7 Ways ADHD is Misunderstood
Seven of the many prevailing stereotypes and myths about ADHD
“But he can focus on things he enjoys for hours at a time!”
That was my own reaction when the school psychologist gently suggested that we learn more about ADHD to see if we wish to have our son assessed.
Despite my degrees in Social Work and Psychology, I actually knew very little about the complexity of ADHD and the myriad of ways it can impact peoples’ lives. Having not been in University since 2009, it was certainly time to update and expand my knowledge.
Fast forward a year and a half and both our son and myself have been formally diagnosed (me at age 36!). My son was diagnosed by the school psychologist and his pediatrician, and I was diagnosed by a psychiatrist specializing in Adult ADHD.
ADHD is about so much more than difficulty sitting still.
Little did I know that this hyperfocus was also part of ADHD and that hyperactivity and inattentiveness are just two parts of a very complex disorder that Dr. Russell Barkley explains is not actually a disorder of attention, it’s a disorder of regulation.
Below I have reframed and expanded on each of the Seven Executive Abilities, described by Dr. Russell Barkley (Barkely, 2015), relating them to struggles in children rather than adults.
1) Impulse Control
The ability to STOP. The ability to pause between the action and reaction. The ability to pause before responding. “ Response inhibition refers to the ability to withhold a cognitive or behavioural impulse that may be inaccurate or maladaptive.” (Barkley, 2015).
Children are particularly prone to impulsivity because their prefrontal cortex, which is highly important in decision making, is not yet fully developed. Neurotypical children are impulsive as a result of being children. Children with ADHD are thought to be approximately 30% behind their peers in PFC development, making the stop and think” process even more difficult.
Working memory deficits may adversely affect the social functioning of children with ADHD .” (Kofler et al., 2011). “Hmm, last time I did this… and this happened… so maybe I should try… this instead…”
While most children with ADHD have average or above-average IQ (many are twice exceptional), learning from past experiences is more challenging when there are differences in the way ADHD brains store and later access information as memories.
Thinking ahead to longer-term consequences of your current behaviour before acting.
Children with ADHD have greater difficulty predicting possible outcomes of their choices and have greater difficulty connecting current behaviour with future consequences.
This means that delayed consequences such as detention, suspension, grounding, removal of future privileges, etc. are not likely to be effective in changing undesired behaviour. I wrote more about this in another blog post, “Punishment Does Not Work”.
Intervention, guidance, and support have to happen at the point of performance, meaning at the location and in the moment the behaviour is occurring.
Similarly, reinforcing positive behaviours must also occur at the point of performance, so we must make efforts to “catch” the child doing something good and not only be on the look out for negative behaviours.
Children with ADHD often struggle with low self-worth and are often blamed for behaviours stemming from their disability. Many children with ADHD internalize the constant negative messages from others, believing that it is their fault, rather than being taught that their brains are wired differently.
So often I hear adults ask (and yes, I have heard myself say it!) “why isn’t he learning from these consequences?” That is why. Impulsivity combined with a deficit in both hindsight and foresight (also referred to as working memory) make it very difficult for children with ADHD to learn from past mistakes without compassionate, non-judgemental support and guidance.
This means that a neurological difference is responsible for difficulty learning from consequences, not a desire to be “bad”, and not from a lack of a desire to be “good”.
As Dr. Stuart Ablon says, “kids with challenging behaviours lack skill, not will.”
Self-directed language to facilitate self-control, also referred to as verbal working memory, or inner speech.
This is our inner monologue and refers to how we talk to ourselves inside our head to guide our decisions and remind ourselves of things we need to do. Children begin by having these conversations with themselves out loud when they are very young and as they mature these conversations gradually become internalized.
Each person’s experience with ADHD is different, however ADHD experts such as Dr. Russell Barkley explain that the capacity for self-talk is less-developed and also develops later in life in people with ADHD.
The ability to talk to oneself in a positive and helpful way impacts one’s self-esteem, memory, motivation, and decision-making. Challenges with this executive function can have a significant impact on daily functioning.
5) Emotion Regulation
Emotional self-regulation is the ability to manage one’s emotions to make them more socially acceptable.
“Our emotions are our motivation.” — Dr. Russell Barkley
The executive functions in kids with ADHD are simply not developed enough to manage emotions as adeptly as a peer or an adult would (Saline, 2018).
If a child with ADHD has “big feelings”, or is experiencing emotional dysregulation, then they cannot entirely control the resulting behaviour. They first need help with managing the feelings and developing self-regulation skills, only then can the behaviour change follow.
We don’t hand a kid a basketball and expect them to sink a basket their first try, we teach them skills first. Why, then, do we expect children to have the skills to manage intense emotions if they haven’t been taught?
Children with ADHD are dependant on the environment and its immediate consequences.
Please note the difference between the environment and adults — Oftentimes adults refer to “natural consequences” and yet they are consequences that the adult has imposed upon the child. Those are not natural. Natural consequences are those that happen without adult intervention.
This means that we, the adults, have to help children and youth develop tools for self-reinforcing for tasks they find less desirable.
Children and students need to find what is reinforcing for them, not have the adults decide what their rewards are, and certainly not have adults use the rewards as a means of manipulating children into doing what the adults want them to do.
What adults identify as behavioural problems come from a lack of skill, a lack of coping strategies, and/or underlying issues or concerns.
“If caregivers are focused only on modifying behaviour, then all they’re modifying is the signal. But they’re not solving any of the problems that are causing the signal.”— Dr. Ross Greene
Addressing the presenting behaviour only “trains” a person to comply and do what is being asked of them, completely ignoring the underlying difficulties that really need to be addressed.
It’s a bandaid solution because it does not teach skills or provide emotional support, and it puts the onus on the child, rather than on the competent adults whose brains possess a fully developed prefrontal cortex.
Addressing the presenting behaviour only “trains” a person to comply and do what is being asked of them, completely ignoring the underlying challenge that really needs to be addressed.
But I digress…. Back to the List… Now, where was I? Oh yes!
7) The ability to plan and problem solve
The ability to simulate multiple possible future options is the highest executive function in humans.
The ability to quickly run through multiple “ hypothetical situations” in our mind, and then the ability to quickly change course when we run into a problem or when one of our options fails.
A lot of children (and adults) with ADHD struggle with cognitive flexibility, or flexible thinking. When we have our mind set on something happening a certain way and that changes, it can be very difficult for us to adapt. This is also a common struggle for people with anxiety, a comorbid condition with ADHD, meaning they commonly occur together.
Children with undiagnosed, untreated, or inadequately treated ADHD are 30% behind their peers when it comes to executive functioning.
© Jillian Enright, ADHD 2e MB
Barkley, Russell A. (2015). Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis & Treatment. The Guilford Press.
Greene, Ross, W. (2021). Lost & Found: Unlocking collaboration and compassion to help our most vulnerable, misunderstood students, and all the rest. (2nd ed.). Jossey-Bass.
Kofler, M. J., Rapport, M.D., Bolden, J., Server, D.E., Raiker, J.S., & Alderson, R.M. (2011). Working memory deficits and social problems in children with ADHD. Journal of Abnormal Child Psychology, 39, 805–817.
Saline, S. (2018). What your ADHD child wishes you knew: Working together to empower kids for success in school and life. TarcherPerigee.