What is attention deficit hyperactivity disorder?

ADHD is a hard wired difficulty directing attention to tasks and activities that do not hold great interest.  You may have noticed that your child can easily focus on TV, video games, or legos (high interest activities) but has significant trouble focusing on less interesting tasks such as homework or reading.  

Every child has more trouble focusing on less favored activities.  This is how all of our brains are wired.  We naturally focus on the shiniest, most interesting thing in the room. As children grow, their ability to direct attention to relatively boring tasks, or to maintain attention on less favored tasks increases.  Each year they get better at tolerating low interest tasks in order to meet goals.  Seat work in school is a great example.  ADHD or ADD is diagnosed when your child has significantly more trouble directing their attention than their peers do.  

It is because the problem is directing attention, and not paying attention that many adults become confused about the diagnosis.  If Sally really has ADHD, why can she play video games for three hours?  If David has ADHD, why can he build legos all afternoon?

When the problem is primarily difficulty directing attention, the diagnosis is Attention Deficit Hyperactivity Disorder, Primarily inattentive type.  Children who additionally have difficulty sitting still are diagnosed with Attention Deficit Hyperactivity Disorder, combined type.

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Why do problems with sitting still and focusing go together so often?

Because the same system of the brain, the “frontal executive network,” is responsible for both.  The executive network of the brain acts as a symphony conductor or corporate executive, activating, regulating, and monitoring other systems in the brain. 

The executive network tells the brain what is the most important thing to focus on, keeps distractions at bay, and decides when it is time to shift attention from one thing to the next.  It also helps us resist the urge to get up and stretch, allows us time to think though a response before jumping in, and allows us to keep what we are about to say in mind while we wait for another person to finish speaking. 

When this executive function is not working as well as it should, kids (and adults) have trouble focusing for long enough on the right things, have trouble shifting to the next task when asked, are restless, impulsive, and interrupt others.  Same brain system: many resulting symptoms.  


How is ADHD/ ADD diagnosed? 

Attention deficit disorder is a clinical diagnosis.  Teachers, family members, and patients are asked whether:

1. They notice attention problems and/ or hyperactivity, and

2. Whether the symptoms significantly interfere with day to day life. 

Typically, questions are asked via symptom checklists and thorough clinical interviews. The latter is critical, as some symptoms of in attention or restlessness can be caused by primary anxiety disorders, depression, or learning disabilities.  

In addition, Neuropsychological assessment allows clinicians to determine: 

1.  Whether additional complicating factors are present such as learning disabilities.  Over 40% of individuals with ADHD also have a learning disability like dyslexia or a math disorder.  Diagnosing ADHD but missing an accompanying learning disability results in frustration as only part of the child's learning barrier is addressed.   

2.  Whether mood disorders such as depression and anxiety are contributing to their symptom picture. 

3.   Strengths and weaknesses in the child's cognitive system that can be used to plan the most efficient study techniques.