What is ADHD?

The definition of this disorder is a work in progress because the exact nature of brain problems is as yet impossible to see.

 

The most recent official definition from the American Academy of Psychiatry was published in 2013, and many in the ADHD field are not satisfied with it because it leaves out any discussion of executive function.

 

The complete name is Attention-Deficit/Hyperactivity Disorder, and it comes in three types:
-Predominantly Inattentive Presentation (formerly called ADD)
-Predominantly Hyperactive-Impulsive Presentation
-Combined Type (formerly called ADD with Hyperactivity)

 

The name is confusing, and most people have trouble remembering that it isn’t just about “being hyper” despite the name.
The symptoms are mental: inattention and distractibility more than experienced by most others; and they are behavioral: hyperactivity and impulsivity (acting or speaking without first considering the consequences).
And, most people don’t realize that the symptoms can also be emotional: sort of like impulsive decision making about feelings.


We all have these traits at times. To be considered a disorder, the traits must be pervasive (affecting more than one area of life), and they must be impairing (disrupting or limiting the individual’s functioning and achievement).

The Evolving Definition


Since the late 1990s and the work of Russell Barkley, it has come to be considered a problem with the brain’s executive function–or self-regulation system. My friend, Jen, says executive function is like “all the work the president’s secretary has to do so the executive can function”. And ADHD is like the president’s secretary being out sick.

My favorite author about ADHD is Thomas E. Brown, PhD and he explains executive function better than I ever could. Please read what he has to say.

http://www.brownadhdclinic.com/add-adhd-model/

 

So what is it really?

 

My very short working definition is: ADHD is impulsivity by thought, word, and deed. How it manifests itself varies with the individual’s personality.

Impulsive thoughts – difficulty sustaining attention,”zoning out” when not involved in something inherently interesting, daydreaming, losing track of time, difficulty thinking things through, difficulty with planning and organization, difficulty keeping thoughts on one topic at a time, thoughts that go off on tangents, procrastination, jumping to conclusions, difficulty getting started, irritability….

Impulsive words – saying whatever comes to mind without considering the consequence to self or others: wise cracks, butting in, talking out of turn, excessive talking, “class clown” behavior, “just telling it like I see it”, talking without listening, excessive loudness, making promises that won’t or can’t be kept….

Impulsive deeds (behavior) – there are thousands of examples: hyperactivity, touching where one shouldn’t, taking what’s not yours, losing things, auto accidents, all sorts of other accidents and “oops” behaviors…. I think substance abuse comes under this heading as well. It’s a quick fix without regard for long-term effects.

Neurotransmitters


In ADHD, it seems that the brain chemicals (neurotransmitters) responsible for attention and executive function are inefficient. It’s like other people are born with solid circuits connecting different parts of their brains; but we have dotted lines. Interest in something, high emotion, risk, and reward are some of the things that connect the dots. So, inconsistency is a hallmark of ADHD.

The ADHD neurotransmitters are:
Dopamine – responsible for attention, alertness, arousal (being ready), and reward (this feels good – I think I’ll keep doing it)…and a lot more.
Norepinephrine – responsible for maintaining alertness and energy– how we do what we do, how we process what we learn, hear,and feel….etc, etc, etc.

ADHD affects emotional regulation as well. The ADHD brain comes to conclusions using dotted-line circuits.  Emotions defy logic and they create solid line shortcuts that can lead to impulsive actions.

I hope that gives you an understanding about why life can be so hard if these brain functions are only working intermittently.

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©2017 By Cathi Zillmann, CPNP, PMHNP & Timothy P. Aiello, PMHNP-BC