ADHD: What's in a Name?

Attention-deficit Hyperactivity Disorder (ADHD) remains a very common diagnosis, and an often misunderstood problem. Part of this confusion stems from the actual name which implies both an inability to "pay attention" and a problem with excessive activity levels. Many parents of children with ADHD will tell you that their children can pay attention for hours -- if it is something they are interested in. While some will falsely assume that ADHD can not be present if an individual can stay focused on some activities, research indicates that individuals with ADHD can sustain attention to highly interesting activities; the "deficit" occurs when the individual is required to sustain attention to tasks that are not inherently appealing. Some might argue that this is simply an indication of irresponsibility, immaturity, or a behavior problem -- but again, research indicates that it is due to the brain's inability to "block out" extraneous information and to inhibit responding to what is immediately more interesting. Essentially, a child (or adult) with ADHD is processing all environmental information (buzzing of the lights, noise from neighbor dropping his pencil, teacher quietly talking with another student, movement in the hallway, etc.), whereas a student without ADHD is much more able to "tune out" this unnecessary information. Adding to the difficulty of staying on task is the fact that ADHD involves a deficit in inhibition, such that the child (or adult) with ADHD finds it much more difficult to inhibit their desire to attend what is most interesting. In my doctoral research, I conducted a study in which children with and without ADHD completed a computer administered task that was rather boring. At times, a cartoon or an uninteresting distractor (i.e., letters) would be played in the corner of a computer screen. Results of this study showed that all children were distracted equally by the uninteresting distractor (because it added confusion to the task, as both involved letter presentation). However, only children with ADHD were distracted by the cartoons. Although the children without ADHD indicated they wanted to watch the cartoon, they were able to resist the impulse to do so, and could remain focused on the task; the children with ADHD could not resist the impulse to watch the cartoon. In a classroom setting, this means that a child with ADHD will have much more difficulty ignoring small distractors (compared to classmates), especially if the distractor is potentially interesting.

In addition to problems with the use of the word "attention" and ADHD, the use of the word "hyperactivity" also contributes to confusion, as many parents and teachers will insist a child does not have ADHD because they are not "hyper. "In the past, the term "Attention-deficit Disorder" or ADD, was used to describe children who exhibited problems with "attention" (again, we now know this is a misleading term) but did not exhibit excessive impulsivity. Because research was indicating that ADHD and ADD were simply different manifestations of the same underlying cause, the professional community changed the terminology, such that three types of ADHD could be diagnosed--ADHD, Predominantly Hyperactive-Impulsive Type, ADHD-Predominantly Inattentive Type (the old ADD), and ADHD-Combined Type. Research seems to indicate that the Predominantly Hyperactive-Impuslive Type is limited to young children before school age, and that once they enter school the problems with "attention" become more obvious, such that they usually meet criteria for ADHD, Combined Type (i.e., problems with both impulsivity and "attention").

When the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is published, the term ADHD may not exist at all, as there is a push in the professional community to have been a more accurately reflect the research. In a few years, we may be discussing "Behavioral Inhibition Deficit" instead of ADHD.