Attention Deficit Hyperactivity Disorder (ADHD) is often misunderstood. The myths that surround ADHD never seem to go away despite a huge amount of research into the causes, characteristics and treatments for ADHD. Most psychological disorders do have myths around them though – such as the image of all autistic children having amazing memories like the actor in the film ‘Rainman’. The myths surrounding ADHD may be in part have arisen by the name we have for the disorder i.e. ‘attention deficit’, and the fact that people tend to see behaviour first. In this blog post some of these myths will be addressed. Looking at these myths in relation to research evidence is important as without an accurate understanding of the difficulties children with ADHD show, it is very difficult to support these children effectively.
A common myth is that most or even all children with ADHD will grow out of their difficulties. Some children do of course show reduced symptoms with development but research has shown that the story of developmental changes in ADHD is complex. In one research study, children were followed up after a 4 year period and asked to complete a set of thinking tasks tapping memory, planning, attention flexibility and controlling responses. On some of the tasks, such as on a long-term memory task where children had to remember patterns and later recognise them, the children caught up with their peers. On another task where children had to use a strategy to keep and update information in their ‘working memory’ they showed improvements with age but didn’t catch up to the levels of their peers. On other tasks, such as those assessing being able to keep information in memory over time there was evidence of continued difficulties. This research shows that the story of ‘growing out of ADHD’ is not a straightforward one.
Some statements you may have come across about ADHD might include ‘ADHD mainly affects behaviour’, ‘ADHD is a childhood condition’, and ‘attention difficulties explain the thinking (‘inattentive’) part of ADHD’. In fact these are myths in the specific sense. While many children with ADHD do have behavioural difficulties, thinking and learning difficulties are very common and often underlie behavioural difficulties that are seen. Obviously the name ‘attention deficit’ suggests that difficulties in attention explains the thinking part but in reality this accounts for only a small part of the difficulties. Research has shown that many of these children do not have a specific attention difficulty at all – at least in terms of how psychologists measure attention.
Children with ADHD often show difficulties in thinking strategically – what we refer to as ’executive functions’. The thinking difficulties associated with ADHD are much broader than executive functions too though. Children with ADHD often show memory difficulties including basic memory processes and not just the more strategic kind of memory associated with executive functions. Other difficulties or differences can include perception of time (and a range of aspects of timing), being able to self-regulate, having an aversion to delay, and being variable in responding.
An important issue to emphasise is that children with ADHD differ from one another. We now know that many children with ADHD show difficulties in executive functions for example but not all do, and those that do can differ in the areas they have difficulty in. Some may have difficulties in ‘working memory’ (a mental workspace where we hold and organise information in our mind) and others with planning. Other children may have a difficulty in using their attention flexibly and/or being able to control their responses. Children with ADHD have different strengths and difficulties and it is important we understand these children on an individual basis for that reason. In our ‘Understanding ADHD’ booklet, we describe a range of these strengths and difficulties and in our linked Strategy booklet we outline ideas for how to support children with their particular set of difficulties.
ADHD is often spoken about as a condition that occurs on its own. Most children with ADHD show difficulties in other areas. Often these will relate to a second or even third diagnosed condition but children with ADHD often show symptoms of another condition but do not meet criteria for a diagnosis. These symptoms may still impact their thinking, learning, behaviour and wellbeing though. These difficulties may include the sensory difficulties we would associate with autism, or fine or gross motor difficulties we would associate with dyspraxia/DCD. Children with ADHD are also more likely than their peers to show specific learning difficulties such as dyslexia. Understanding these common co-occurrences is critical to fully support a child with ADHD.
A few years back members of our team were involved in a large scale research priority exercise (called a James Lind Alliance exercise) with young people, their families and health and education practitioners across a range of areas of learning difficulty including ADHD. Several of the top questions families and professionals felt were a top priority for research focused on how do we optimally support these children for best outcomes. A huge part of tackling this question involves the need to dispel these common myths and to understand children with ADHD based on research evidence. This research, which shows that ADHD is associated with a wide range of difficulties and that children differ from one another in their specific profile of difficulties, highlights the importance of taking an individualised approach to supporting children with ADHD.
Visual photo credit: Photographer valentinrussanov via Getty images.