Thursday, May 9, 2013

Thoughts On ADHD


      I formed my opinion about ADHD as I listened to my patients describe what it felt like and how it affected their lives.
     ADHD is genetic. It is the most common inheritable neurological condition in human beings. Through natural selection, genetic traits that get passed into future generations are ones that give a biologic advantage or have beneficial aspects. Imagine yourself walking through the jungle a few thousand years ago. You had to be constantly aware of all the things happening around you because, while you were looking for something to eat, there probably was something nearby that was planning on eating you. You needed to be aware of every change in movement, shadow and sound in your immediate environment. For thousands of years of human history, that hyper-awareness helped one stay alive and increased the chances that those genes would be passed on.
     Fast-forward to today and imagine that you are sitting in a classroom listening to the teacher. A car goes by the window and you turn to look, a kid drops his book and you turn to look and when you turn back to the teacher, she has gone from A to D and you've missed part of what she said. To her, you were "inattentive" but, in fact, you were focusing on every change happening around you. What was an advantage in the jungle becomes a disadvantage in the classroom.
     Along with the tendency to rapidly shift focus, the ADHD gene is coupled with other traits - having high energy, intelligence, creativity, and heightened imagination. It is said that these kids lack focus, but I've found that they can actually hyper-focus - they can lock in on something they are interested in to the exclusion of everything else. The down side is that they quickly get bored with things they aren't interested in. Consider all the people who did poorly in conventional school but learned how to use ADHD traits to their advantage - Edison, Einstein and Bill Gates, for examples.
     When I've lectured about ADHD, I've always talked about the Good, the Bad and the Ugly. The Good is what I've mentioned above, the Bad is that ADHD kids lack Executive Function - the ability to think before you act and to consider the consequences of your actions. The Ugly is that they have a tendency to become easily frustrated and to have problems controlling anger.
     In short, I've always felt Attention Deficit was a misnomer - These kids don't “lack attention", they just don't always pay attention to the things that they need to pay attention to- the things that will help them succeed in school, business and social interactions. I’ve frequently heard teachers and parents say, “I know he’s smart, but he just can’t seem to get it”. For those kids, ADHD medications can be a Godsend. I’ve seen kids go from getting “F”s to “A”s after taking Ritalin. I’ve had kids happily show me the first spelling test in their life where they “got them all right!” Once they start seeing themselves as a success rather than “the kid who always screws up”, their lives can change for the better.

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