong evidence that ADHD is a neurobiological disorder, a problem with the brain and its neurotransmitters. After a review of the research on ADHD, the American Medical Association concluded that “ADHD is one of the best researched disorders in medicine, and the overall data on its validity are far more compelling than for many medical conditions.”
Differences in brain functioning have been shown in multiple imaging studies of people with ADHD compared to those without ADHD.Typically those with ADHD show less activation in critical areas of the brain when performing tasks that require concentration, decisionmaking, or selfcontrol. Some imaging studies have also found differences in the volume of specific brain regions in children with ADHD.
There is also strong evidence that the primary cause of ADHD is genetic, due not to any single gene, but to combined effects of a number of genes. Simply stated, ADHD runs in families. If a parent has ADHD, their child has more than 50 percent chance of having ADHD; for siblings of a child with ADHD, the risk is 32 percent. Environmental and perinatal factors can play a part, but twin studies have shown that more than 80 percent of problems with inattention, hyperactivity, and impulsivity are the result of genetic factors.Causes of ADHD are linked to chronic problems in the release and reloading of two specific neurotransmitter chemicals, dopamine and norepinephrine, that are crucial for effective communication in the management system of the brain.The brain of someone with ADHD apparently makes these chemicals, as does everyone else, but often it does not release and reload them effectively.This leads to significant inconsistency in the student’s ability to focus and get things done, especially if the task is not a high-interest activity.
- See more at: http://www.chadd.org/Understanding-ADHD/New-Understandings-of-ADHD.aspx#sthash.r12QYQ1G.dpuf