The New ADHD

What's new about attention deficit? A lot, according to Yale Professor Thomas Brown. You'll think differently about the condition once you get all the facts.

The new understanding of ADHD provides a useful way to more readily recognize, understand, assess, and treat this complex syndrome.

Findings from neuroscience, brain imaging, and clinical research have made the old understanding of ADHD as essentially a behavior disorder no longer tenable. It is being replaced by a new understanding of ADHD as a developmental impairment of the brain's self-management system, its executive functions.

This new paradigm can provide a useful way to put together many of the not-yet-integrated pieces of research on this puzzling syndrome, which causes some children and adults to have great difficulty in focusing and managing many aspects of their daily life while being able to focus on other tasks well. This new understanding provides a useful way to more readily recognize, understand, assess, and treat this complex syndrome, which impacts about 9 percent of children and almost 5 percent of adults.

Here are 16 prevailing myths about ADHD, along with the latest facts, to update your thinking about the condition.

MYTH: Really Something New?

The new model of ADHD as developmentally impaired executive function is completely different from the older model of ADHD.

THE FACTS: The new model of ADHD differs in many ways from the earlier model of this disorder as essentially a cluster of behavior problems in young children. The new model is truly a paradigm shift for understanding this syndrome. It applies not only to children, but also to adolescents and adults. It focuses on a wide range of self-management functions linked to complex operations of the brain, and these are not limited to readily observable behaviors.

However, there are substantial and important points of overlap between the old and new models of ADHD. The new model is an extension and expansion of the old model. Most individuals who meet diagnostic criteria for the new model will also meet the criteria for the older model. The old model is no longer tenable, not because it identifies individuals with a different disorder, but because it does not adequately capture the breadth, complexity, and persistence of this syndrome.

MYTH: Not Always a Challenge

A person who has ADHD always has difficulty with executive functions, such as sustaining focus on a task and keeping several things in mind, regardless of what he is doing.

THE FACTS: Clinical data indicate that executive function impairments characteristic of ADHD are situationally-variable; each person with ADHD tends to have some specific activities or situations in which she has no difficulty in using executive functions that are significantly impaired for her in most other situations. Typically, these are activities in which the ADDer has a strong personal interest or about which he believes something very unpleasant will follow quickly if he does not take care of this task right now. Research findings indicate that intra-individual variability in performance from one context or time to another is the essence of ADHD. Multiple studies have shown that performance of persons with ADHD is highly sensitive to contextual factors -- reward, nature of the task, and internal cognitive and physiological factors.

MYTH: Signs in Childhood

Anyone who has ADHD will show clear signs of it during early childhood and will continue to have difficulties with executive functions for the rest of his life.

THE FACTS: For decades ADHD, under various names, has been seen as essentially a disorder of childhood; DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-IV) diagnostic criteria stipulated that at least some of the symptoms must be noticeable by age seven years. More recent research has shown that many with ADHD function well during childhood and do not manifest any significant symptoms of ADHD until adolescence or later, when greater challenges to executive function are encountered. Over the past decade research has shown that impairing symptoms of ADHD often persist well into adulthood. However, longitudinal studies have also shown that some individuals with ADHD during childhood experience significant reductions in their ADHD impairments as they grow older.

MYTH: High IQ and Challenges

People with high IQ are not likely to have executive function impairments of ADHD because they can overcome such difficulties.

THE FACTS: Intelligence as measured by IQ tests has virtually no systematic relationship to the syndrome of executive function impairments described in the new model of ADHD. Studies have shown that even extremely high-IQ children and adults can suffer impairments of ADHD, which significantly impair their ability to deploy their strong cognitive skills consistently and effectively in many situations of daily life. Clinical observations indicate that high-IQ individuals with ADHD often face lengthy delays before they obtain a correct diagnosis and appropriate treatment. This is due largely to uninformed teachers, clinicians, and patients themselves, assuming that high IQ precludes ADHD.

Next: Executive Function in Adolescence

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This article appears in the Fall issue of ADDitude.
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TAGS: Myths About ADHD, Adult ADD: Late Diagnosis, Diagnosing Children with ADHD

 

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