Children with ADHD
It's a multi-determined, genetic neurodevelopmental disorder that emerges, often times, as kids start to enter school and as they demonstrate more age-inappropriate behaviors compared to their peers.
What cognitive weaknesses are present in children with ADHD?
Kids with ADHD have a number of key, core cognitive weaknesses that greatly affect their behavior and how they perform daily tasks. In addition to the verbal and motor disinhibition, they have an increase in impulsive behavior. They also have extreme weaknesses with their ability to delay gratification.
As things go out in time they have a harder time keeping that in memory and responding to that appropriately. Impaired working memory, this is a uniquely human trait or ability, and that is to simultaneously remember and maintain goal-directed behavior in the presence of distraction.
Significant emotion dysregulation or the ability to manage emotion and also utilize emotion to motivate their behavior. So they tend to be very driven by immediate emotions and have a much harder time self-motivating, generating that emotion independently and using that emotion to drive their behavior.
Is there an age when weaknesses become more apparent?
Typically what we tend to see as clinicians is problems that begin to emerge as the demands of an environment change. So as they enter pre-school and kindergarten, when they are required to inhibit, to remain seated, to attend to tasks for more than a minute at a time, that's where we start to see kids look more and more age-inappropriate.
We generally give a round-about figure of about 30 percent off of their age is about where they are functioning socially and developmentally.
What should parents expect when managing ADHD?
Treating this as a chronic disability, I often times will talk with parents and saying I'm going to be like your pediatrician. You're going to be coming in to me periodically as needs arise. It's not a, let's get it fixed and go on with life.
I liken to what we are dealing with to a car with a severe problem in alignment. If you're to let go of that wheel, the parents need to have a hold of that wheel constantly. If you let go of that wheel any point in time you're going to find yourself in a ditch. It's those ditches that usually, parents and children find themselves in when they come into my office. It's those ditches that we try to avoid in the long term by structuring their environment differently.