Common Misconceptions About ADHD

Posted on Nov 26 2019 - 8:20pm by My Little Villagers

This is a guest post written by Dr. Robert J. Hudson, MD, FAAP (aka Dr. Bob) Dr. Bob is a Clinical Professor of Pediatrics with the University of Oklahoma School of Community Medicine in Tulsa. He has practiced general pediatrics for three decades and devoted the past sixteen years as a behavioral pediatrician helping parents with their children who exhibit behavioral or learning problems, including ADHD. For more information about Dr. Bob, please visit his website.

Image Source: Pexels / mewntatdgt

What it is, isn’t and What to do about it.

ADHD is not a behavioral problem. All kids with ADHD are not alike

Every child is much more than the ADHD part. In children under 10 I prefer to use symptoms rather than diagnoses. A diagnosis puts a child in a box of preconceived and misconceived concepts. No two children with an ADHD label are the same, have the same personalities or challenges. In addition, a diagnosis of ADHD is very limiting (six of nine symptoms in either inattention or hyperactivity categories is mandatory to meet diagnostic criteria). What if your child has four of one and five of the other? No ADHD diagnosis but the child is still struggling and suffering with these symptoms; so, you do nothing? With a focus only on the ADHD symptoms much of who your child really is may be overlooked. A more wholistic approach of behavior and learning assessment is the best practice. A more encompassing view is included in two posts on my blog that consider “What makes Children Tick”. Infants have inborn (inherited) personality traits called temperament traits (TT). These become the building blocks of executive functions. 

Executive Functions are the brain processes that determine the symptoms of ADHD

Neuroscience research of the past fifteen years in executive functions (EFs) has expanded our understanding of behavior and learning. These vital brain processes will help understand why ADHD isn’t a behavioral problem and why all ADHD kids are not alike, plus why they do behave the way they do! 

Let’s take a dive into this new area to better and more fully understand your child

Executive Funct9ons (EFs) are made up of two groups; one driving behavior and one driving learning. The behavioral EFs are called “hot” EFs and the learning ones as “cool” EFs. I think for once the naming people got it right; behavior hot, learning cool. 

These determine your child’s social emotional development and learning efficiency. Residing in between these two groups but necessary for both functions is the EF, impulse control. Research by my university team assessed TT and EFs of 1100 PreK students at the first of classes to predict which students would have behavior or learning issues or both. We followed throughout the year and found we did predict correctly which students would struggle using these assessments.  It is predictable.

The EFs that predispose a child to the diagnosis of ADHD are inhibitory control (impulse control) and working memory. Any behavior issues of an ADHD child are only the disruption caused by less impulse control. So, if your child has behavioral problems as resistance, shyness, sensory issues, etc., these have nothing to do with ADHD but are due to a different cause (weak EF) and therefore any ADHD treatment will have no effect on their behavioral symptoms. It is a common occurrence with those diagnosed as ADHD to have all of their issues, “Due to being ADHD”. This unfortunate circumstance lumps all kids with ADHD as the same and as you know they are as different as all other kids.

Understanding which symptoms are causing their problems and separating these from ADHD symptoms allows your child to have help focused on the real cause of the behavior. It is common for children with ADHD to have behavioral and learning issues. If your child also has social skills that has have nothing to do with ADHD. if your child has two problems and should be addressed as two separate problems. This is like a child with difficulty with math and or reading or both.

ADHD has three areas of concern. First let’s briefly discuss what makes these children tick. All have nine TT & eight EFs that drive everyone’s behavior and learning. Each TT or EF have a different set point. Some symptoms may be expressed a little or a lot or function perfectly. That degree set point determines severity of symptoms. The TT & EFs that create the symptoms of ADHD are:

  1. Temperament trait of Activity or Energy level
  2. Executive Function of Impulse control 
  3. EF Working memory (This is the complicated one with five components)

Each TT and EF needs to balance to function most effectively. If too little or too much it creates imbalance and ADHD issues.  

A child with a low activity level doesn’t have enough energy to accomplish all his tasks. If very high he has an abundance of energy. High energy alone doesn’t mean ADHD. That occurs only when the impulse control is low or weak. High energy and high impulse control are the super achiever. High energy and low impulse control are hyperactivity of
ADHD. Impulse control is responsible for our ability to ignore distractions and focus our energy on solving the problem at hand. The last set of EFs is working memory (WM). WM has five parts:

  1. Initiate (Ability to start the work on time)
  2. Working memory (Brains RAM, retrieval of information needed to solve the problem)
  3. Planning and organizing/time management 
  4. Organization of materials
  5. Monitoring progress and completeness

Initiate is the ability to begin a process of problem solving. Society has moralized this and calls it, procrastination. This is not a moral weakness but an EF deficit that prevents some from getting started on tasks/problems in a timely manner. 

Working memory is the EF that facilitates retrieving needed information to solve a problem at hand and returning it to a remembered place for later use. It is our brain’s RAM. Planning and organizing EF is self-explanatory but time management is included. This shows up if the project only begins the night before, you know the drill. Organization of materials EF is easily recognized as your child’s closet, room and backpack that contains lost teacher notes or permission slips and all matter of lost (unfindable) things. The last WM EF is monitoring. It is the last process step of homework when the child goes back over work to be certain nothing was left out or forgotten. Many ADHD kids omit this step to find they left an answer for latter, but they didn’t get credit because they “forgot”.

The good news is that each EF can be strengthened beginning as early as 2-3 years old. 

Each year over the past 20 has seen research illuminating a new and more complete understanding of what makes your child tick. The center of this new understanding is the brain processes, executive functions. These EFs drive behavior and learning and predict how children will do in school, socially and in life generally. These predictions are far better than using IQ, or past social research into environmental influences on development. Children do not forget on purpose, plan poorly or procrastinate intentionally. This is hard wiring before a year old. They are still responsible but need help. You would never yell at a deaf child, yelling at a child with ADHD is the same. By understanding these new facts, you can let go of frustration, anger and guilt to find empathy to help your child. He or she is struggling and doing the best they can with help.

Hope this helps you and your child.

Thank you, Dr. Bob, for such wonderful insight!

If you enjoyed this blog post, please consider becoming an ADHD Awareness Contributor. You can receive free ADHD products, have you or your child featured as an ADHDmazing ADHDer of the week, choose the next blog topic, get name recognition for your support, and MORE. This month’s ADHDmazing Giveaway is a signed copy of Dr. Bob’s wonderful book, The Normal But Not-So-Easy Child.


Leave A Response