The second dimension failing to develop
on schedule will appear about 2 to 3 years after and this is known as the attention
deficit but it isn’t here again we have a misnomer there are
at least six or seven kinds up attention and supporting networks in the human
brain they are not all disrupted by this disorder what we want to know is which one to
help us with differential diagnosis to help us tell ADHD from an anxiety disorder and from
autism and all the other psychiatric disorders which all interfere with
attention at some point in life ADHD is not the only attention-deficit we need to be more precise if someone
comes to us and says my child or I inattentive that is useless
diagnostically what I need to know is to nature up the inattentiveness and we have now
known for a decade that the inattentiveness that we see in
ADHD is distinct from that produced by all other
disorders because it is most I think accurately described as a
failure of persistence the first attention
problem is persistence toward a goal notice that this implies behavior
motivation and the future that is very important
the other forms of attention do not ADHD is not a problem of perception us children of processing how the post
your your part of our brain functions it is a problem weird the motor part of
the brain this Frontalot can you sustain action toward a goal adequately to
attain it that implies a motivation deficit and
that is true and it implies future directed behavior
and that is true ADHD is a failure to direct behavior
forward in time we cannot persist toward these delayed en pointe in life the cash the goals the things that need
to get done so persistent its deficit one in the area of attention now to persist
toward a goal you must be able to resist distractions
but that too is not a perceptual issue it is a motor
issue the person with ADHD does not have problems with perceiving
distractors better than others it is that they respond to distractors
more than others and dad is an inhibitory failure not a
perceptual difference you and I may also hear the noise in the
kitchen the person with ADHD is compelled to
react to what all did you hear that I guess they’re
washing dishes maybe I’ll stop in and take a look did you know I was a dishwasher when I
was back in college that’s how I earn my way to see what’s going on here you all
heard the dish but it was your relevance to what we’re here to do today but to the ADHD individual the
distraction is going to provoke a response and the
response can be inhibited and now they’re off to the races
skipping from one thing to another time another now there is a third aspect here that is
impaired but it is not one of attention most
people when they’re distracted reengage the incomplete a goal the person with ADHD is far less likely
to do so and this has nothing to do with the
tension this is working memory so I would want a
family to understand that there’s more here than inattentiveness there was a working
memory disorder and I would want them to know that
working memory is one of the five special executive functions but the
human brain suggesting that ADHD is he FDD executive function deficit disorder
because working memory is where we remember what we’re doing it is remembering so as to do it is
consciously effort fully holding in mind the what the winner of what we are doing it’s what you lose at my age and when you hit menopause you do not lose memory you lose working memory you forget what you were
doing where you were going what the goal was the steps to the goal how you were
getting there it is that that allows you to reengage the incomplete a goal because you are holding in mind the goal
it is that which ADHD children and adults will lose the goal is gone it is for gotten and
now anything else compelling around them
will capture their behavior hence the symptom skips from one in
completed activity to another the ability to
reengage a goal is a working memory disorder and that’s
what they cannot do and this begins to open the door on the
possibility that the other four executive functions
are impaired as well more on that later so let’s understand
that there are three interacting attentional problems but that they are
best thought of as executive deficits not attention deficits and they are the
problem with persistence toward the future resistance have distractions along the
way and working memory and now you
understand the nature of this attention problem from the one that’s
produced by anxiety and depression and autism and all the other disorders
including the learning disabilities which have nothing to do with these I
would want families to understand that there is more to ADHD then just the in addition Andy’s
attention and working memory problems that at its
heart in its sole it is a disorder of self-regulation not
one of attention I think the biggest problem we have had
as a group in convincing the general public about the seriousness of our
children’s disorder verses autism or schizophrenia or the
other disorders is the very name itself is trivial ADHD go to Starbucks good god have some
caffeine we got more serious fish to fry year in psychiatry than the fact that you just can’t pay
attention right part of the reason that our disorder that the name of this disorder
is so often pilloried in the media is because I think we miss named it this
is a developmental disorder a self regulation not attention and
thatch is a serious disorder a serious as manic depression and in its own way
as autism but it doesn’t convey that to people if they understand it only as eighty d HD as opposed to Sr DD a shelf regulatory developmental disorder so I would want
families to understand the seriousness of this that this isn’t simply inattention there are some profoundly unique human
traits that are not emerging as they should in
this individual and if you understand that your
understand the bigger picture the why of everything if it’s just an
attention problem why am I seeing impairment in virtually every domain in which this childish ass to function
that would not come from just inattentiveness but it would come from
an executive function disorder a self-regulatory disorder so I would
want parents to understand that this is the essence of this disorder
self-regulation what is that it is first evolved the
ability to consciously willfully choose to inhibit your behavior and then to engage in a series of self-directed actions
that is after all what self control is you start to do things to yourself these are responses that are not
directed at the world around you they’re directed at you right you’re
trying to change your behavior in some
fundamental way the second part of self control that your child struggles is not just the Stockton but the
thinking the thinking is the self-directed
activity the stuff I’m doing to myself why would I do these things to myself to
change my behavior from what it would otherwise be and why
would I do that to change my future self-regulation is not just for short term
self-improvement it’s for long-term self-improvement its
to see to your own welfare over the long term should you act this
way given the street sustained or delayed
consequences that lie ahead for you that is what you must stop and think
about and that is what they don’t stop and think about the delayed consequences so your child is not just inattentive they cannot stop engage in a series of self-directed actions that they will
now use to modify and moderate their behavior so as to
bring it in line with their long-term welfare the future and that’s what yours your child is struggling so mightily
with in their development it’s what the other
kids are acquiring and your child is so far behind him