The reason why it was thought of as something you grew out of was because the focus was based on the H, hyperactivity. This part of the disorder is where the motor skills move faster than the cognitive part of the bran can keep up. This has been studied by Dr Barkley in great detail, and he has seen this whole idea differently. During the early stages of development the brain is certain areas of someone who has ADD are smaller, not by much around 3-10% but it effects the part which allows self regulation.
Self regulation is the part which tells you to stop and wait, wherever or not it is a good idea. It is that small voice in your head which some people listen to and some don’t. Well with ADD that is the part which under develops during childhood. In fact that under development means that the brain with ADD is functioning 30% younger than a brain without ADD. So when a five year old has developed the point when they are talking to themselves (if you listen to a five year old in bed you will hear what I mean), the 5 year old with ADD is still not doing this as their brain is running at the age of a 3 and a ½ year old. So without this development they are not developing that all important self control. This is the part which has been miss represented with ADD and why throughout this site it will only be referred as ADD and not ADHD. As hyperactivity is not a part which should be factored in, instead what it is is the control of actions in the loosest sense.
Coming back to adulthood this self control gets better as you get older, especially with Cognitive Behavioural Training or CBT, you don’t tend to run into traffic any more, but the control to stop yourself when for example you see something you want, you cant afford it but you buy it anyway without thinking. That lack of control will still play a part of the adult with ADD.
So that is one part of ADD moving onto the next part maintaining focus. Another part which is hampered by ADD is the ability to stay committed to a task. Now loosing focus on something can be considered normal, after all who doesn’t lose focus from time to time. The difference with ADD is the absolute constant loss. When a person with ADD is interested in something they will get hyper focused ignoring everything else, but when they have something they have no interest in, it becomes an incredibly difficult challenge, as when something which has no interest needs to be done the mind will seek distraction, and when a person with ADD gets distraction it will seek out the distraction, rather than ignore it. This can be very difficult as an adult as the mind focuses only when it is absolutely gun to the head level pressure if the person is not interested.
Working memory is the next big factor in ADD and what this covers is the part of your brain which draws the required memory at the required time. A way to imagine this is with a computer, there are two key parts to memory. The hard drive is what stores things that you want to keep, which sits there for as long as it is needed. The memory is used just for the short term to temporarily stored while a required process is completed, and this is the part which a person with ADD cannot process anywhere near as well as a person without ADD.
So long term memory is great, remembering a birthday part when you were 6 will probably not be a problem at all, remembering something from 20 minutes ago which you need to recall will be difficult. For an example of what is meant, imagine that you find at home you realise that you are out of cat biscuits. This isn't something you buy everyday so you set off and start walking a mile up the road to the shops to buy cat biscuits. Along the way your mind starts wondering and you think about various unimportant things and finally after 25 minutes you get to the shops.
From there you enter the supermarket and get a trolley (as this is something you always do when you go to the supermarket). You then start wondering around and notice some bread, which is probably something you need, oh and get some milk, you then wonder what you should have for dinner, and go get something which takes your fancy, you then see an offer on washing powder and think that’s a good offer and get that, finally you have all your items and head to the till. From then you bag your items and head back home thinking various things again till you get home realising that you have forgotten the cat biscuits and you already have 2 loaves of bread.
Working memory is one of the big factors to ADD, and is one of the most commonly known, but there is one more important one that needs to be addressed.
Regulating emotions is the final factor that needs to be covered. It is by no means least but it is one that needs to be covered as it tends to be forgotten. Dis-tractability, forgetfulness is common knowledge but the ability to control emotions is not covered as much. A person with ADD will have difficulty controlling raw emotions, frustration and anger are so easy to be released from a person with ADD, especially when stress plays a part in a situation. This is one of the biggest reasons why children with ADD get shut off from friendships, as people do not like confrontation, or anger. As mentioned early self inhibition is a problem with ADD in regards to controlling actions, this is also a problem regulating emotions.
So these are the main factors of ADHD (ADD) but what is going on inside the brain to cause these issues? The frontal part of the brain is the part that we need to focus on as this is the part is where the executive functions are found. Executive functions are the parts where self control are found and takes 30 years to fully develop. Dr Russel Barkley has said that there are five executive functions that we currently know of, and to understand what is not working in the mind of a person with ADD I am going to go over these five functions.
The first is stopping and waiting, which is the ability to stop yourself from doing a task and moving onto something else for example. It is the function which allows you to not only refocus onto something, but to also ignore a distraction, in effect you are stopping yourself from getting distracted by something else that is going on in the world. The ability to control yourself to stop and wait is something which sets us apart from every other living thing in the world, nothing else has this ability, as well as controlling the motor system of your body. An example of this is stopping yourself from running into the road, which can be difficult for a child with ADHD, as the consequences are just not apparent yet.
The second is the ability to relive the past otherwise known as hindsight. The mind holds images which you can recall at any point. It is the theater in your brain which can bring you memories whenever required. Why this is important though is not only remembering what you did as a child, but learning from things you've seen. For example you see someone at work who does something wrong. They make a mistake and they not only learn from that mistake but you do as well, and it becomes a visual image in your mind which you recall when needed to remember why doing a certain thing is wrong. It also allows you to recall if you owe people or they owe you, even remembering the taste of a wine can be recalled by first imaging where you where when you were drinking it. The images of your mind is what links every other sense that you want to recall.
The third is the speech to yourself, which is a function developed overtime as you age. You start being able to do this from when you were 3-5 years, but at this point you can't do this internally. This is why if you have toddlers you can hear them sometimes talking to themselves in bed with nobody there, and what they are doing is just thinking to themselves. As your mind develops you learn to control this to go from the outside to the inside, so that you can speak to yourself within yourself, an interesting side note, did you know that you cannot think to yourself and talk at the same time. The reason for this is that they are all wired in the same way, so if one is operating the other cannot.
The fourth is to emote to yourself, and what that means is that you create emotions within yourself, no other species can do that and it is unique to humans. What this means is the ability to create an emotional state of your own, rather than having external emotions effecting you. These emotions are required in order to control your own motor skills, to be able to have self discipline and self regulation in everyday lives. Without this you will get a difficulty to keep yourself focused on a task for an example, as without that regulation you will get affected by outside influences.
The final function is planning, problem solving and manipulate thoughts in your head. This is where you make plans for your future, using previous images and experiences that you have had to create the plan. But cold calculation is not the only part to this, it requires an imaginative thought process, in order to create new ways around a problem which never existed before, creating multiple different outcomes. Reasoning and decision making are other factors to this final executive function. Being able to make decisions based on information given, and as mentioned before experience you've gained.
The Executive Functions with ADHD
In terms to what happens for a person with the disorder, is that all these functions have a 30% lag in the mind's development. So for example a regular 5 to 7 year olds cognitive function is at the ability where they can at this point start thinking to themselves rather than talking aloud to themselves. They can at that point control their own motions by internally telling themselves, and this is what is delayed for the child with ADHD. The 5-7 year old with ADHD is still not able to control themselves as the inhibition system is still lagging behind, and so they are running at around a 3 year olds development, so a 5 year old with ADHD still requires external sources of control rather than internally controlling themselves.
So bring it forward to adult age, the executive functions in the brain is still developing right up to the 30's, but for a person with ADHD although control is higher it is still brings difficulty in comprehending what is read, seen and heard. So of course by that in regards to ADHD if something is said unless the person has absolute focus then things could be missed out, or reading large amounts could be skipped, or if you are watching an instructional video things may be missed.
So in real terms at the time of writing this I am currently 35, so the development in my brain is pretty much complete and looking back over the years of my life I can really see how much more improved I am, but I do still have the same old issues with ADHD. If I try to read uninteresting things, I know that I will unintentionally start skipping paragraphs. It is the same situation with videos, lets say YouTube, unless I am 100% focused I start to look at different things, reading other sites etc, and the only way I know as a workaround to this is simply go over this again and again the same thing so it starts to stay in your mind.
With regards to things being said to you, the only real technique I know is if possible write down as much as possible. the working memory is unreliable so it is best not to rely on it. With things written down reading it over and over ensures that nothing is missed, and this is the life of an adult with ADHD. You will need to in effect reverse the natural development process of creating everything internal, making it external. What I mean by that is as mentioned everything written down in anyway possible, notepads, calendars, Outlook reminders, sticky notes, anything that works for the person.
I hope that this has given you an insight to the world of ADHD, if there is anything you want to know please let me know, as there are plans for many more posts about the world of adult ADHD.
No comments:
Post a Comment