ADHD (Attention Deficit Disorder with or without Hyperactivity) is a disorder that affects many children and adults. However, there are many myths surrounding this pathology, even denying its existence. Dr. Russi, a specialist in Child Neurology, explains them below.
“ADHD does not exist, it is a fad and an invention of the pharmaceutical industries?”
ADHD seems to have become in recent years the focus of much media attention. In fact, it has even been said that it is an “invented” or “fashionable” disorder. Day after day, parents are bombarded and blamed with a series of contradictory and, on many occasions, totally incorrect information.
However, far from being a “fashionable” disorder, the truth is that ADHD was described in scientific literature for the first time more than 100 years ago by the English pediatrician George Still.
Since then, much progress has been made in the knowledge of the pathology, and there is currently an infinite amount of scientific evidence (functional neuroimaging tests, SPECT, PET, molecular genetic tests, etc.) to corroborate that ADHD is a real disorder, with a neurobiological basis. In ADHD there is a chemical dysfunction that causes an alteration in the functioning of the frontal region of the brain and related circuits (frontostriatal connections).
The fault lies with the parents, with the lack of limits. Is it the result of modern lifestyle and inadequate teaching methods”?
ADHD is not a question of “lack of discipline or heavy-handedness”. It is a medical problem, just like diabetes or high blood pressure. Every child with ADHD has a disorder of neurobiological origin that, although it may be positively or negatively influenced by the environment, it is not generated by it. Emotional problems, stress or incorrect educational patterns do not cause ADHD.
What causes ADHD is a neurochemical dysfunction in specific areas of the brain, and there is an important genetic component and environmental factors that increase the risk of ADHD (alcohol, drugs and tobacco intake during pregnancy, prematurity and low birth weight, etc.).
The part of the brain involved in ADHD is the prefrontal lobe and is responsible for:
- Inhibiting and “curbing” our behavior and emotions.
- Maintaining attention in tedious, repetitive or long tasks, “persisting in the effort”.
- Using self-control.
- Making plans for the future using an “internal language” (rules or self-instructions).
For an action to be carried out (concentrating, organizing actions, controlling impulses, etc.), there must be a good functioning of the brain circuits that are in charge of it. For this to be possible, chemical messengers called dopamine and norepinephrine are needed. These messengers help information to pass from one neuron to another, thus completing the neuronal circuit that allows a given action to be carried out. Thus, when this delicate balance is disturbed (due to a defect in these substances) and the message is not able to pass from one neuron to another, the result is an incorrectly performed brain function. Therefore, ADHD is no different from other diseases, it is no one’s fault, it can be treated and you can move on.
“He’s a slacker who doesn’t try hard, because when he wants to he does well”?
A striking symptom in children with ADHD is that their school work and performance can be highly variable from day to day. That is, some days they finish schoolwork easily and without help, while other days their work is poor and they need a lot of supervision to finish it. This can lead us to label them as “lazy”. The problem is not that they cannot do the work, but that they find it difficult to maintain the pattern of work and productivity in a consistent manner, in the same way that other children of the same age and who do not suffer from this disorder, are able to do it. This is why there is a “variability disorder”. Having good and bad days more markedly than other children is part of the very nature of ADHD, and parents and teachers should be aware of this characteristic so as not to fall into a false judgment. Productive and consistent work needs the ability to inhibit the impulse not to engage in a more “rewarding or fun” task.
“Is it an immaturity problem that will resolve over time”?
ADHD is real, it is a disorder that does not suddenly disappear “over time” or “when the child matures”. By letting “time pass” the only thing that is achieved is to seriously jeopardize the emotional, social and academic development of the child. The reason they seem more immature has to do with the fact that they are more in control of the situation and the immediate consequences than other children their age. They are also less in control of their ability to follow rules, “talk themselves out of it” and regulate behavior based on rules. Children with ADHD have difficulty creating and finding an “internal motivation” strong enough to stay on target when the incentive is not immediate, as older children do (good grades at the end of the term, long-term rewards, etc.). This makes them more likely than other children to abandon the work or task at hand. It is, therefore, a disorder that must be taken very seriously, that does not go away by itself and for which there are very effective treatments.
Doesn’t learn from mistakes and always stumble over the same stone”?
Stopping to think and reflecting on the consequences of our actions allows us to “retain” certain information in our brain, study the possibilities, compare them with our past experiences, and plan a “future action”. We are able to make conjectures about what will happen next because we have thought about our past actions and built with them an assumption of the future. This explains why human beings are able to use their “sense of the past” to construct a “sense of the future”.
On the other hand, as in ADHD there are difficulties to inhibit a behavior and to think before acting, it is logical that it is very difficult for them to learn from their past experiences and mistakes, in order not to repeat them in the future. The difficulty in “inhibiting their feelings and actions,” in the same way that other kids their age without ADHD do, is what makes these children appear emotionally immature. “ADHD is not a problem of knowing what to do, but doing what you know you have to do.” “It’s a disorder of self-control, of willpower, of organization and direction of behavior guided toward the future….”
He doesn’t have ADHD because he can concentrate on video games and movies”?
In people with ADHD the problem is not that there is an absolute lack of concentration, but that there is greater difficulty (compared to children their age without ADHD), in maintaining attention in tedious and/or boring tasks, especially if they are long and the gratification is not immediate (example: studying to get a good grade at the end of the course). They are stimulated by strong motivation and immediate gratification. Since they cannot create “internal” or “intrinsic” motivation as well as others (and cannot stick to activities, plans or goals as well as others when the incentive is small), they more easily lose the motivation needed to keep up the effort. As we explained in the previous section, they find it difficult to use their sense of the past to create a sense of the future, which is why it is very difficult for them to delay gratification.
Is there currently controversy about ADHD and its treatment?
Today, in the accredited and serious scientific media there is no doubt or controversy regarding the existence of ADHD as a real and neurologically based disorder, nor in reference to the efficacy and safety of the pharmacological treatments that exist to treat it. The research results and the more than 200 controlled scientific publications are so conclusive that there is no controversy in this regard.