ADHD experts respond to common questions about ADHD in children and adults...
“How can a child with attention deficit hyperactivity disorder (ADHD) focus intently for hours on a video game but be unable to make it through a single chapter in a textbook?”
Russell A. Barkley, Ph.D., responds: It seems paradoxical that children with ADHD can maintain focus on things that interest them but can’t stick with other things, like homework. Such behavior suggests that the child is being willfully disobedient or that a lack of discipline and poor motivation are the problems. But such behavior is neither willful nor the result of poor parenting.
ADHD is not merely a disorder of attention, excess activity, or poor impulse control, though these features are usually the most conspicuous. Underneath lurks a profound disorder in the mental mechanisms that give humans the capacity for self-regulation.
ADHD disrupts a person’s ability to manage her behavior or to act with future consequences in mind. That’s why kids with ADHD are at their worst when they must complete tasks that have no immediate payoff. Goal-directed, future-oriented behavior demands that a person be able to motivate herself internally. This ability is described as willpower, self-discipline, ambition, persistence, determination, or drive. ADHD disrupts this mental mechanism, leaving those with the disorder “low on fuel” in motivating behavior toward future rewards.
If a task provides motivation and offers immediate gratification — such as playing a video game — a person with ADHD will have no problem sticking with it. Give these kids a task for which there is no external reinforcement or payoff, however, and their persistence falls apart. They jump from one uncompleted activity to another and become bored and disengaged.
To help a child with ADHD complete work when there is little immediate reward or interest in the task, adults can establish artificial rewards to sustain motivation. Earning tokens, chips, or other external rewards will help them persist. Without such rewards, they cannot themselves muster the intrinsic willpower to stick with a task. So, if your child with ADHD needs to read an entire chapter of a textbook, offer a reward for each segment of the work. Eventually, he will be able to sustain attention for longer periods, as tenacity becomes a habitual response to work.
“Isn’t ADHD just an excuse for a lack of discipline?”
Robert M.A. Hirschfeld, M.D., responds: The idea that willpower can solve all problems is as American as apple pie, but so are compassion, tolerance, and wisdom. Some people with diseases such as diabetes and hypertension can organize their lives to limit the effects of their disabilities. But some, no matter how hard they try, need insulin to break down sugar or medication to lower their blood pressure. We offer them support, and we do not blame them for their failure to “fix” themselves.
The same goes for ADHD.
Unfortunately, when it comes to brain disorders, such as ADHD, depression, or other neurological conditions, a harmful attitude creeps in: the belief that ADHD, and other disorders originating in the mind, reflect “bad character” and that all it takes is more willpower to overcome them.
As a psychiatrist, and also as the father of a child with ADHD, I know how destructive this view is. Many people with depression suffer for years because they’ve tried to make themselves feel better, and they still can’t function. Coworkers and spouses become frustrated and blame the sufferer when attempts to “jolly” a person out of a depression don’t work. Their lack of understanding adds guilt and shame to the long list of problems that depressed people cope with.
My son could not will himself to not have ADHD. Trying to get him to change his ADHD behaviors didn’t work. And had we stopped at that, his life would have been marked by frustration and failure. Without proper medical, psychological, and educational interventions, no amount of willpower could have helped. Fortunately, our continued interventions have enabled our son to shape his own destiny and experience many successes.
Challenges remain, and he’s needed our support — not our demands — to overcome them. We didn’t want our son to experience the fate of earlier generations of kids with ADHD who didn’t have the benefits of new knowledge and better science.