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The second dimension failing to develop on schedule will appear about 2 to
3 years after
and this is known as the attention deficit but it isn't
here again we have a misnomer there are at least six or seven kinds up attention
and supporting networks in the human brain they are not all disrupted by this
disorder
what we want to know is which one to help us with differential diagnosis to
help us tell
ADHD from an anxiety disorder and from autism and all the other psychiatric
disorders which all interfere with attention at some point in life
ADHD is not the only attention-deficit
we need to be more precise if someone comes to us and says my child or I
inattentive that is useless diagnostically
what I need to know is to nature
up the inattentiveness and we have now known for a decade
that the inattentiveness that we see in ADHD is distinct
from that produced by all other disorders because it is most
I think accurately described as a failure
of persistence the first attention problem is persistence toward a goal
notice that this implies behavior motivation
and the future that is very important the other forms of attention do not
ADHD is not a problem of perception
us children of processing how the post your your part of our brain functions
it is a problem weird the motor part of the brain
this Frontalot can you sustain
action toward a goal adequately to attain it
that implies a motivation deficit and that is true
and it implies future directed behavior and that is true
ADHD is a failure to direct behavior forward in time
we cannot persist toward
these delayed en pointe in life
the cash the goals the things that need to get done
so persistent its deficit one
in the area of attention now to persist toward a goal
you must be able to resist distractions but that too
is not a perceptual issue it is a motor issue the person with ADHD
does not have problems with perceiving distractors better than others
it is that they respond to distractors more than others
and dad is an inhibitory failure not a perceptual difference
you and I may also hear the noise in the kitchen
the person with ADHD is compelled to react to what
all did you hear that I guess they're washing dishes maybe I'll stop in and
take a look
did you know I was a dishwasher when I was back in college that's how I earn my
way
to see what's going on here you all heard the dish but it was your relevance
to what we're here to do today
but to the ADHD individual the distraction
is going to provoke a response and the response can be inhibited
and now they're off to the races skipping from one thing to another time
another
now there is a third aspect here that is impaired
but it is not one of attention most people when they're distracted reengage
the incomplete a goal
the person with ADHD is far less likely to do so
and this has nothing to do with the tension this
is working memory so I would want a family to understand that there's more
here than
inattentiveness there was a working memory disorder
and I would want them to know that working memory is one of the five
special executive functions but the human brain
suggesting that ADHD is he FDD
executive function deficit disorder because working memory is where we
remember what we're doing
it is remembering so as to do it is consciously effort fully holding in mind
the what the winner of what we are doing
it's what you lose at my age
and when you hit menopause
you do not lose memory you lose
working memory you forget what you were doing
where you were going what the goal was
the steps to the goal how you were getting there it is that that allows you
to reengage the incomplete a goal
because you are holding in mind the goal it is that which ADHD children and
adults will lose
the goal is gone it is for gotten and now
anything else compelling around them will capture their behavior
hence the symptom skips from one in completed
activity to another the ability to reengage a goal
is a working memory disorder and that's what they cannot do
and this begins to open the door on the possibility
that the other four executive functions are impaired as well
more on that later so let's understand that there are three interacting
attentional problems but that they are best thought of as executive deficits
not attention deficits and they are the problem with persistence toward the
future
resistance have distractions along the way
and working memory and now you understand the nature of this
attention problem from the one that's produced by anxiety and depression and
autism and all the other disorders including the learning disabilities
which have nothing to do with these I would want families to understand that
there is more to ADHD
then just the in addition Andy's attention
and working memory problems that at its heart in its sole
it is a disorder of self-regulation not one of attention
I think the biggest problem we have had as a group in convincing the general
public about the seriousness of our children's disorder
verses autism or schizophrenia or the other disorders
is the very name itself is trivial ADHD
go to Starbucks good god have some caffeine we got more serious fish to fry
year in psychiatry
than the fact that you just can't pay attention right part of the reason that
our
disorder that the name of this disorder is so often pilloried in the media
is because I think we miss named it this is a developmental disorder
a self regulation not attention and thatch
is a serious disorder a serious
as manic depression and in its own way as autism
but it doesn't convey that to people
if they understand it only as eighty d
HD as opposed to
Sr DD a shelf regulatory
developmental disorder so I would want families to understand the seriousness
of this
that this isn't simply inattention
there are some profoundly unique human traits
that are not emerging as they should in this individual
and if you understand that your understand the bigger picture
the why of everything if it's just an attention problem why am I seeing
impairment in virtually every domain
in which this childish *** to function that would not come from just
inattentiveness but it would come from an executive function disorder
a self-regulatory disorder so I would want parents to understand that this
is the essence of this disorder self-regulation
what is that it is first evolved the ability to consciously
willfully choose to inhibit
your behavior and then to engage
in a series of self-directed actions that is after all what self control is
you start to do things to yourself
these are responses that are not directed at the world around you
they're directed at you right you're trying
to change your behavior in some fundamental way the second part of self
control that your child struggles
is not just the Stockton but the thinking
the thinking is the self-directed activity
the stuff I'm doing to myself
why would I do these things to myself to change my behavior
from what it would otherwise be and why would I do that
to change my future self-regulation
is not just for short term self-improvement
it's for long-term self-improvement its to see to your own welfare
over the long term should you act this way
given the street sustained or delayed consequences that lie ahead for you
that is what you must stop and think about and that is what they don't stop
and think about
the delayed consequences
so your child is not just inattentive
they cannot stop engage in a series
of self-directed actions that they will now use to modify
and moderate their behavior so as to bring it in line with their long-term
welfare the future and that's what yours
your child is struggling so mightily with
in their development it's what the other kids are acquiring
and your child is so far behind him