Attention Deficit/Hyperactivity Disorder (ADHD)

Attention Deficit/Hyperactivity Disorder (ADHD). The DSM IV TR number is 314. Go here for the diagnostic criteria:

There are three subtypes of this disorder: Inattentive Type (classic ADD), Hyperactive-Impulsive Type (classic ADHD) and Combined Type (meaning some days merely inattentive and on other days hyperactivity and impulsivity are mixed in). At its core, ADHD is a cognitive condition surrounding Executive Functioning features that are “managed” by the frontal lobes of the brain, a part of the Cerebral Cortex which is the cognitive system of the brain. These executive functions have to do with planning, organizing, sequencing, pacing, shifting (i.e. making transitions), task completion, working memory and self-regulation, all of which pose challenges to those with AD/HD. Inattentiveness or an inability to focus on tasks and its counterpart, distractibility, are the classic, well-known manifestations of this condition. I tend to perceive this particular aspect as more about one who is so easily distracted than one where it looks like they just can't (often believed as won’t) pay attention. I think the distinction or emphasis on this one aspect has serious treatment implications. If one believes that Johnny just won't pay attention, then the intervention emphasis is going to be on, somehow, getting him TO pay attention. Usually this involves an intense program of behavior modification and dictates to PAY ATTENTION as stated in behavioral contracts. If, on the other hand, the emphasis is on what's distracting Johnny, then the interventions focus on helping him to minimize the distractions (or actually removing them for him) as well as drawing (re-directing) his attention back to the task at hand by actually showing (i.e. demonstrating) him where to be, for example on the page, in class.

My analogy here is with the Follow The Dot Books. In those books, every dot has a number with the most important number being #1, as that’s the starting point. ADHD people have all the dots in their head but the dots don’t have any numbers. Difficulty in getting started (finding the starting point, Dot #1) results in enormous anxiety and frustration when trying to organize, sequence and complete projects. I think it is that frustration, experienced by those with ADHD, that blossoms into meltdowns.

Also with ADHD there is the additional aspect of hyperactivity and impulsivity, a condition that most find intolerable and frustrating, especially when one tries to keep up with or calm down the person. We say about these kinds of people that they “Act first and ask questions later” or that they "Get carried away with themselves," cliches that clearly indicate a hyperactive and impulsive person. Simply put, when one’s cognitive system is compromised by, for example, frontal lobe inefficiency, the more primal energies generated by the Limbic System (the brain’s emotional system) have a path to escape and manifest in emotional and behavioral impulsivity. Adrian Raine of the University of Pennsylvania has noted: “The prefrontal cortex is like the guardian angel of behavior. This region helps process emotions such as rage and the impulse to act out. It's the part of the brain that says, 'Hey, hold on a minute.' " Such abnormalities and impulsivity issues are, to one degree or another, found not just in ADHD, but across all the conditions addressed on this website.

C.H.A.D.D. (Children and Adults with Attention Deficit Disorder) Chapters exist around the country and around the world to offer support and advocacy. See

See also the ADHD Bibliography on the Resources page.

Tourette Syndrome
Obsessive Compulsive Disorder
Oppositional Defiant Disorder
Intermittent Explosive Disorder
Bi-Polar Disorder
Generalized Anxiety Disorder

All material on this website ©2009 by Bridging the Chasm and Garry L. Earles, L.I.C.S.W.