Recently I was interviewed on a cable TV show. The questions from the interviewer reminded me that even very well-educated people often have misunderstandings about ADHD.
This is an informational blog for people interested in knowing more about ADHD. Understanding is the key to providing success for people who have trouble meeting their potential.
One question proposed for discussion was:
What is the difference between ADD and ADHD? Many people believe that the older term of ADD meant without hyperactivity, while ADHD meant the symptoms included hyperactivity. The interviewer was surprised that the term ADD (nomenclature from the Diagnostic and Statistical Manual, DSM-V) is no longer used.
All people with Attention Deficit Disorder are now referred to as ADHD, with three subtypes:
1. ADHD predominantly inattentive presentation
2. ADHD predominantly hyperactive/impulsive presentation and
3. ADHD combined presentation. Combined is used when both of the symptom criteria or behaviors for inattentive and hyperactive/impulsive behaviors are observed.
To meet the criteria for ADHD Inattentive Type one must have at least six of the following eight behaviors, for at least six months, that directly impact their social and academic/occupational activities.
Hyperactive and Impulsive also require at least six of the following behaviors, observed by others:
Additional criteria require that these behavioral difficulties:
It is also important that the severity is indicated as mild, moderate or severe, based on the number of symptoms or behaviors that are observed.
ADHD is not about being smart or not smart. In fact most people with ADHD are very creative people.
If you think that you or a loved one may have ADHD, it is a good idea to meet with a professional who specializes in working with people with ADHD, who can offer not just a diagnosis but also education, treatment and strategies to help you understand yourself or you loved one and to navigate your life more successfully. If this is you, please call Weaver Center to set up a consultation.
Among the most frequent questions asked by students with ADHD and their parents is, “Why is it so hard for me (them) to get to the important things that have to be done?” They often know they are in trouble but do not know why. We hear many derogatory declarations regarding laziness, not seeming to care, hard to get started, hard to finish, and most frequently, working far below potential!
The following is important information for parents, students, teachers and others about the issue of motivation and productivity. These difficulties look motivational but in fact they are neurological, and can be much better addressed with strategies once the challenge and difficulties are better understood.
The most important "treatment" for those with ADHD is understanding why motivation is hard and what to do about it.
People with ADHD actually do not have difficulty with motivation. Look at how they behave, think and organize things that are of high interest to them. Some are up early on Saturday mornings and have difficulty stopping playing a videogame and learning everything they can about it. We often observe over-focus, indicating that those with ADHD may stay with high-interest tasks longer than those without ADHD. Sometimes this confuses people as to why kids that are diagnosed with ADHD are diagnosed that way, considering how over-attentive they tend to be with high-interest tasks.
Therefore, what is the issue about motivation with low-interest tasks such as homework, chores, responsibilities, etc.? Why do kids with attention deficit appear so unmotivated and require so much external motivation, such as yelling, conflict, and behaviors that neither parent nor child want but seemingly can't avoid? I’ve spoken with parents who say, "I'm just not the person that I feel like I am when I'm so mad and disappointed that my child won't move unless I'm yelling at them for things they need to get done around the house."
The understanding is rather simple and the solutions are simple too, although maintaining consistency is crucial and can be difficult for both parent and child.
All humans “get” the things that they are interested in more readily than things that they are not interested in. There is one major difference with a person with ADHD. People with ADHD cannot feel the consequences of their decisions IN THE MOMENT. They usually know the consequences. Just ask, “What is going to happen if you do not do your homework, or your chores, or your room?” So why don't people move and be motivated with that knowledge? Because they do not feel the consequences like those without ADHD. People without ADHD feel the consequences in the moment. They don’t just know them but also feel the anxiety, apprehension, etc., of what will happen if they are not performed in a timely fashion. Therefore, without those of us without ADHD actually initiate, persist and produce to reduce anxiety or the feelings of the consequences. For those of us with ADHD, we do not feel the consequences even though we know them. So the most common response to multiple requests to move is generally, "I have plenty of time, I can do it later, why are you yelling at me?” The responses do not necessarily indicate that they do not want to get things done. They indicate that they do not feel the consequences, so they do not feel the pressure, so they do not move like those of us who do feel the consequences. Therefore, we parents remind and remind because we know that if our kids don’t get started there will be problems.
So once you understand that this apparent motivational problem is not intentional, willful or careless, you can begin to appreciate how difficult it is for your child to get started, continue and complete tasks that are of low interest. Interestingly enough, it is just as hard for people with ADHD to stop doing something of high interest as it is to get started on things of low interest.
What can we do to help bring the consequences into the moment when movement is necessary?
1. Make less interesting tasks more interesting. Setting up rewards does exactly that. Pair high-interest (rewards) with low-interest (starting tasks) to create a "system of rewards." You can see on our website an example of how to set one up. This is referred to as the old grandmother or grandfather principal. If you do this, you’ll get that. Work before rewards (low-interest before high-interest).
2. Set up a competing challenge with him/her using a bit of a David and Goliath model (we refer to this as Cognitive Discrepancy Therapy, which will be discussed more thoroughly in an upcoming blog). For example, you have a youngster give the “ADHD Adversary” a name. It could be Goliath, Darth Vader, Spinach, or anything they view as a challenge for them. This can be fun between parent and child. The child attributes their self-statements to that character or object. So it’s Darth Vader who’s saying, “In a minute, I got plenty of time, one more thing, etc.” The parent’s response is “The best way to fight Darth is to do it now! Don’t let Darth get to you, see if you can prevail. It may be tough but every time you win you develop mental muscle.” In this example, nothing is stated about the consequences because these kids do not get those in the same way that we do. However, giving them a challenge in the moment can be very helpful to them in understanding how Darth can try to prevent them from starting something uninteresting or from breaking away from something very interesting. The competitive way of saying, “Don’t let Darth beat you!”
3. Proximity, consistency, familiarity. If you understand that your child is not moving because they don’t feel the consequences, then one way to destress conflict is to come closer in proximity to your child, still using same volume of voice, but without the anger or frustration that numerous requests often come to. In other words, you are acting loud without being upset. Then both you and the student can laugh about it afterwards because it was a strategy that you know was needed to help them get started.
These approaches come from understanding that the child is not intentionally having trouble moving or being motivated, but it is the nature of their difficulty and they need your help to move. The more consistent you are with these methods, the more mental muscle is developed in the child, lessening conflict, and in the end the child is able to act more motivated.
Remember that having ADHD is a REGULATION deficit not an ATTENTION deficit. With high-interest there is over-attention and with low-interest there is under-attention. People do not have a lot of control over that. Therefore, by definition they need control help from the outside, which can create conflict. By understanding ADHD and implementing helpful strategies, conflict and stress can be reduced, motivation to get moving can be increased, and the home or classroom is a happier place and so is the child, who really does not want to have these difficulties.
It's also good to remember that following their school years there are infinite choices, if their self-esteem remains intact, to be as productive if not more productive than those without ADHD.
One method Dr. Weaver uses to treat his clients with ADHD is Cognitive Dissonance Therapy. This is a simple and elegant therapy that creates a dualism in the client's mind between the disability and the person. Through creating a persona for their disability, people with ADHD are able to view the disability as the antagonist in their life undermining their efforts to be more attentive, organized and productive. Likewise, they create a protagonist to represent their selves fighting to overcome the effects of this disability. For example, people have created antagonists such as Cruella deVille, Darth Vader or Dr. Doom, and protagonists such as Ariel, Yoda or "Eggplant" -- they can be whatever one wants as long as it keeps him or her focused and motivated. The dissonance between the two different identities detaches the problem from the person.
Next, the person begins to recognize the characteristics of their antagonist -- what makes this character so powerful and what negative influences need to be fought with new and effective strategies to change and better control their own behavior -- such as: Darth Vader makes the person sit on the couch when he should be doing homework, and that the antagonist is most powerful when the client is bored. The person with ADHD then develops strategies that the protagonist can use to stop the antagonist, such as to break down a task into tiny tasks and then put all of one's energy into completing each one of those tiny tasks, one at a time. Through the internal conversations that are created because of these two characters, the person with ADHD has an easier time changing and controlling the effects of his disability.
Dr. Weaver teaches Cognitive Dissonance Therapy through one-hour weekly therapy sessions. He says that usually after 4-6 sessions, the client sees improvement in their ability to address and overcome the symptoms of ADHD.