Understanding Your ADHD Diagnosis: Medical Information About Attention Deficit

A doctor talks about ADHD symptoms, causes, misconceptions and treatments associated with a diagnosis.

Inside the ADD Mind, Part 2

"Imagine a cook who sets out to cook a certain dish, who has a well-equipped kitchen, including shelves stocked with all the necessary ingredients, and who can even read the recipe in the cookbook. Now imagine, however, that this individual does not take from the shelves all the relevant ingredients, does not turn on the oven in a timely fashion so as to have it at the proper heat when called for in the recipe, and has not defrosted the central ingredient. This individual can be observed dashing to the shelves, searching for the next spice mentioned in the recipe, hurrying to defrost the meat and heat the oven out of sequence. Despite possessing all the equipment, ingredients, and instructions, this motivated but disheveled cook is unlikely to get dinner on the table at the appointed hour."

The "motivated but disheveled cook" sounds very much like a person with severe ADD who tries to accomplish a task but is unable to "get it together." Individuals with ADD often describe themselves as intensely wanting to accomplish various duties for which they are unable to activate, deploy, and sustain the needed executive functions.

Executive functions and awareness

A 43-year-old man came to my office with his wife to be evaluated for attentional problems. Both of the couple's children had recently been diagnosed with ADD and had benefited from treatment. When I explained that most children diagnosed with ADD have a parent or other close relative with ADD, both parents laughingly responded, "Those apples haven't fallen far from the tree." Both agreed that the father had more ADD symptoms than either of the children. Here's how the wife described her husband:

"Most of the time he's totally spaced out. Last Saturday he set out to fix a screen upstairs. He went to the basement to get some nails. Downstairs he saw that the workbench was a mess, so he started organizing the workbench. Then he decided he needed some pegboard to hang up the tools. So he jumped into the car and went to buy the pegboard. At the lumber yard he saw a sale on spray paint, so he bought a can to paint the porch railing and came home totally unaware that he hadn't gotten the pegboard, that he had never finished sorting out the workbench, and that he had started out to fix the broken screen that we really needed fixed. What he needs is a lot more awareness of what he is doing. Maybe that medicine our kids are taking can give him that."

From this wife's description, one might conclude that the central problem of ADD is essentially a lack of sufficient self-awareness. She seems to believe that if only her husband were more steadily aware of what he is doing, he would not be so disorganized, jumping from one task to another without completing any single one. But most people do not require constant self-awareness to complete routine tasks. For most people, most of the time, operations of executive functions occur automatically, outside the realm of conscious awareness.

For example, while driving a car to the local supermarket, experienced drivers do not talk themselves through each step of the process. They do not have to say to themselves: "Now I put the key in the ignition, now I turn on the engine, now I check my mirrors and prepare to back out of my driveway," and so on.

Experienced drivers move effortlessly through the steps involved in starting the car, negotiating traffic, navigating the route, observing traffic regulations, finding a parking place, and parking the car. In fact, while doing these complex tasks, they may be tuning their radio, listening to the news, thinking about what they intend to prepare for supper, and carrying on a conversation.

Even the simpler example of keyboarding on a computer illustrates the point. If one can type fluently without stopping to consciously select and press each individual key, one's mind is left free to formulate ideas and to convert these into words, sentences, and paragraphs that convey ideas to a reader. Interrupting one's writing to focus on and press keys one at a time costs too much time and effort; it cannot be done very often if one is to write productively.

Many other routine tasks of daily life - for example, preparing a meal, shopping for groceries, doing homework, or participating in a meeting - involve similar self-management in order to plan, sequence, monitor, and execute the complex sequences of behavior required. Yet for most actions, most of the time, this self-management operates without full awareness or deliberate choice.


This article appears in the April/May issue of ADDitude.
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