Question:

My son seems to have some of the symptoms associated with Attention Deficit Hyperactivity Disorder, but he’s far from hyperactive. He can be forgetful and spacey at times, but he doesn’t have behavior issues. Can you tell me more about this disorder? 

Response:

Attention Deficit Hyperactivity Disorder (ADHD) and Attention Deficit Disorder (ADD), commonly referred to as cognitive disorders, encompass a combination of symptoms such as difficulty sustaining attention, hyperactivity, and impulsive behavior. Children with ADHD and ADD are often seen as having behavioral problems. In an article written by Dr. Thomas Brown, M.D., 2021, “many people living with ADHD didn’t have any significant behavior problems: they have difficulty focusing their attention on necessary tasks and using working memory effectively.”  Those with this disorder struggle to engage in the ‘self-management system’ located in the brain.  Studies in neuroimaging have shown a structural difference in the brains of those with ADHD/ADD that play a role in focus and attention.  What has often been considered behavioral choices – laziness, sloppiness, and forgetfulness – can be attributed to differences in brain structure.

There are three subtypes of ADHD. With the Predominantly Inattentive type, the majority of symptoms fall under inattention.  The child may often fail to pay close attention to details, have trouble staying focused on tasks/play, appear not to listen, have difficulty organizing tasks, and avoid tasks requiring focused mental effort.  

The Predominantly Hyperactive/Impulsive type is characterized by hyperactivity and impulsive symptoms.  The child may often fidget with or tap his or her hands or feet, have difficulty staying seated, have trouble doing activities quietly, be in constant motion, talk too much, and have problems waiting their turn.

The Combined type is a mixture of inattentive symptoms and hyperactivity/impulsive symptoms.  The child may exhibit symptoms in both the inattentive and hyperactivity/impulsive subtypes with the combined type.  

In his article entitled, “3 Defining Features of ADHD That Everyone Overlooks,” William Dodson, M.D., LF-APA, 2021, highlights three significant characteristics of ADHD/ADD that influence one’s “perceptions, emotions, and motivation.”  

The first feature is what Dodson, 2021, refers to as the Interest-Based Nervous System.  This particular feature can be recognized as an “intense concentration on a task…that is created by a momentary sense of interest, competition, novelty or urgency created by a deadline”.  With this feature, the child’s nervous system is interest-based as opposed to importance or priority based.  

The second feature is Emotional Hyperarousal.  This feature is characterized by “internal feelings of hyper arousal”.  It can be recognized by a difficulty relaxing and sitting still and an inability to shut down the brain and body at bedtime.  An additional feature of emotional hyperarousal deals with one’s thoughts and emotions.  Children with ADHD tend to have what Dodson, 2021, refers to as “passionate thoughts and emotions that are more intense than those of the average person” Dodson goes on to say that these children “experience happiness and criticism more powerfully than others”.  

The third feature is what Dodson, 2021, refers to as Rejection Sensitivity. This refers to an “intense vulnerability to the perception, not necessarily the reality, of being rejected, teased or criticized by important people in their lives”.  These feelings of rejection cause “intense emotional pain that may also be triggered by a sense of failure or falling short”, Dobson, 2021.  

The process of diagnosing ADHD/ADD involve tests and interviews focusing on symptoms, a thorough medical history, and evaluation of other conditions that are commonly diagnosed with ADHD (Obsessive Compulsive Disorder, Oppositional Defiant Disorder, Mood Disorder, Anxiety and Autism Spectrum Disorder).   In order to meet the criteria for ADHD/ADD, there needs to be a consistent pattern of inattention and or hyperactivity that interferes with daily functioning in at least 2 settings (e.g., school/home/job).  

The recommended treatment for ADHD/ADD is often a combination of medication, behavior therapy and counseling.  Medications are commonly prescribed to help improve symptoms of inattention and hyperactivity.  Behavior therapy focuses on working with the child to develop strategies to help them better deal with challenging situations.  Counseling provides the child with the opportunity to talk about the issues they struggle with and learn new and different ways to deal with these issues.  

Learning how to best parent a child with ADHD/ADD is an integral part of helping the child to be successful.  It’s important for parents to educate themselves on ADHD/ADD and how your child is impacted by it.  Helping them to understand their disorder and communicating to them that it’s not their fault can aid in supporting a healthy self esteem. When teaching your child new skills, or asking them to complete a task, it’s important to provide them with clear expectations, while focusing on one task at a time, to help them avoid feeling overwhelmed.  In regard to discipline, children with this disorder do best when it’s done in a caring and supportive manner as they may be sensitive to criticism. Parenting a child with ADHD/ADD can be challenging, but luckily there are many resources available to help support and guide you in caring for your child.  

Gladys Smith, Licensed Independent Social Worker & Co-founder of Soul Creek Nature Therapy.