In last month’s Glebe Report I wrote about ADHD, describing it as a neurobiological condition that affects executive functions. Executive functions are a range of control processes in the frontal lobes of the brain that allow us to connect, integrate and prioritize our cognitive functions. Some call them the “conductor of the orchestra” or the “CEO of the brain.” Executive functions govern our motivation, initiation, timing, planning, organizing, focus, effort, emotion regulation, self-monitoring, prioritizing and remembering to do things.
People with ADHD demonstrate chronically impaired executive functions. As a result, they suffer substantial negative impact on their work, school, home and social functioning. It is not a problem of intelligence or willpower – people with ADHD want to succeed but they often lack the necessary skills to do so.
So what can be done to help? There are three main types of interventions for ADHD.
A priority intervention for ADHD is to develop a thorough understanding of what it is and what it is not. People with ADHD, as well as their parents, spouses, teachers, co-workers and friends, should learn as much about ADHD and executive functions as possible. Developing a disability perspective (i.e., understanding that people with ADHD cannot do these things versus they are just not trying hard enough) can help set realistic expectations and reduce stress.
As with everything these days, the Internet is rife with misinformation about ADHD. There are websites asserting that ADHD is not real, that it has been fabricated by the pharmaceutical industry, that it is caused by poor parenting and that it is a result of radiation from cell phones. These claims are simply not true.
Check out the books, websites and videos by Russell Barkley, Peg Dawson, Ross Greene, or Joyce Cooper-Kahn. They are leaders in the field of ADHD, behaviour and executive functions. You can find research-based advice and information on the website of the Centre for ADHD Awareness, Canada, www.caddac.ca, the website www.understood.org, and the online magazine Additude, www.additudemag.org.
And be sure to learn about the many strengths (such as creativity, enthusiasm and generosity) that are evident in people with ADHD.
Knowing that ADHD is a neurobiological, genetic and chronic difference in brain development, medical interventions are considered critical for improving day-to-day functioning.
People with ADHD and/or their parents are strongly encouraged to speak with their family doctor or pediatrician to discuss medication options. It can take time to determine the most helpful medication at the suitable dosage, so be prepared for some trial and error.
ADHD medications fall into two categories: stimulants (such as Concerta, Adderall, Vyvanse, Biphentin, Ritalin) and non-stimulants (such as Straterra, Intuniv). Stimulant medications are usually tried first and have an 80-to-90-per-cent chance of producing clinically significant improvements in ADHD symptoms. The non-stimulant medications are often tried if the stimulant medication has not been effective. They have demonstrated a 55-to-60-per-cent chance of improvement.
ADHD medications help people pay attention, control impulses, regulate emotions and avoid risky behaviour. They have neuro-protective benefits, meaning that medications promote development in the affected brain areas. Research based on imaging has found that youth with ADHD who have taken medications for years have brains that are similar to youth who do not have ADHD at all. In contrast, youth with ADHD who have not taken medications continue to have less activity and less volume in their frontal lobes.
Another interesting finding is that children and youth who take medications are less likely to abuse drugs or alcohol when compared to those with ADHD who do not take prescription medication.
Supports for executive functions
Remember that people with ADHD know the expectations for appropriate behaviour, but their weak executive functions make it difficult for them to follow through. Parents, teachers, co-workers and friends may need to assist with motivation, planning, organizing and other executive functions.
Moreover, it is crucial for people with ADHD to take advantage of the help that is available. Researchers found that students with ADHD who ask for and use help from teachers and parents have more academic and vocational success, as compared to those who try to go it alone.
People with ADHD need help and do not benefit from a wait-and-see approach. Being proactive, encouraging and supportive of the people with ADHD in our lives will allow them to flourish and to demonstrate their unique gifts and talents.
Jenny Demark, Ph.D., C.Psych, is a psychologist who lives in the Glebe and works nearby.