ADHD (Attention Deficit Hyperactivity Disorder) has had a lot of names over the years, including labels such as “hyperkinesis” and “minimal brain dysfunction”.” Just as its name has changed, our understanding of its primary features also has evolved. Even the current diagnosis is not without some controversy. Is ADHD one disorder with many variations? Is it three distinct subtypes or disorders (primarily inattentive, hyperactive/impulsive, and combined)? Is it something else? It is possible that the diagnostic criteria (and labels) will change. If we held a contest to give ADHD a new name based on our most current knowledge, what name would win?
David Rabiner, Ph.D., a researcher at Duke University, puts out a monthly newsletter (Attention Research Update at www.helpforadd.com) summarizing interesting studies about ADHD. Looking at some of these studies could give us some interesting, though perhaps unlikely, labels for the 21st century:
“Working Memory Disorder” (WMD): Not quite as devastating as weapons of mass destruction, this WMD can nevertheless have a profound impact on ability to successfully complete tasks. Working memory involves short-term storage and manipulation of information. Individuals with ADHD may struggle with this cognitive function. Kofler, et. al., (2010) found that boys with ADHD attend well to tasks that do not require working memory, but their on-task behavior declines relative to non-ADHD boys when confronted with tasks requiring working memory. Working memory, self-regulation, and other “executive functions” may be critical to our understanding of ADHD.
“Fatty Acid Deficit” (FAD): While there have been many FADs and alternative treatments sold to desperate parents over the years, research suggests that fatty acids may not be a fad. In fact, there is a great deal of support for the notion that supplementation with fatty acids (such as Omega-3 fish oils) can help individuals with ADHD. Sinn & Bryan (2007) found that parents (who were “blind” to their child’s treatment status) reported significant improvement in their child’s ADHD symptoms, as well as decreased cognitive problems and oppositional behavior, as a result of fatty acid supplementation.
“Green Access Deficiency” (GAD): You don’t have to be a “Green” to know that children spend a lot less time outdoors than they used to. While playing lots of video games doesn’t cause ADHD, it certainly doesn’t help with the development of patience, self-regulation, delayed gratification, emotional regulation, and sustained attention. A study by Kuo & Faber Taylor (2004) has shown that, just as our brains need sleep, they also need a rest from constant stimulation or sensory overload. Kuo and Faber Taylor found that exposing children to ordinary natural settings while engaging in after-school and weekend activities may help to reduce attention difficulties in children with ADHD.
Another possible label is “Electronic Information Excess Implementation Overload” (EIEIO): Dr. Mack Hicks, founder of Center Academy Schools, authored a book (The Digital Pandemic: Reestablishing Face-to-Face Connections in the Electronic Age, New Horizon Press, 2010) that looks into the impact of video games and electronic media on developing brains. Dr. Hicks notes that the Henry J. Kaiser Family Foundation recently released its 2009 study of student electronic media use. The study found that media use for 8- to 18-year-olds averaged seven and one-half hours per day, up one hour from 2004! This cumulative exposure to all things digital poses a serious threat to personal and cognitive growth. The data indicate that the majority of parents don’t set rules on the amount of time spent on media. When they do, the media exposure is reduced. Heavy media users report less personal contentment, more strain with parents, and lower grades than light users. They’re also more bored and unhappy and get into trouble more. The solution? Parents need to set the schedule around family goals and relationships first – and then fit in electronic media where appropriate.
These proposed labels are not likely to win a legitimate contest, and they may reflect just a small part of the overall ADHD picture. But they do give us some insight into several aspects of cognitive functioning and interventions for ADHD.
In addition to the more recent research, there are some things we know about ADHD that have remained constant for some time:
Careful assessment is important. No two children (or adults) are identical, and understanding unique learning styles and strengths and weaknesses can help determine the best interventions.
Early diagnosis and intervention can decrease the likelihood of ADHD developing into a more severe problem such as a conduct disorder or school failure.
Multimodal treatment can be critical, including school interventions, home interventions, counseling or coaching, and medical or health management.
Dr. Andrew Hicks received his doctorate in clinical psychology from Vanderbilt University in 1988. He is CEO and Clinical Director of Center Academy Schools. Center Academy was founded in 1968 and serves students in grades 3-12 who may have ADHD, LD or other learning difficulties. There are 11 Center Academy locations in Florida and Georgia, including four in the Jacksonville area. More information about Center Academy may be found at www.centeracademy.com.
Kofler, et.al., (2010). ADHD and Working Memory: The Impact of Central Executive Deficits and Exceeding Storage/Rehearsal Capacity on Observed Inattentive Behavior. Journal of Abnormal Child Psychology.
Sinn, N., & Bryan, J. (2007). Effect of supplementation with polyunsaturated fatty acids and micronutrients on learning and behavior problems associated with child ADHD. Journal of Developmental and Behavioral Pediatrics, 28, 82-92.
Kuo, F. E., & Faber Taylor, A. (2004). A potential natural treatment for ADHD: Evidence from a national study. American Journal of Public Health, 94, 1580-1586.