Forging New Pathways : Brain, Attention

Autism Spectrum Disorder and ADHD: Part 2

Guest Author — Mon, 24 May 2010 19:40:00 GMT

This post is the second of three in a series focused on ADHD: Part one described ADHD as a neurodevelopmental disorder and then discuss deficits related to regulating behavior and controlling impulses. Part two (this post) 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.

PART TWO

Deficits Following Rules

Children with ADHD have more difficulty following instructions and adhering to rules than do peers without ADHD. The ability to follow rules and direction is referred to as rule governed behavior. The deficit in rule governed behavior is not attributable to a deficit in motivation, but is a symptom of the inability to sustain inhibition. ADHD children also have difficulty implementing rules. ADHD children know rules, but they frequently can't inhibit the impulse to violate a rule.

Barkley and others explain that non-ADHD children are able to talk themselves out of acting on an inappropriate impulse. This skill is referred to as self-directed speech or self-talk. As the name suggests, self-directed speech means the child talks to himself about behavioral options prior to moving into action.

Studies show ADHD children have immature self-directed speech. They often fail to talk to themselves about their options before acting and they omit key information when considering their options (e.g., negative consequences).

Deficits sustaining attention

Current research shows children diagnosed with ADHD lag behind other children in the area of attention span by as much as 30%. However, it is also true that the ADHD child can hyper focus on tasks or activities they find interesting. The fact that ADHD children are capable of attending to certain activities for long periods of time is often confusing to parents and teachers. It is not uncommon for parents and teachers to believe a child does not have ADHD because he can hyper focus on building legos or playing Nintendo. ADHD children do not have problems attending to activities they find stimulating or interesting. Thus, variable attention is a hallmark symptom of ADHD.

Research indicates that ADHD children attend to the same information as other children and are generally able to discriminate between important and unimportant information. However, ADHD children generally have serious problems attending for as long as other students of the same chronological age to non-stimulating tasks. Due to this type of "off task" behavior, ADHD children are thought to be highly "distractible," moving from one activity to another without completing anything. However, according to Barkley it is more accurate to say ADHD children are:

Easily bored
Unable to defer gratification in an age appropriate manner
Drawn to the most stimulating aspect of any given situation

Thus, what looks like a problem of distractibility is really a more serious problem: namely, the inability to persevere during an under stimulating tasks (sustain inhibition).

Deficits Doing Work Consistently

Studies indicate that ADHD children are of average to above average intelligence. However, ADHD children produce very inconsistent work in the classroom -- both in terms of the quality and the quantity of their work. Sometimes ADHD children are able to complete work without any assistance and, yet, other times they are unable to complete small amounts of work with one-to-one supervision.

Multiple studies have demonstrated that ADHD children exhibit a high degree of variability in the quality and quantity of their work. This variability is often interpreted to mean that ADHD children are disinterested in learning. The fact is ADHD children are interested in learning. The problem is that consistent work requires the consistent ability to sustain inhibition.

In order to produce consistent work, children must be able to inhibit impulses when they are bored, tired, or otherwise disinterested. Non-ADHD children are able to maintain the quality and quantity of work their because they are neurologically less impulsive, and they are able to use more sophisticated self-directed speech when they are bored and need to stay on task to produce work.

Conclusion

Now that you have reviewed the challenges that confront children and teens with ADHD you will be better able to determine if your ASD child or teen is challenged by a co-occurring disorder. In the next installment of this blog, I will review parenting strategies from the RDI Program and from Barkley’s Taking Charge of ADHD that will help you effectively manage problems with attention and behavioral inhibition.

______________________________________________________________________________________________________________________

Christopher Mulligan, LCSW, is Founder and Clinical Director of Groupworks West in Los Angeles, California. He has held clinical and administrative positions at therapeutic day schools, day treatment centers and residential settings in the Los Angeles area and has been a mental health consultant to two local school districts: Santa Monica Malibu Unified School District and Redondo Unified School District. Christopher began his career teaching kindergarten and first grade for four years.

In addition to being an certified RDI consultant, Christopher specializes in group intervention, family therapy and parent management training. For over 17 years, Christopher has designed comprehensive treatment plans for children and families challenged by complex psychiatric diagnoses and behavioral problems such as: Pervasive Developmental Disorders, ADHD, Bipolar Disorder, Impulse Control Disorders, Anxiety and Depression, OCD, Tourette’s Syndrome, Eating Disorders, and Addiction. He has worked with adolescents transitioning to and from residential treatment and also is experienced in divorce and custody mediation for families of special needs children.

Christopher received a BA from Sarah Lawrence College and an MSW from the University of Southern California (USC).

GroupWorks West Inc.

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

Email: groupworkswest@aol.com

Autism Spectrum Disorder and ADHD: Part 1

Guest Author — Mon, 26 Apr 2010 13:45:00 GMT

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

The Mechanics of Attention

Gutstein — Wed, 16 Sep 2009 19:13:00 GMT

Have you ever walked into a crowded room and been unable to see a friend standing right in front of you?

New research from MIT suggests “when we look for something in our environment, our attention scans one thing at a time, using a serial as opposed to a parallel process.”(Buschman, Miller) This means that in a crowded room or atmosphere, we are not always going to be the initial center of attention for our spouses and friends, instead we have to wait our turns as their brains process familiarity and finally settle on the face with features that are recognizable. And, in turn they have to wait for us to recognize them as we simultaneously scan the room, pausing briefly on one face at a time. But, what controls this rate of recognition? By studying monkey brains, scientists Miller and Buschman at MIT found that visually our brain waves “act like a built-in clock that times the shifts of attention from one position to the next”(Buschman, Miller) making sure that our visual attention moves at a rate of 25 times a second and does not go to waste before we reach an important discovery.

What does this mean for other areas of the brain? By analyzing the timing of the proverbial visual shifting attention clock (our brain waves) scientists may be able to further our understanding of how we process across other regions of the brain. It is their hope that brain waves act as a general metronome for the brain, ensuring that all of our processes are kept in synch, in step with each other and dancing to the right music. Bringing us closer to improving our understanding of conditions like attention deficit disorder, and perhaps even towards finding ways to increase the rate of cognition in the brain.

"Serial, Covert Shifts of Attention during Visual Search Are Reflected by the Frontal Eye Fields and Correlated with Population Oscillations."
Timothy J. Buschman, Earl K. Miller.
Neuron, 63(3) pp. 386 - 396, 13 August 2009.