The diagnosis, Attention Deficit (Hyperactivity) Disorder, or Attention Deficit Disorder with Hyperactivity (generally referred to as ADHD) is everywhere these days. In some communities it seems almost everyone supposedly has it. The stimulant medications used to treat ADHD are about as commonly prescribed for children as antidepressants are prescribed for adults. Some people think that's all plumb crazy. Some think it's an indication of a runaway rat-race culture where kids need to be stimulated to compete while adults get depressed because competition has replaced connection with others. Without a doubt, there is significant interest in knowing what ADHD really is. It is also extremely common to wonder if you have ADHD or if your children have ADHD.
So, what is ADHD? This disorder, and its variants, involves a consistent deficit, over many settings, in one's ability to focus or pay attention and/or in one’s ability to control their activity level. The person who is afflicted seems unable to concentrate, is often fidgety, or seems to have a need to be fully engaged in activity at all times. It is very important when diagnosing ADHD to be sure the problem occurs in many settings. When doctors see patients who have these behaviors at home, but not at school or at work, or when the problem seems to occur at school or work but not at home, most likely the problem is not ADHD.
One common misunderstanding in the diagnosis of ADHD is that people notice their children focusing in certain ways, even though they cannot focus in almost any other way. Although the diagnosis of ADHD must be a problem in many settings to be diagnosed, there are certain activities that are so stimulating that a person's ability to focus on them does not preclude the diagnosis. Specifically, any activity that involves a screen, such as television, video games, or any kind of computer activity, typically does not pose a problem for a person who has ADHD. People afflicted with ADHD also often have no problem with especially active pastimes, such as sports. Stimulation is the central ingredient for any activity that will not be a problem for the person with ADHD.
In fact, stimulation is really the key to understanding ADHD. ADHD that does exist over many settings is caused by a feeling that the environment is not stimulating enough. That is the simplest way of understanding why stimulant medication seems to help in the treatment of ADHD. As part of a need for stimulation, the person afflicted with ADHD gets lost in the thoughts of their own mind or within the excitement in their environment. The person seeking stimulation within their own mind seems spacey and seemingly cannot focus on either the simplest instructions or on more detailed information such as a teacher’s instructions in the classroom. The person seeking stimulation in the environment behaves in a hyper-kinetic fashion, almost as though there is a need to stir things up just to make things interesting. In seeking stimulation within the environment, staying on any one task simply isn't enough to keep the ADHD individual's interest.
The primary treatments for ADHD are stimulants, and some of the anti-depressants can also be helpful. When a person needs stimulation, these medicines provide that stimulation so the person can focus. There can be, however, reasons unrelated to ADHD that cause chronic under-stimulation. An observed lack of focus and/or hyperactivity may actually be caused by an over-focus on what others are thinking or doing (especially in inattention without hyperactivity) which can indicate anxiety. Lack of focus can also indicate a need to withdraw from the emotional and social constraints of normal interpersonal communication (when inattention takes place accompanied by hyperactivity) which can involve other kinds of mood disorder. Inattentive and hyperactive behaviors occur in these cases for emotional and personality-based reasons, and do not necessarily indicate ADHD. Yet stimulants and anti-depressants do, at times, seem to help even when ADHD is not the problem. The fact is that stimulants increase focus in most people as they find their environment more stimulating, regardless of the reason for the lack of focus. On the other hand, if the problem is emotional, the reason an anti-depressant would be helpful is obvious.
Although stimulant medications will sometimes help even when ADHD is not the correct diagnosis, there are also significantly negative side effects about which people need to be aware. Children who are unfocused because they are anxious will often feel much more anxious when prescribed a stimulant. Some will even start feeling panicky. When prescribed a stimulant, children who are unfocused and also have anger problems can become extremely emotional and tearful without provocation or, alternately, can spin up into a rage. Many children will feel numbed and lose their spark when taking a stimulant medication. Although that can be a normal reaction for a few days, if the spark never returns, that particular stimulant is likely the incorrect match for that child.
Incorrectly diagnosing and treating ADHD can cause other difficulties as well related to the impact of being labeled "ADHD" when the problem is really something emotional. Once the problem is given the name ADHD and the child believes the problem exists, ADHD can become a way of being for that child all of the time, instead of just in uncomfortable situations. If the problem is actually related to emotional factors, treatment with the wrong medicines can even preclude or delay the discovery of the real cause of the behavior. One of the worst outcomes from an incorrect diagnosis is that a child can come to believe that a pill is necessary to treat the problem, thus making them unlikely to develop the skills necessary to overcome the problem without medicine when that would actually be possible. When a child is diagnosed with ADHD, they often stop trying to concentrate. In some ways it's almost as if they're encouraged not to focus.
Because of these dangers of incorrect diagnosis, there are several ways to address issues of focus and hyperactivity that should be tried before medicine is considered. These same interventions should be used as an adjunct to treatment with medication even when the diagnosis of ADHD is certain. In people who have difficulty focusing, but who are not hyperactive, there is often extreme sensitivity to what others are doing or feeling. Because sensitivity to others is such a strong factor, studying or doing homework in a quiet, solitary setting can enhance focus. Such people also benefit from taking more time to complete tasks and from being in close proximity, with eye to eye contact, when listening. Activities that bolster confidence, and interpersonal support that reflects a true belief in the child’s abilities, are also essential. In cases where the lack of focus is not due to ADHD, if the unfocused person can begin to believe in himself, often his difficulty with focusing resolves as he worries less and less about the judgments of others. Even when the problem does truly involve ADHD, confidence acts as a buffer to the disorder and helps the child focus in spite of the attention deficit.
Cases of inattention with hyperactivity also benefit from the interventions indicated above, but the hyperactive behavior leads to more complications. These complications are primarily addressed by consistency. In childhood cases of hyperactivity, it often helps to initiate behavioral programs that allow the afflicted boy or girl to experience consistency from the environment and from authorities. Such children often have difficulty understanding when their behavior is upsetting others because they are not intentionally bothering anyone. When a person regularly experiences negative feedback from others for acting in a way that is natural to them, they soon develop a negative attitude toward others simply because they feel others think their true self and natural way of being is "bad." They also sometimes develop a need to get attention through negative behavior because of the feeling that getting positive attention is hopeless. The consistency of reward programs helps to overcome all this negativity as a child develops confidence that doing what is right and attempting to control one’s behavior leads to positive outcomes. With a behavioral program, the child learns to behave in ways that are positive and constructive because they receive affection and privileges when they are getting closer and closer to meeting specific positive goals. Behavioral programs help parents to be consistent, and help children to understand how to earn loving attention for positive behavior (please see articles, The Satisfaction Meter and Sample Reward System).
If you are concerned about the possibility of ADHD in yourself or your child, contact a mental health clinician. Whether medication is required or not, you might benefit from learning new ways to cope with these difficulties. There are currently a great number of diagnosed cases of this disorder, but many people, clinicians as well as school officials and parents, typically believe it is diagnosed too frequently. Because diagnosing ADHD when it is not really there can have a very negative impact, really knowing whether one has ADHD is extremely important. Although the medications themselves can have a negative impact, these medications actually tend to help many people concentrate better, even when ADHD is not the central problem. But mistakenly treating a patient for ADHD when the problem is actually emotional or interpersonal can have serious negative effects that must be avoided for the sake of the child’s or adult’s general well-being. If you are, and always have been, inattentive, unfocused, or hyperactive in a large variety of settings, there is a good chance you have some form of ADHD. ADHD can cause people very significant problems in getting along with others or doing good work. If correctly diagnosed, stimulant medications can be a god-send for those suffering from ADHD. Perhaps ADHD is too frequently diagnosed. Maybe its prolific diagnosis does indicate something about the exaggerated desire for success in our children. But when diagnosed correctly, treatment of ADHD isn't crazy at all - it's a necessity.
