In this week's blog post, guest author and RDI Program Certified Consultant, Chris Mulligan L.C.S.W, will summarize current research in the area of Attention Deficit Hyperactivity Disorder (ADHD) in order to assist parents in sorting out the source of their child or teen’s challenges with attention. This post is the first of three in a series focused on ADHD: Part one will describe ADHD as a neurodevelopmental disorder and then discuss deficits related to regulating behavior and controlling impulses. Part two will cover deficits related to following directions, sustaining attention, and doing work consistently. Part three will discuss parenting strategies for effective management from an RDI Program perspective. This series also draws from the work of Dr. Russell Barkley – a highly respected researcher and clinician who has written two of the very best books on ADHD; ADHD and the Nature of Self-Control and Taking Charge of ADHD. 

As you embark on your RDI Program, you will be asked to determine with the help of your consultant if your child or teen is affected by a co-occurring psychiatric or developmental disorder. The most common co-occurring conditions include anxiety, mood, tic, learning, and attention disorders. As all children and teens with ASD have deficits in their capacity for sustained attention, the question of how to differentiate ASD related challenges from a co-occurring attention deficit disorder can be perplexing. 

Medical and mental health professionals currently characterize ADHD as a neurodevelopmental disorder of self-control rather than a deficit in attention. Russell Barkley believes the name ADHD is actually misleading because it overemphasizes problems related to attention. According to Barkley and others the most significant problem facing the child or teen diagnosed with ADHD lies in the area of self-control or behavioral disinhibition. To say ADHD is a neurodevelopmental disorder means ADHD cannot be accounted for by environmental or social factors (e.g., poor parenting or an inappropriate school setting). 

The term neurodevelopmental further means ADHD related symptoms arise early in development, are exhibited across many different settings, and are persistent over time. According to the research of Barkley and other experts worldwide, ADHD consists of five core symptoms:

1. Deficits regulating behavior (hyperactivity and Hyper-responsiveness)

2. Deficits controlling impulses

3. Deficits following rules

4. Deficits sustaining attention

5. Deficits doing work consistently

Deficits Regulating Behavior 

Many studies have demonstrated ADHD children are significantly more active than their peers (even during sleep). Research has also demonstrated ADHD children have more difficulty regulating their behavior according to the demands of the moment. The ADHD child typically struggles in lowering his activity level following a physical activity. Conversely, it can be equally difficult for the ADHD child to reach the appropriate level of arousal if he is tired or relaxed.

ADHD children have difficulty regulating their behavior because they are hyper-responsive. Although ADHD children are physically hyperactive at home and within the classroom, they have a far greater problem with exhibiting too much behavior. The term hyper-responsiveness means that ADHD children "over" responds to situations when compared to typical peers -- they laugh more and louder, they run too fast, they talk too much and too loud, and they become too excited when playing. Simply put, they have great difficulty with finding the “right amount” of behavior (which is always contextual). 

Deficits Controlling Impulses

The hallmark symptom of ADHD is behavioral impulsivity. Typical impulsive behaviors include talking out of turn, talking too much, grabbing, running and yelling during inappropriate times, touching peers, taking short cuts, and risk taking behaviors. 

Due to neurological problems involving the frontal region of the brain, ADHD children move from thought to action without taking into account important social information, such as how their actions will affect family and friends. The impulsive child has difficulty planning behavioral responses. A person or an event stimulates the child and then he "flies" into action. Events happen so quickly for the child that he does not have the time to see his role or contribution. Thus, the most salient consequence of impulsive behavior is that it makes learning from experience very difficult -- even very negative experiences. 

The reason for this is ADHD children respond so quickly to an event or situation that they do not have the time to reflect on their behavior. One can say the child or teen with ADHD lives in the present at all times, which deprives him of an appreciation of past events, which in turn deprives him of the ability to plan for the future. 

Groupworks West was founded in 2000 by Christopher Mulligan LCSW to improve the quality of life of those challenged by autistic spectrum disorders (ASD)—parents, children, teens and young adults. Groupworks West offers social development groups for children and teens with ASD as well as Relationship Skills Groups for ASD young adults.  Christopher Mulligan is a Westside Regional Center vendorand a certified RDI (Relationship Development Intervention) clinician. In addition to social development groups, Groupworks West provides family counseling and parent consultations.

Christopher Mulligan, L.C.S.W. 

GroupWorks West Inc.

1453 14th Street, Unit F
Santa Monica, CA 90404
Phone: 310.428.4781

Email: groupworkswest@aol.com