ADHD As A Spectrum Disorder?  

December 26, 2016

As many of us know, Attention Deficit Hyperactivity Disorder (ADHD) has many faces. Some people with ADHD can’t stop moving (hyperactive), some have a difficult time focusing (inattentive), and some experience both. New research (Nigg & Rodden, 2016) suggests ADHD may actually be a spectrum disorder, rather than a disorder with only two types. Scans show that connections in brain networks may account for the variety of concerns associated with ADHD. Nigg and Rodden report that individuals with ADHD have slower developing myelin sheaths around the axons in their brains, which impacts efficiency of communication within and between different regions of the brain. Nigg likens this to having dial up internet connection versus a fiber optic cable. He speculates that variability of axonal development in different regions of the brain may account for the different symptoms or severity of symptoms in one case of ADHD versus another, hence the “ADHD spectrum”.  

A closer look at how our brains process information from the environment provides a better understanding of the difficulties an individual with ADHD experiences. A typically developing brain has a balance between bottom-up and top-down signaling. Bottom-up signaling processes sensory information. Top-down signaling has to do with goal-directed behavior. So if something changes in the world around us the bottom-up signals notify us of the change while the top-down signals tell us whether we need to act on this new information or if we can ignore it and continue on doing what we are doing. A brain impacted by ADHD appears to be weaker with the top-down signals so it is difficult for a person with ADHD to return to the task at hand. Therefore, a person with ADHD attends to the change in the environment (people talking while they are studying) and struggle to get themselves back to the task at hand. This results in difficulty with inattention, impulsivity and emotional regulation commonly observed in people with ADHD.  

Due to the variability in the process described above we know that each student with ADHD needs different interventions or accommodations. There are times where strategic seating is appropriate and times where it might not be necessary. Students who are inattentive or have difficulty getting started on tasks may need to be seated at the front of a classroom whereas students who have symptoms consistent with hyperactivity may need to be seated toward the back of a classroom in order to get the movement they need or to stand while working without distracting others.  

According to Dr. Russell Barkley (2016) the following recommendations are among his top ideas for ADHD management:    

  1.  Keep verbal instructions brief.
  2.  Prioritize opportunities for action over lecture based activities.
  3.  Maintain a disability perspective – the child with ADHD isn’t choosing the behaviors of concern.
  4. Anticipate problems and make plans accordingly.
  5. Use rewards first to improve behavior before punishment to eliminate unwanted behavior.
  6. Externalize time: use timing devices for showing work periods.
  7. Provide immediate feedback.
  8. Increase the frequency of consequences.
  9. Externalize motivation: use incentives to encourage compliance.
 10.Maintain a sense of humor.

-by Chris Denton, School Psychologist