Understanding ADHD and hyperfocus

What exactly is ADHD/ADD?

The DSM-5 describes the essential feature of Attention-Deficit/Hyperactivity Disorder as being a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development.

What does this mean in real-life terms?

For most people reading on ADHD/ADD the 4 most observable behavioural characteristics are:

. Hyperactivity

. Impulsivity

. Inattention  

. Distractibility

For anybody who has an ADHD child, they know full well what this experience is like. ADHD is a continuum condition, so the child may be a whirling dervish, talking constantly, jumping all over the place, and flitting from one interest to another, or they may be only mildly fidgety and distracted.

The ADD child tends to be dreamier as opposed to hyperactive and often appears to be lost in his own world. Both ADHD and ADD kids are distracted; – the former by whatever is going on around them and the latter by their own thoughts and ideas.  

Whatever point of the continuum they are on, their symptoms interfere significantly with their ability to function optimally at school, home or with friends. It is these symptoms that often lead to a diagnosis being made and, in many instances, medications being prescribed.

Why do ADHD/ADD children have these behaviours in the first place?

The functions affected by ADHD are located in the frontal lobes of the brain and are referred to as the EXECUTIVE SKILLS. These are:

• Sustained attention
• Organisation
• Planning and prioritising
• Time management
• Task initiation
• Goal directed behaviour
• Response inhibition
• Emotional and behavioural control
• Working memory
• Flexibility
• Metacognition

You can see how important these are and how some or many may be lacking in the ADHD child. So what happens in the ADHD person’s brain?  In our frontal lobes, the main neurotransmitter responsible for waking up our brain to carry out all these executive functions is dopamine.

We all have the same amount of dopamine – ADHD or not. What happens in the ADHD person’s brain is that a message is transmitted across a synapse by dopamine. There is a reuptake system in the ADHD person’s brain that reabsorbs the dopamine so that the dopamine neurotransmitter doesn’t get across or gets across to a limited extent.

As yet there is no scientific way to measure how much dopamine gets reabsorbed – so one child may have 70% reabsorbed and another may have 10%. This explains the wide range in their behaviours and executive skills –some being only mildly affected, whilst others are severely affected.

Furthermore, ADHD is not just a condition within the individual, but has a far reaching impact on every one of the family members as well as extended family, within the school context and so on.

Children with ADD/ADHD exhibit a whole range of behaviours that can disrupt family life:

• They often do not “hear” parental instructions, so they do not obey them.
• They are disorganized and easily distracted, keeping other family members waiting.
• They start projects and forget to finish them—let alone clean up after them.
• Children with impulsivity issues often interrupt conversations and demand attention at inappropriate times.
• They might speak before they think, saying tactless or embarrassing things.
• It is often difficult to get them to bed and to sleep.
• Hyperactive children may tear around the house or even do things that put them in physical danger.
• The demands of a child with ADD/ADHD can be physically exhausting.
• The need to monitor the child’s activities and actions can be psychologically exhausting.
• The child’s inability to “listen” is frustrating.
• The child’s behaviours, and your knowledge of their consequences, can make you anxious and stressed.
• If there is a basic difference between the parent and child’s personality, the parent may find their child’s behaviours especially difficult to accept.

So what is the best way to deal with these different symptoms / behaviours?

This is where appropriate behavioural interventions come in:

It’s important that parents recognise that their child’s behaviour is not intentionally aimed at frustrating, them but instead is not within their control. Just this acknowledgement can change a parents’ stance from angry and frustrated to compassionate and understanding.

When parents are offered insight into understanding the condition and given tools and techniques to better equip them to deal with the difficult, frustrating aspects of their child’s condition, they are far more empowered to deal with it.

Knowing that the aim is to increase dopamine in the ADD/ADHD child’s brain is vital as dopamine is increased by exercise and pleasure as opposed to punishment. Therefore, the typical discipline strategies that work for neurotypical children often do not work with ADHD/ADD children. Instead, they may disconnect further or become defiant and rebellious.

Motivation strategies such as reward systems and anything that engages their brain in a way that interests them and motivates them have better responses. This knowledge gives important clues as to how to do homework with ones’ ADHD child, how to deal with the often very challenging routines such as getting dressed and ready for school in the morning, settling down for activities in the afternoon and getting to bed without arguments and procrastination.

Getting and keeping their brains stimulated and interested is the key to dealing with an ADHD child. All parents with such children will know what it’s like when their children are interested in something – they literally can’t tear themselves away from the activity, be it Minecraft, reading or any hobby that they love.

This is because when they are stimulated, the dopamine pours in and they become hyper focused on what they are doing. They then exhibit the opposite of ADHD behaviour in that they become hyper focused and attentive to the activity they are busy with and then struggle to switch focus. This also explains why often in the classroom they can focus beautifully in one subject but completely switch off in the other, depending on their level of interest.

Therefore, it would be more apt to call ADHD a problem with prioritising attention as opposed to a deficit in attention.

With all of this in mind, optimal treatment should begin with:

1. An assessment by a suitable professional such as a child psychiatrist, neurologist or a neurodevelopmental paediatrician.
2. If deemed necessary, medication is prescribed as stimulant medications like Ritalin and Concerta trigger more dopamine being released into the frontal lobe.
3. In some cases, therapy is recommended to help the child deal with issues that arise from the condition.
4. Research has shown that a protein-rich, balanced diet and reduction in sugary foods and flavourants is recommended.
5. Studies have overwhelmingly shown that parental training in how to understand and manage the ADHD/ADD child is crucial in making the difference to the child’s behaviours and the entire family’s approach towards the condition

To illustrate, Sam was diagnosed with ADHD when he was 6 years old after his teachers observed him struggling to concentrate and focus in class. At home his mother struggled to do homework with him culminating in much shouting and tears (on her part) and disinterest and disconnectedness on his.

He was only attentive and focused when subjects or activities around home interested him, but as soon as he was required to do basic things like hanging his towel up after his bath, playing quietly instead of provoking his siblings and generally being cooperative, mayhem would ensue.

Eventually, after much resistance, his parents put him on medication. At school his teachers almost immediately noticed a difference in being able to focus but it was not the magical elixir his parents had hoped for. At home he continued to be disruptive and when not getting his way would nag incessantly, have huge tantrums and often do things that were completely beyond their understanding.

They sought out an ADHD parenting coach who helped them to understand that although medicine certainly deals with certain of the behavioural aspects of ADHD, it is not a cure-all and that parents need to learn effective behavioural strategies to cope with the child and for the family to function better as a whole. This helped them immensely and today at 12 Sam is far better contained and appropriate in his behaviour.

This case study was used as it’s important for parents to have a realistic idea of the benefits and limitations of ADHD medicine and to understand that there is no one instant cure but rather a mixture of different interventions is required. However, it is vital to remember that ADHD is not a diagnosis that ruins a child’s life. It is instead a diagnosis that opens the doors to educational, therapeutic, and medical supports and accommodations.

Lorian Phillips will be hosting a series of practical webinars for parents on raising a child with ADHD in August.

For more information, visit www.bellavista.org.za