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ADHD and Language issues often go hand-in-hand. Dr. Doug Emch helps us out with some ADHD FAQs.

What Exactly is ADHD?

As a child and adolescent psychiatrist, one of the main problems that I get approached with regards the question of ADHD. It usually stems from a concern about school performance, but the real underlying query has to do with whether the given problem is or is not ADHD.

ADHD at heart is a problem of self-regulation and can manifest in problems with attention, mood, and behavior. It is composed of three core features: inattention/distractibility, impulsivity and hyperactivity (which is actually an optional symptom which when absent was formerly called ADD).

Our present understanding is that it is a lifelong neurobehavioral/neurodevelopmental disorder that effect roughly 3-7% of the population. Symptoms must be present by 7 years of age, but the diagnosis can occur at any age. In fact, one report indicated that the average age of diagnosis with ADHD in America is 39. The symptoms must also occur in multiple settings such as school, home and church. It is one of the more heritable conditions in psychiatry, but the symptoms can also be acquired through trauma and toxic exposure. In fact, recent research suggests that a western “unhealthy” (i.e. toxic) diet is implicated in ADHD occurrence.

The area of the brain most affected is the frontal lobes, that area just behind your eyes. It is perhaps the most evolved area of our brains and likely what makes us all-too human. The frontal lobes are the seat of what is termed the executive functions. For a good review of this in relation to ADHD, please see Dr. Ari Tuckman’s More Attention, Less Deficit, the first chapter of which is about executive functions and is available to download through is website, http://tuckmanpysch.com. In general, executive functions involve the ability to regulate attention, organize, shift, sequence, hold items in working memory, problem solve, and self-direct. Thus ADHD can manifest in deficits in any of these areas.

Severity of ADHD

ADHD as a disorder tends to have a wide spectrum of severity, frequently presenting with a co-occurring illness, or comorbidity. In general, 60% of kids with ADHD have a co-occurring learning disability. Contrary to popular belief, kids (and adults) with ADHD can pay attention fantastically well provided that they are interested in the topic. These interests are most commonly witnessed in kids with video games, television and sports, but it isn’t that uncommon for kids who really enjoy reading to get sucked into a book to the exclusion of the world. The problem manifests with an inability to then shift away from that interesting item, often requiring escalating in tone or stepping in front of the television to break that intense focus, or hyperfocus. The fact that kids can pay attention often throws families off because of the misconception that with ADHD you cannot pay attention to anything. What you usually see is that when the novelty is gone, such as after the first month of school, boredom sets in and problematic behaviors arise. Sometimes the pattern occurs whereby school grades gradually plummet over the course of a term from A’s to F’s.

Do Kids Outgrow ADHD?

All research seems to indicate that the underlying deficits with ADHD (i.e. executive dysfunction) are life-long. The presentation tends to change over the life-course. In general, the hyperactivity subsides with puberty, leading people to believe that they’ve outgrown the illness. However, the underlying impulsivity and distraction generally persist, obviously so in 40-60% of adults diagnosed with ADHD as children. In adults, because school is generally no longer the problematic area, one sees symptoms emerging with finding and keeping jobs, poor relationships, poor job performance, poor concentration, poor organization, poor self-discipline, and low self-esteem. These co-occurring symptoms or disorders are often the presenting issue if the ADHD has gone untreated. Treatment of these issues often only leads to marginal responses until the underlying ADHD is addressed.

Although ADHD is thought of as a life-long problem, the brain is highly plastic and changes in response to the environment. The brain continues to actively grow until about 25 years of age, and after that, continues to change dramatically in response to its stimulus. So it is not unreasonable to think that the brain, including areas of executive function, can change with training and that the problematic symptoms can be disciplined away, so to speak. In fact, therapy for ADHD often focuses on skill sets and tasks to help discipline the often problematic issues, like having a place to put your keys every time you come in the door so that excessive time is not spent searching for them each morning. Mindfulness and meditation can also help improve concentration. Dr. Lidia Zylowska (www.lidiazylowska.com) from UCLA has published research on mindfulness in ADHD and has promising results. It might be that symptoms can diminish to the point of non-interference.

Dr. Doug Emch is a child and adolescent psychiatrist who works with Centerstone and has a private practice in the Belle Meade area where he also treats adults. For more information, visit www.emchpsychiatry.com.

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