ADHD

ADHD boy in class

Are These Individuals Defined by Hyperactivity?

While it might seem that a person with Attention Deficit Hyperactivity Disorder must be overly active or “hyperactive”, this is not always true.  It is true that many children and adults with ADHD are really overly physically active.  That said, there are also many that are not very active.  Individuals with ADHD who are not overly active find it hard to focus their thinking on one thought for very long.  This is the “attention deficit” part.  They are able to sit quietly, daydreaming, their mind wondering from one thought or another.  Girls and women are more likely to have this calmer type.  This situation is a problem in school and at work.  Because they are sitting calmly and not being disruptive, they don’t come to anyone’s notice.  But because they are daydreaming and not focused, it’s hard to learn anything or accomplish much.

Articles related to ADHD:

Good Kids and People

Individuals with ADHD are mostly good children and adults.  They can be a great asset to most situations.  They are not stupid, are not hard to work with, and are not bad individuals.  One theory about the start of their value to society goes like this.  The original prehistoric individuals with ADHD were the ancient tribe’s hunters and food gatherers.  They hunted for food sources for the entire extended family.  Because of their quickness, vigilance, and high energy, they were able to gather a lot of high-quality animal and fish protein.  Over the eons this protein/lipid-rich diet supplied what was needed for human brain growth.  As everyone became intellectually more capable they realized that they could grow their own food, too, and not always have to hunt it down.  These later seed and crop planters and farmers provided a more consistent and secure food supply.  Making it happen started with the hunters.

Those with ADHD As A Community Brain Trust

A few years ago one of us was standing around with a group at the annual meeting of the Society of Neuroscience.  This small group had randomly come together in an open hallway as one or another of us were walking down the hall and ran into each other.  There were 7 or 8 of us who stopped and chatted for about 5 minutes.  The others in this informal discussion circle were some of the most brilliant and productive neuroscientists in the United States.  One in the group made a joke about an East Coast colleague being so active and productive in research and publishing that, “It’s as though he has ADHD!”  Another in the circle spoke up, “So what, I have ADHD.”  Then another chimed in, then another.  In this circle of about 8 of these brilliant neuroscientists, 5 or 6 each said he had ADHD.  Each was clearly proud of it and happy with the great gift of cognition and energy that it provided.

How the Brain Is Wired

Inattention

ADHD is a brain-based disorder.  It is not imaginary and not changeable with stern parenting or strict education.  It is how a person’s brain is wired, hard-wired, often for life.  Some people with ADHD have the “inattentive” type while others have the “hyperactive/impulsive” type.  Inattention means that your mind drifts and allows you to wander off the task in front of you.

Hyperactive

The “hyperactive/impulsive” type is the type that most people think of when they think of ADHD.  Hyperactive is continuously moving.  Or so the person with ADHD might seem to parents, friends, spouses, and relatives.  The social situation matters only if the person cannot freely move around.  If hindered they become really uncomfortable and might become disruptive.  In the classroom or business meeting these individuals talk out of turn.  Children “fidget” even when they are asked to sit still.  If he or she cannot move much they might start tapping their fingers or toes.  Anything that helps “get the wiggles out.”  They’re restless. 

Impulsive

The impulsivity part of ADHD would be funny if it did not so often lead to problems.  These individuals’ bodies move and act before the executive circuits of their brain, their mind, has even thought about it.  The dilemma can be illustrated with the old military sequence of shooting a weapon at a target: ready, aim, fire.  The person with ADHD-style impulsivity might well fire before any thought takes place, then he thinks about it and gets ready and aims.  One can see the risk of harm.  The summersault can start and complete before the child thinks about the mud puddle just ahead.  Another aspect of this is interrupting others when they are talking.  Or bursting into a social group uninvited.  And making snap decisions, even important ones with long-term consequences, without much thought.

As These 3 Aspects of ADHD Sort Out Among Individuals… 

As we sort these 3 features among people who have ADHD, it gives us 3 types:

A combined inattention and hyperactivity-impulsivity type

A mostly inattentive type

And a mostly hyperactive-impulsive type

ADHD Remains a Medical Puzzle

The medical science world does not really and specifically know what causes ADHD.  And because no one really knows, there is a “laundry list” of things that experts conjecture might cause it.  Those experts who believe in one or another cause devise the reasons why they think their view is the correct one.

Here are a few examples

  • family history and genes
  • a mother’s cigarette smoking, alcohol use, or drug use during pregnancy
  • a mother’s exposure to harmful environmental toxins during pregnancy
  • a direct exposure of the person with ADHD, such as high levels of lead at a young age
  • low birth weight
  • brain injury during birth or while growing up

Then Reality Steps In…

The ADHD described at the start of this page is just typical, garden-variety, uncomplicated ADHD.  The clinical reality is that ADHD as a condition and as a diagnosis it can become complicated.  In addition to ADHD, children can have learning disabilities, anxiety conditions, conduct problems, depressed mood states, and the poor judgement to use harmful drugs and/or alcohol.  Mix any one, or two, or three of these situations with ADHD and that person really struggles in life.  A good psychiatrist or other health care professional who believes in the person with complicated ADHD can be a powerful ally and support to assist the child or adult to work through everything and come out winning.

ADHD Treatment

Treating ADHD is covered more on the Member Page (https://www.neuroscirandd.com/member-page/adhd-treatment/).

Here’s a brief overview.

To put it right out in front, a person with moderate ADHD, or ADHD that is more severe than moderate, needs medication.  There is no way around it.  Many people hope to avoid using medication.  Parents often try to avoid medication use for their children.  In avoiding medication they leave their child at risk.  It might be that person with mild ADHD could work it out, make it through life and not use medication, and still win.  But even so, why?  Why purposefully spend a life at 80% when one can spend their life at 95% with little extra effort?

Here’s Why

There’s an old, black-and-white television series, The Adventures of Robin Hood, shown in the 1950s.  In one episode their strong, muscle man, Little John (played by Archie Duncan), is carrying a box.  He struggles.  He can’t keep carrying it.  He just can’t do it.  Little John can’t understand this because the box is not that big and he can carry anything.  He thinks there must be some foul black magic in the box that’s making him weak.  When they open the box, it has a stone block in it for minting the King’s gold coins.  That’s why he couldn’t keep carrying it.  It was one huge piece of solid stone.  The point of the story is this.  Anyone can put a 10-pound backpack on their back and hike all day.  Put on a 150-pound backpack and most of us would collapse in a few steps.  Without medication, you’re asking a person with ADHD to carry around a 75-pound backpack all the time.  They are going to struggle and at times fall.  With medication, it shrinks to a 10-pound backpack like the rest of us carry.

What the Medication Does

The medications are supposed to lessen hyperactivity, lower impulsivity, stop inattention, and help the person to focus.  If all this works they succeed in school, at work, and at home with family.

Which Medication?

Methylphenidate, the amphetamines, and other “stimulant” medications work best for most people.  At the right dose, these medications increase the neural circuitry of the executive function part of the brain.  The person can think more clearly and keep everything under better control.  These medications turn down the volume knob on the brain circuits that push for endless activity and impulsivity.  For most people they are safe to use with a health care provider following along.

There are other medications that sometimes work when the stimulants don’t work or cause problem side effects.  These medications are not stimulants.  These non-stimulants take longer to start working than the stimulants.

A Person with ADHD Needs More Than Just a Tablet or Capsule

Just tossing a medication dose toward a person who needs medication is never a good idea.  Someone with ADHD needs to learn what the medical condition is all about.  The education and support come in the form of therapy.  The combination of the right medication and best-fit therapy is the most powerful way to lessen the impact of ADHD.  This arrangement provides a guide through the ADHD jungle.  There are many types of therapy.  Maybe behavior therapy or interpersonal therapy.  Family therapy or marital therapy (for parents or for adults) might be helpful.  Training on specific skills or situations (stress management, test taking in school, dating relationships) could improve success.  Another helpful set of skills one can learn is parenting skills training (raising a child with ADHD, while eventually rewarding, is a fast-moving challenge day-to-day).

Helpful links:

National Institutes of Health, National Institute of Mental Health

https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

Center for Disease Control and Prevention (CDC) – United States

https://www.cdc.gov/ncbddd/adhd/index.html

Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)

https://chadd.org/

The Mayo Clinic

https://www.mayoclinic.org/diseases-conditions/adhd/symptoms-causes/syc-20350889

American Psychiatric Association

https://www.psychiatry.org/patients-families/adhd/what-is-adhd