Wednesday, July 17, 2013

HYPERACTIVE AND INNATTENIVE: Speeding without a map in sunglasses

     Because ADHD is classified as a behavioral diagnosis we will need to identify the three essential characteristics of ADHD; Hyperactivity, inattention, and impulsivity. Not all of these criteria need to be present at the same time, although it is probably impossible to really have ADHD you have a normal attention span.  The diagnosis also requires that these characteristics be seen from an early age (even before delivery some mother say!), present in multiple settings (at least at home and school but often at church, scouts, dance, basketball practice, birthday parties and grandmother’s house), different from their peers (usually longer lasting and severe), and causing impairment. These behaviors sadly create havoc in both academic and social arenas.
     Hyperactivity is exactly what it sounds like.  These kids are on the go, bouncing off the walls, swinging from the chandeliers, “as if driven by a motor (see American Psychiatric Association DSM IV criteria for full descriptions).  The energizer bunny is their team mascot.  They just keep going and going and going and going.  On a positive note even extreme hyperactivity tends to decrease with age.  Over time the physical component slows down as the brain matures, particularly in the area called the basal ganglia.  Fidgeting and other fine motor activity, however, often continues unabated throughout life.  Their keys are jangling, gum is clicking, and toes are tapping even when they are trying to sit as still as possible and doing their best to listen to you.  These children are like cars whose accelerators are stuck racing down the hill towards the cliff while they fiddle with the satellite radio.
     ADHD carries in the name the hallmark of inattention or distractibility.  This may include vigilance, freedom from distractibility, processing speed, working memory or even motivation. Neuropsychological tests can help to measure these qualities which have their origin in the chemical processes of the brain. The scientific research in this area will deserve its own discussion in the future.  Dr Joel T. Nigg presents a comprehensive discussion of this topic in his book “What Causes ADHD?” 
   The brain based defect actually appears to be in the control or modulation of attention.  It is obvious that at times children with ADHD concentrate so completely on some things, particularly those that interest or challenge them, that their problem seems more like selective or over–attention. It is not that they cannot pay attention, but more that they pay attention to everything: the sounds of the refrigerator or overhead lights, the TV downstairs, the pattern or the floor or even their own thoughts. The problem is not distraction but more one of  attraction to whatever they can see, hear, feel or smell. They live in a world of overstimulation and over-reaction.
          The impulsivity associated with ADHD (leaping before they look) includes difficulty with sequential memory or emotional mood swings.  More on this next time.

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