What is ADHD

 While it may feel like a modern problem, the behaviors have been documented as far back as the late eighteen century. Dr. George Still, a UK pediatrician recognized it as hyperkinetic disorder in 1902.[i]Still discussed a lack of” moral control” including cognitive relation to environment, moral consciousness, volition, and capacity for reasoning.[ii]In 1980 the American Psychiatric Association renamed the disorder Attention Deficit Disorder (ADD) with or without hyperactivity, and it kept that name until being documented as “Attention Deficit-Hyperactivity Disorder (ADHD)”[iii]

The American Psychological Association describes ADHD as “a behavioral condition that makes focusing on everyday requests and routines challenging.”[iv] One concern I have with this definition is that it focuses on behavior. That implies that if you just change your conduct, you can solve the problem. It encourages the notion that kids can just learn to sit still or pay attention. For this reason, we need to recognize that ADHD is a disorder. ADHD brains are wired differently.  In scans, scientists can see how some structures in the brains of kids with ADHD are physically different than kids without ADHD. The frontal lobe, for example, which helps people organize, plan, pay attention and make decisions, is smaller in the ADHD brain. Networks that transmit signals in the brain work differently in ADHD patients. Differences in neurotransmitters like Dopamine and Norepinephrine also behave differently. [v] 

Thinking about ADHD as a physical disability allows both students and educators to react differently. When a student walks in with impaired sight, we would not dream of saying, “just try harder to see.” Because ADHD is the result of a different brain, it is equally unhelpful to say, “just try harder to focus.” ADHD students often experience depression and anxiety related to struggles and failure. By keeping the material reality of ADHD in mind, we can change the conversation around how we support their success. 

The exact causes of ADHD are unknown, although there are several theories. Some research shows a genetic link with ADHD running through families.[i]There is no known single cause or risk factor. One hypothesis according to Thapar et al in 2012, is that there are” multiple environmental risks, each of small effect, with the overall burden of these risks remaining similar over time and between countries.”[ii]Likewise, there is no cure or long-term treatment. According to one study, approximately 60% of children with ADHD still have symptoms as adults.[iii]Symptoms may change with age and individuals learn to manage it. According to a study by Roman-Urresarazu et al (2016), even if symptoms decrease or disappear, the structural differences in the brain still persist.[iv]Fortunately, symptoms do not appear to increase with age and adults tend to have more coping skills and resources to manage persistent symptoms.[v] 

[i]Biederman J, Faraone SV, Keenan K, Knee D, Tsuang MT (1990) Family-genetic and psychosocial risk factors in DSM-III attention deficit disorder. J Amer Acad Child Adolesc Psychiatry 29: 526–533

[ii]Thapar A, Cooper M, Jefferies R, et alWhat causes attention deficit hyperactivity disorder?Archives of Disease in Childhood 2012;97:260-265.

[iii]Sibley MH, Swanson JM, Arnold LE, et al. (2017) Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity. J Child Psychology Psychiatry. 58(6):655-662. doi:10.1111/jcpp.12620

[iv]Roman-Urrestarazu, A., Lindholm, P., Moilanen, I. et al. Brain structural deficits and working memory fMRI dysfunction in young adults who were diagnosed with ADHD in adolescence. European Child Adolescent Psychiatry 25, 529–538 (2016). doi:10.1007/s00787-015-0755-8

[v]Low, K (June 9, 2022). Does ADHD Go Away? Verywell Mind. https://www.verywellmind.com/do-kids-outgrow-adhd-20509Accessed 6/29/2022

    [i]Lange KW, Reichl S, Lange KM, Tucha L, Tucha O. The history of attention deficit hyperactivity disorder. Atten Defic Hyperact Disord. 2010 Dec;2(4):241-55. doi: 10.1007/s12402-010-0045-8. Epub 2010 Nov 30. PMID: 21258430; PMCID: PMC3000907.

[ii]Still GF. Some abnormal psychical conditions in children: the Goulstonian lectures. Lancet. 1902;1:1008–1012.

[iii] Lange KW, Reichl S, Lange KM, Tucha L, Tucha O. The history of attention deficit hyperactivity disorder. Atten Defic Hyperact Disord. 2010 Dec;2(4):241-55. doi: 10.1007/s12402-010-0045-8. Epub 2010 Nov 30. PMID: 21258430; PMCID: PMC3000907.

[iv]ADHD American Psychological Association. https://www.apa.org/topics/adhdAccessed 6/27/2022

[v] ADHD & the Brain. (February 2017). American Academy of Child & Adolescent Psychiatry (121) https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/ADHD_and_the_Brain-121.aspxAccessed 6/27/2022