I have written and rewritten this post many times over the past 3ish weeks. I am wanting to communicate this clearly as I believe it is so important to see how these two attention issues are fundamentally different - therefore treatment interventions going to be different (and hopefully frustration levels lowered too:). I give more information on ADHD as that is what has more research, but hope that I have laid out the underlying differences in a way that helps to see them separate issues. If I am unclear, please let me know and I will try to clarify:)
Dr. Russell Barkley has been studying ADHD for many years. As stated in my last post you can check him out at www.adhdlectures.com or read his books. He has compiled and conducted much research in the area of ADHD. He shared that he believes that there are probably 7 different Attention Disorders that factor analysis shows in the research rather than just ADHD as we currently know it. However, at this time only ADHD is recognized by the DSM team, and when the DSM-V (the diagnostic tool that psychologists use to diagnose mental health issues) comes out next year it will still just have ADHD as the only Attention Disorder. There are various reasons for this that I will not bore you with, but they are essentially political. However, just because a particular group of people have not stated that there is a disorder, it does not mean that the disorder does not exist;) On the other hand, what really is a disorder? Just a cluster of symptoms that a subset group of people have that means that they are somehow doing something different than another subset group of people. But...I digress...
Dr. Barkley spoke about how he believes that ADHD as currently understood is actually 2 different disorders. As you may know, a person can get a diagnosis of ADHD and then specify if it is predominantly Hyperactivity/Impulse or predominantly Inattentive (or combined). Dr. Barkley believes that the research shows that there is a disorder that manifests itself as Hyperactivity/Impulsivity and another disorder that looks like what we call Inattentive. He says that it is important to distinguish between them because he says the underlying causes of what is going on with the person is very different, and therefore treatment implications are very different. Again, people who have not studied Dr. Barkley's work will not know about these differences in conceptualization and there are no official differences in diagnosis as the current diagnostic system is set up (other than as stated above). Therefore, the information I am giving you now, as I understand it from the conference from Dr. Barkley, is primarily to help you (and me!) conceptualize the problems that we see with these kiddos and how to help them be as successful as possible.
The crux of what Dr. Barkley said was, ADHD is an "Intention Deficit Disorder" whereas the other disorder that has been called in research "SCT" is "Concentration Disorder." People talk about them as Executive Functioning Disorders - essentially the frontal lobe of the brain is the "computer" that takes all kinds of information, integrates it, makes a plan, and executes the plan (tells the rest of the brain to follow through). Specifically with ADHD, the right frontal portion of the brain is not processing information effectively much like a person who has had an injury to that portion of the brain (although there are more parts of the brain than that which are affected in ADHD). I will go into that in the next post...
I will attempt to discuss the differences between these the best way I can. I very much agree that these distinctions are essential to understand and are crucial when discussing treatment implications and long term life planning.
ADHD: developmental delay in inhibition (they are very disinhibited)
SCT: developmental delay in concentration
ADHD: is an OUTPUT disorder - they have no problem with processing information
SCT: INPUT disorder - they are not inputting and processing incoming stimuli accurately
ADHD: the problem is with sustained attention, not necessarily what they are attending to
SCT: the problem is that they do not attend to the correct information (focused on the wrong details)
ADHD: friendships tend to be few and far between, they tend to be rejected by others due to, well, the way they act in relationship to others
SCT: tend to be overlooked and neglected in relationships. They tend to not focus on the "right" information in relational interactions and thus don't "connect" well with others.
ADHD: very impulsive and hyper
SCT: tend to be slow moving/sluggish
ADHD: Their behavior is hard to control and manage
SCT: The kids are very likeable, they just don't get things done
ADHD: it is a temporal disorganization (time management disorder)
SCT: Spatial disorganization (they can get it done but it is unorganized and often not right)
ADHD: a production disorder - they tend to not get things finished, but if they do it is done correctly
SCT: Accuracy disorder - they get it done, but it is wrong (they are not attending to the right details)
ADHD: vast majority will respond to stimulant medication
SCT: less than 20% respond to stimulant medication
Other symptoms of ADHD (aside from constant moving and talking and the inability to control urges lol!!)
* Dr. Barkley shared that instead of thinking of ADHD as an attention problem, we need to think of it really as an INTENTION deficit disorder. He says that these kids can filter information just fine (or pay attention to incoming stimuli), the problem is with how they see the future (their intention of what to do with that stimuli).
* There is an impairment with working memory (holding various pieces of information simultaneously and using that information to proceed logically). It is not that they do not know the rules or they are unable to recall what they were supposed to be doing. The kiddos can tell you what the rules are, but they sure aren't logically using them!
*ADHD show dis-inhibition in all areas of life, not just one or two areas or settings
* The hyperactivity piece is about intention with incoming stimuli (so much stimulation, so little time to do something with it). As an example of this, adults will not have the hyperactivity piece. They report feeling "restless" and experience "anxiety."
*Their emotions are rational - they are intense, but they are rational. This is unlike people with mood disorders (e.g. depression) who have emotions inconsistent with the reality of their lives. When you talk to ADHD people about why they feel a certain way, while they may be making a bigger deal out of something than they need to but it is still consistent with reality.
* They are UNABLE to persist in a task when there is not immediate gratification. What takes them a long time to do when there is not immediate gratification can take a very short time when there is immediate gratification. Outcome is highly variable and not consistent with the persons ability to understand what needs to be done, but rather with what is motivating them to complete the task. This was probably the most enlightening piece of information for me that has fundamentally changed the way I engage my child with ADHD.
* ADHD directly impacts a persons ability to handle delayed reinforcement (e.g. waiting for the reward). It is not that the person is being lazy or oppositional (although that happens often with people with ADHD, it is a separate problem and not a symptom of ADHD per se) but rather that they cannot keep in their mind the concept of time long enough to work for something in the future.
* ADHD people tend to feel pretty good about their accomplishments. They like to normalize their behavior and lives, but that is not a good assessment of their lives or accomplishments (they don't have much of a problem with "confidence.")
* One often finds a readiness to learn, but there is a struggle with the actual ability to learn or the attention to stay on task to learn
* over half by adolescence will be rebellious and antisocial (which is logical due to the impulse control and feeling like others don't understand them even though they believe themselves to not have problems).
* unable to sub-vocalize. Fancy way to say that they cannot think to themselves. They talk...A LOT. This is so evident with our daughter. She talks non-stop. We always giggle when when chooses to pray at meals because she gives God a blow by blow descriptive play of the day...as if He didn't know lol! In just the past couple of months I am thrilled that we actually have certain times in the day where we can get to short periods of quiet!
* these kids know the answers of how to act/what the rules are/what they should be doing. They just do not follow through. It is not that they are "inattentive" to the rules, don't know what they were told to do, didn't pick up on the instructions given, etc. Therefore, simply telling them what to do will not help.
*social maturity is about 30% delayed
My next blog post will be on understanding Executive Function and how that impacts ADHD. The one after that will be on Treatment Implications. Again, if you find this information helpful, or if you don't find it helpful and want better/more information, please check out Dr. Barkley's lectures at www.adhdlectures.com .
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