ADHD

The continuous process of attention involves organizing and setting priorities, focusing and shifting focus, regulating alertness, and sustaining the effort required to regulate the mind’s processing speed.

How often do you ever notice the effects of attention processes on multiple aspects of daily life?

I recently had an epiphany, or more like a light bulb moment, when it comes to how closely related various parts in our brain are. It’s as if they all work together so well, from keeping track and organizing thoughts, to process information for things we may want or need at any given time. And while this link between these functions has been noted before, what was eye-opening was noticing just how subtle yet powerful their connection can be!

These observations led me to conclude that attention is essentially a name for the integrated operation of the executive functions, which can be clustered together. Each cluster encapsulates one important aspect, and there are four clusters in all. This includes the motor, sensory, cognitive awareness, and self-regulation clusters. Although each has a single word label, they represent an amalgamation of abilities.

Thomas E. Brown had compiled a six clusters model to describe the executive functions of the brain. This is relevant as ADHD is a neurobiological condition that can cause inattention, hyperactivity and/or impulsivity, resulting in executive dysfunction and emotion dysregulation. Thomas E. Brown, PhD, is an assistant clinical professor of psychiatry at the Yale University School of Medicine and associate director of the Yale Clinic for Attention and Related Disorders. He is a former member of CHADD’s professional advisory board.

Cluster 1: Organizing, Prioritizing, and Activating for Tasks

Individuals diagnosed with ADD often complain that procrastination is a major problem. Sometimes these individuals lament that they keep putting off important tasks until the task has become an emergency.

Often individuals with ADHD only start a task or project when they face dire consequences in the very immediate future. The individual will usually not think about what is happening because it takes too much energy and effort, therefore needing drastic measures before starting a venture or project.

Many people with attention deficit disorder report that they often are aware of specific tasks they need, want, and intend to do but are unable to get themselves to start the necessary actions. Often these are routine tasks such as completing homework assignments or doing laundry.

These are some of the less common tasks that may not be as easy to do on one's own, such as completing a thesis for graduate school or asking for a pay increase. Filing taxes is also another common task that falls in the ‘important responsibility’ basket that individuals with ADD or ADHD often struggle to get started on and complete. These activities are better off being delegated and completed by someone who knows what they're doing in this area.

ADD can often make prioritizing tasks extremely stressful and difficult. Of course, it is important to keep things in order, but people living with ADD will have a much more difficult time than others regarding priorities and organisation. Especially with different jobs coming up at once, each one of them requires attention, effort and dedication, which can make the individual with ADHD feel overwhelmed by all that needs doing, on top of their other responsibilities.

Cluster 2: Focusing, Sustaining, and Shifting Attention to Tasks

Individuals with ADD syndrome often have a hard time focusing on the task at hand. It's not uncommon for them to lose focus after just a few minutes of being immersed in any one thing, and they may find it difficult or even impossible to return their attention to that same point where they left off. In addition, some individuals with ADD struggle because when presented with multiple stimuli simultaneously, such as hearing someone speak while reading written words, they can't settle long enough on either stimulus without losing interest before returning unconsciously; this is called "selective distractibility."

For people with ADD syndrome, focusing on a task can be difficult due to their excessive distractibility. They are drawn away by any number of things that might catch their eye, whether it's the TV in the background or an interesting conversation nearby. Even when they have focused on work for some time, distractions will often manage to pull them out and recall all focus back onto them at once.

Many things in life can cause distractions and get a person sidetracked from the task at hand. But unlike most people, those with ADHD have severe trouble screening out said stimuli as their thoughts come to them without warning or control.

The ADD syndrome is characterized by chronic difficulty blocking out distracting information which comes continuously through vision and sound, although it's not always an issue for everyone. They find themselves unable to ignore the multitude of thoughts, background noises and perceptions in their environment. This is not simply a problem for children or adolescents; adults also experience difficulty when pulled from one task to another without focus. When individuals switch tasks too frequently, it can hinder productivity. Each time the individual changes their activity, there is an initial delay before getting back into that flow state, where things come naturally again.

Adults with ADD often have the problem of being unable to concentrate on one task and then switching their attention, or they can't stop focusing when it's time for them to change tasks.

Hyperfocusing can also be difficult to manage in some situations, such as when they're driving, or at work, and have been so engrossed in their task that they've lost track of everything else around them, like people speaking directly to them.

People with ADD syndrome often find it hard to transition between tasks. Sometimes they get caught in a loop of thoughts, which sometimes happens when using the computer or talking. Some individuals with ADD report similar difficulties writing down their ideas as well.

Individuals with attention deficit disorder (ADD) usually have difficulty transitioning between tasks (e.g. conversations, working on computers, and written assignments) for a prolonged period of time. This can be due to problems focusing and distractions that can happen at any time without warning.

However, there are steps you can take if these symptoms occur while trying to use your laptop:

(1) first try taking some deep breaths as stress has been shown to worsen symptoms;

(2) secondly, close all other programs, so only one is open. This will help you focus more effectively; and

(3) thirdly, organize what needs to be done by placing items on a list.

Maintaining effective attention requires the ability to select important stimuli and screen out distractions. The difficulty is that it also requires your brain's ability to focus on other important matters at any given time. This is vital as we need a variety of things in our day-to-day activities.

Maintaining an effective level of attentiveness requires selecting which external or internal stimuli are most important and being able to shift ones' focus when needed so one can concentrate on other words/images etc. Yet, there will always be a necessity for those two components. Thus, selecting what’s relevant and prioritizing goals.

People with ADD syndrome usually report chronic difficulty focusing their attention, sustaining focus on a topic, and shifting their focus to meet the demands of learning or work. You may experience these difficulties occasionally; however, individuals with ADD syndrome seem to be more persistent, pervasive, and problematic.

Cluster 3: Regulating Alertness, Sustaining Effort, and Processing Speed

Many with ADD syndrome find that they frequently become very drowsy, to the point where they can hardly keep their eyes open when sitting still and being quiet. However, some describe themselves as “borderline narcoleptic,” so this is not usually a problem when physically active or actively engaged in conversation.

Success in school, work, and life can be difficult when you have trouble staying awake. For example, it's hard to stay focused on your surroundings while drowsy in a lecture or meeting. This also happens with reading if the material is not interesting enough; however, they need to read so they don't fall asleep! Similar difficulties arise when people try writing an essay or report because their mind starts drifting off into deep sleep territory where memories are at risk of being lost forever.

Some people report the same drowsiness when driving long distances on a highway, without seeing much of anything or stimulation of negotiation heavy traffic.

Douglas (1999) observed that boys with ADHD were both too slow on some tests but also had trouble slowing themselves down enough to make fewer errors in more demanding tasks. In addition, they were unable to regulate processing speed appropriately for changing task demands.

Cluster 4: Managing Frustration and Modulating Emotion

Many clinicians report that patients with ADHD struggle to manage their emotions. As it turns out, according to the DSM-IV diagnostic criteria for attention-deficit hyperactivity disorder, there are no items regarding emotion in the diagnosis. But my own clinical research on children and adolescents has led me down a similar path as many other psychologists, namely, concluding that sometimes managing one's emotions is difficult even if they don't have an emotional problem, such as depression or anxiety disorders.

Individuals who have attention deficit hyperactivity disorder (ADHD) also find themselves struggling with how they feel emotionally throughout the day, which they say isn’t included in any way under guidelines of what constitutes a diagnosis of ADHD according to the diagnostic statistical manual of mental disorders (DSM).

In Brown’s research, he looked at ADD symptom rating scales for each age group, and from the research, a cluster of symptoms is related to how individuals with ADD manage frustration. For example, in analyzing reports from patients with ADHD, their problems come down to two closely related types: (1) difficulty in regulating emotions; or (2) having very low thresholds for the feeling. Both might be due because these kids have trouble staying focused on one thing, which is frustrating.

Some people with ADD syndrome also meet full criteria for another disorder that more directly reflects problems managing one or more emotions, such as anxiety, depressive and bipolar mood disorders. One issue is simply that persons with ADD syndrome can suffer from chronic frustration, leading to other psychiatric issues in their lives. In addition, some people diagnosed with attention deficit hyperactivity disorder (ADHD) may have comorbid conditions such as depression, anxiety and even bipolar disease.

Cluster 5: Utilizing Working Memory and Accessing Recall

ADD is more than just difficulty remembering things. It also includes problems with short-term memory, which has been commonly misnamed as "long term" in the past.

Working memory has several functions. One important one is to hold one bit of information active while working with another. For this function to work, a person needs a "hold" button in their memory to keep the currently held piece of information on track until it's needed again and can be stored away into long-term storage. Without such a system, though, these all have been taken over by other bits that were not relevant when they entered our working memories but are now taking too much space therein as more items pile up after them. Thus, making any new input difficult or nearly impossible for us to process correctly without losing something we've already worked hard to remember before the moment passes.

Working memory is an active computational unit that holds information and actively processes this current information in connection with the vast files of longer-term memory. Thus, working memory function and operation depend on its capacity to hold relevant data over short periods while simultaneously processing more recent inputs from sensory areas.

Just as a computer needs RAM (random access memory) to store data, we need working memory. Working memory is like the file manager and search engine of our brain that stores information for short periods of time to use it efficiently. Unlike long-term memories such as things you remember from your childhood or last weeks' vacation, working memories are temporary. Still, they're crucial because, without them, everything would be chaos!

This short-term or working memory can help process different types of information before storing it in other forms if necessary.

Working memory is important for doing math, even simple arithmetic!

The difference between working memory problems and those with insufficient attention was a matter of debate among researchers. However, neuroscientists found that the working memory is not just a storehouse of thoughts, but also it involves "working attention" and "working memory," which together create one complex system. These complex systems work together to manage the continuous flow of information in the mind.

Cluster 6: Monitoring and Self-Regulating Action

ADHD has been characterized by difficulties with hyperactive and impulsive behaviour, which presents as acting without sufficient forethought or being chronically restless and hyperactive; it can also be challenging to slow down and accurately control your actions.

Children with ADHD have often been described by their teachers as wild, restless, and impulsive. The child may exhibit difficulties controlling what they say or do, so parents must take a greater role in supervising them than other children of the same age. Researchers have identified "impulsive and erratic behaviour" as a core problem in these hyperactive and impulsive symptoms of ADHD. However, it is important to highlight that an individual with ADHD may not necessarily demonstrate hyperactivity. In fact, some individuals diagnosed with ADHD may appear to lack energy and seem quiet and reserved.

Russell Barkley (1997) research indicated that the inability to inhibit is a primary problem for individuals with ADHD. In fact, because of this impairment in their executive functions, it can be said that all other abilities are impaired as well. Thus, the impairment of one's ability to inhibit is the one in which the development and effective functioning of all other executive functions depend.

ADD is a neurological condition that makes it difficult to monitor and regulate one's actions. People with ADD report chronic difficulties inhibiting action, monitoring their context/self-monitoring, or taking appropriate action.

ADD is more than just hyperactivity and impulsivity. It can make everyday tasks such as school, work, or family life difficult to do well in because of the many different types of ADD-related impairments.

Evidence-Based Treatment Approaches for ADHD

A common belief that is commonly thrown around is that medication alone can manage ADHD. While there is no cure for ADHD, medication can have positive effects on inattention, impulsivity, and hyperactivity. However, a multimodal or comprehensive approach is most beneficial for individuals diagnosed with ADHD. This includes appropriate diagnosis, improving personal and family understanding of the disorder, behavioural interventions with a highly skilled psychologist, educational supports/ADHD coaches, and ongoing psychiatric assessment to monitor pharmacological treatment.

It has been found that ADHD is primarily biological and genetic in its origins, indicating that environmental factors such as teaching and parenting quality can help to minimize/intensify the difficulties experienced by an individual with ADHD.

ADHD coaches may also be a good fit for individuals diagnosed with ADHD, specifically for career performance and support.

An ADHD Outpatient Program is another useful support for consideration for individuals with ADHD. This will usually consist of a 1 day per week program for the duration of 12-weeks. It can be covered by Private Health Insurance, subject to the individuals' level of cover – therefore, it is good to check first!

By Emily Burton | Psychologist Melbourne

Additional Reading and References

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What is ADHD? - Psychiatry.org

What are the symptoms of ADHD? - HealthLine.com

Facts about ADHD - CDC.gov