ADHD: What Are the Signs?

What are the other signs of ADHD?

Research is showing us that ADHD impairs the brain's executive function ability. It's as if the brain has too many workers but no boss to direct or guide them. When the brain's executive function abilities operate appropriately, we think, plan, organize, direct, and monitor our thoughts and activities. In essence, our brain has a capable executive or boss.

Of course, none of us is born being our own executive. We acquire these skills as our brains develop and mature. Until we are able to monitor and regulate our own activities and lives, we rely on people and things outside of ourselves to guide and direct us. Puberty marks the time when we become increasingly "brain-able" to be our own boss.

Our executive abilities also help us to concentrate longer and to keep track of our thoughts, especially those we need later. We are less distracted by our own thoughts and find it much easier to return to work after we've been distracted.

The brain's executive abilities also help us inhibit, or control, behavior. Inhibition is the ability to delay or pause before acting or doing. It allows us to regulate our thoughts, actions, and feelings. This self-regulation or self-control helps us manage or limit behavior. We learn to say "not now" or "not a good idea" to impulse. We learn to control our activity levels to meet situational demands. For example, to yell at a ball game is fine (unless we are shouting in someone's ear). Yelling in a classroom is usually not okay.

Thanks to our brain's executive abilities, we become driven more by intention than impulse. That means we pause and reflect before we act. For instance, we are able to consider the demands of a situation along with the rules. We can delay an immediate reward in order to hold out for a later reward that's more meaningful.

With ADHD, the very brain areas responsible for executive function and inhibition are impaired. Children with ADHD can be considered hyperresponsive, because they behave too much. They are more likely to respond to events that others usually overlook (Barkley, 2000). Their characteristic disinhibition often causes others to find them annoying, irritating, or exasperating.

Obviously, executive function difficulties can create distress and problems with daily functioning, including emotional control. In addition to symptoms of inattention, impulsivity, and hyperactivity, you may also see these types of executive function problems:

It's important to remember that the self-control and self-regulation problems seen in people with ADHD are not a matter of deliberate choice. These problems are caused by neurological events or conditions. People with ADHD know how to behave. They generally know what is expected in a given situation. But they run into trouble at the point of performance-that moment in time when they must inhibit behavior to meet situational demands. Their troubles may show up in how they act in the outside world, or in their internal selves. They characteristically have inconsistent performance. This inconsistency is often mistaken for a lack of regard or respect, or as a lack of effort.

Because of inhibition problems, the disorder also makes it hard for the young person to follow the rules, especially if the rules are not crystal clear. Children with ADHD usually need a lot of incentive to follow the rules, too. That doesn't mean that they are intentionally bratty or demanding. When a child's executive and inhibition mechanisms are not functioning fully or normally, then we need to provide external incentives to pump up the child's ability to inhibit thoughts, feelings, and actions.

Performance usually improves when external guides, rewards, and incentives are provided. These might include step-by-step approaches, extra praise and encouragement, and the chance to earn special privileges for better performance. More will be said about these approaches in Section II of this Briefing Paper.

*Drawn from the American Psychiatric Association (1994), Diagnostic and Statistical Manual of Mental Disorders (4th ed.), pp. 83-85. Reprinted with permission.

Reprinted from National Information Center for Children and Youth with Disabilities (NICHCY) Briefing Paper, Revised Edition, April 2002. Contact NICHCY at P.O. Box 1492, Washington, DC 20013-1492; phone: 800/695-0285 or 202/884-8200 (Voice/TT).