4 Truths About ADHD
Research on ADHD has grown exponentially over the years. We just typed “ADHD” into the PubMed.gov database and got back 48,225 results - over half of which are from articles published just in the last 10 years. While we always have a lot to learn about the brain, we do indeed know a lot about ADHD, its neurobiology, its impact on individuals with the condition and their families, and its treatment. Nevertheless, ADHD is not immune to the spread of misinformation and the slow dissemination of evolving knowledge. Therefore, what you have heard about ADHD or what you think is true about ADHD might be outdated or incorrect.
Great ideas don’t always hold up once we study whether or not they work. But some of those ideas become a part of our daily knowledge before the research has had a chance to catch up. Take Learning Styles Theory for example. We are taught that people are either auditory, visual, or kinesthetic (hands-on) learners, and by virtue of knowing the “type of learner” one is, they can learn more effectively if the teaching method aligns with their learning style. This hypothesis makes a lot of sense. But after being tested repeatedly, it has never shown to be an effective tool for improving learning. (The truth is we’re all hands-on learners.) Yet, knowing a child’s learning style is considered an important component of their education and even written into Individualized Education Plans for students with learning supports.
We all fall into the trap of misinformation - it’s normal and okay. When most of our information is coming from quick news stories and social media, we miss a lot of context and can easily misinterpret information. Although it can feel uncomfortable (or even embarrassing), it’s okay to notice that something you once believed was true isn’t so true - and pivot. In fact, it’s an incredible parenting move to model how opinions and beliefs change as you learn more!
While the existence of ADHD is not lore, some of what we think we know about it is. Here are some of the most common misunderstandings about ADHD that we hear, sprinkled with some research. We hope that by busting these common myths, parents of kids with ADHD feel more empowered, supported, and effective in their parenting efforts!
Myth #1 - ADHD is an “attention-deficit” disorder
This one always throws people, and not surprisingly so, given that “attention-deficit” is literally in the name. The term “attention-deficit” implies an inability to focus. And since attention is the gateway to explicit learning, an inability to attend means an inability to learn. However, individuals with ADHD and their parents know they can and do focus and learn. Focusing consistently on activities that are hard or boring, though… that’s the challenge.
ADHD is better described as difficulty with self-regulation. Wait, what happened to ‘attention’? Yes, you read that correctly. Getting distracted is just one way humans dysregulate. We can also struggle to regulate our bodies (Think: fidgetiness, trouble staying seated), emotions (Think: quick to anger or overwhelm), and minds (Think: attention, but also planning and organizing our approach to a task). Prominent ADHD scholar, Dr. Russell Barkley, suggests that ADHD be renamed SRDD - Self-Regulation Deficit Disorder.
An Important Note on Emotional Regulation: While impulsive emotions and difficulty controlling emotions - which might look like impatience, low frustration tolerance, over-excitement, aggression, temper tantrums, etc. - are common among individuals with ADHD, they are not listed as symptoms of ADHD. Many of you with ADHD or who have a child with ADHD might be surprised to read that. Indeed, a 2014 study found that approximately 25-45% of children and 30-70% of adults with ADHD experience emotion dysregulation, and when emotion dysregulation is coupled with/a part of ADHD, the interference in one’s life and well-being is much greater. Given the high prevalence of and level of impairment caused by this symptom, focusing only on the cognitive and behavioral elements of ADHD while ignoring the emotional elements seems, frankly, ridiculous.
Myth #2 - individual therapy is the most helpful treatment for kids with adhd
It’s not every day that a therapy practice says we can’t help. We love helping! It’s kind of our thing. But, unfortunately, the research on ADHD treatments is clear that individual therapies - cognitive-behavioral therapy, play therapy, talk therapy, etc. - have not been shown to get rid of ADHD or reduce ADHD symptoms among children. However, CBT is a promising therapy for older adolescents and young adults. The most effective treatments for ADHD are medication, parent-based behavioral interventions (i.e., Parent Management Training, Parent-child Interaction Therapy, etc.), and classroom management strategies.
Why are interventions to support parents and teachers more effective than individual therapies? Because ADHD is not a disorder of knowledge; it’s a disorder of performance or productivity. Individual therapies take children from their “real-life” environments, offer information, and teach skills. While introductory knowledge of self-regulation skills can be helpful for children with ADHD, meaningful change happens at the point of performance.
The point of performance is the where, when, and with whom a problem occurs. For children with ADHD to benefit from interventions, they must receive support in the place and time challenges arise - and by the people in their lives guiding them.
For example, telling your child, at home, to pay attention more during class, probably won’t have the intended effect. But, if a student is off-task, a teacher patiently guiding their attention to the math assignment - in the moment - has a greater chance of success. Now, if we add in immediate praise or a tangible reward for being on-task - BOOM - you got yourself a solid ADHD intervention.
A Critical Caveat… Although individual therapy is not an effective way to treat ADHD, many children, teens, and adults with ADHD experience anxiety and depression - both are good targets for individual therapies, such as Acceptance and Commitment Therapy, Dialectical Behavior Therapy, and Exposure Response Prevention. Additionally, older teens and adults with ADHD may benefit from organizational skills training.
myth #3: attention is a muscle we can work at
Go to the gym. Lift weights. Get stronger.
This is an oversimplification of the process, but if you want to build muscle mass and physical strength, we have a pretty good idea of how to do it. Lift weights over and over, and you’ll eventually lift heavier weights or the same weight more times. The magic of physical training is something we often take for granted – that lifting weights in the gym generalizes to a broader strength that can be applied in someone’s real life. Simply put, picking up increasing amounts of iron helps us move furniture, run faster, and toss our children in the air.
Unfortunately, attention - as far as we know - cannot be sculpted in the same way as our physique. Focusing on a task for 5 minutes, then 6 minutes, then 7 minutes, etc. is highly unlikely to lead to a longer attention span. Research on computerized interventions, such as CogMed, has found limited-to-no benefits on developing children’s working memory. Working memory is the ability to hold information in mind while we’re problem-solving. (Think: Solving a math problem in your head.) As you can imagine, working memory is closely tied to attention. Any small positive effect on working memory from computer programs is either time-limited and/or, more importantly, not generalized to the real world. Even if your child shows better performance on a working memory computer game over 8 or 12 weeks, it does not necessarily translate to them remembering and more quickly moving through their morning routine.
When we use the term “building attention,” we are really talking about introducing environmental supports or constraints to be able to use your child’s attention span. Helpful strategies include removing distractions (Think: Phones and electronics!), taking short breaks every 20-30 minutes (Think: move your body, talk with a friend, or even check your DMs), writing out and reflecting on goals (Think: a “Goals Diary” or sticky notes with reminders of our goals), adding in social accountability (Think: a friend or parent “Study Buddy” to show and celebrate our incremental progress), giving small rewards along the way (Think: a sticker for every five math problems completed), and consuming glucose-rich food and beverages during the activity (Think: Snacks!). While none of these strategies “increase” attention span, they can create greater opportunities for your children to access their attention.
What about meditation? I hear that helps. You are correct that meditation may have a variety of positive effects, but the research is limited. We also know that your child would need to practice every day - with lots of reminders and positive support - to notice a benefit. And we also know that if we don’t practice regularly, the benefits will wane over time. Nonetheless, meditation is generally harmless and can be a helpful complementary support for kids and parents. Research has indicated that mindfulness interventions such as Mindfulness-based Cognitive Therapy (MBCT) and Mindfulness-based Stress Reduction (MBSR) are useful complementary supports for adults with ADHD. We appreciate and utilize mindfulness regularly in our therapeutic approaches, as we know mindfulness is also helpful for anxiety, depression, and other mental health concerns.
Is meditation worth it then? Absolutely. It’s a low-cost, low-risk way to cultivate present-moment awareness, connect to what’s showing up in our bodies, and give ourselves greater control over our emotions. And if it helps with attention, even briefly, then great!
myth 4: every kid has adhd now
ADHD has been all over the news for years (often not in a positive light), and it seems like all of our friends and our children’s friends have ADHD. The statistics, however, paint a different picture. While the number of children diagnosed with ADHD has increased over the years, the prevalence of ADHD is still a far cry from the notion that “everyone has ADHD now.” According to the CDC, in a study from 2016 to 2019, 9.8% of children and adolescents aged 3-17 years old have ever been diagnosed with ADHD. (By comparison, in the same study, approximately 4.4% of children and adolescents aged 3–17 years had ever been diagnosed with depression.) This percentage represents an estimated 1.5-2 fold increase in the number of children and teens diagnosed with ADHD compared with 10-20 years prior.
Woh, that’s a big increase! Yes, it is. However, prevailing hypotheses about this “increase” presuppose that the following are likely culprits:
greater awareness about ADHD by professionals and the public
changes to the diagnostic criteria along with a sensitivity to how girls’ ADHD symptoms may present (we’re looking at gender equity in healthcare here)
better access to healthcare (e.g., Affordable Care Act, parity laws, etc.),
increased use of mental health screening tools and referrals for follow-up evaluations by pediatricians and primary care physicians
reduced stigma about ADHD and mental health in general.
Indeed, we may be doing a better job of identifying - and empathizing - with children (and adults) in need of support. Yay!
Parents often ask us, “Isn’t ADHD overdiagnosed?” That’s a difficult, if not impossible, question to answer because we don’t know how many people should be diagnosed with ADHD. All we know is how many are. However, this question has another question beneath the surface, and that is, “Does my child actually have ADHD or are they just caught up in the ‘diagnosis frenzy’ going on right now?”
What we love about neuropsychological testing is how the process cuts through the noise. It puts aside the news, politics, and TikTok, and takes a deep dive into one person. An evaluation places your child front and center, collects objective data, and captures how your child is struggling - and successful - in their life. Whether the prevalence of ADHD is high or low, whether ADHD medications are over- or under-prescribed, and whether your child’s classmates have the diagnosis are all irrelevant and do not enter the evaluation. What matters is whether your child is engaging in school, making and keeping meaningful friendships, flexibly adjusting to change, appropriately tolerating discomfort, and reaching their goals.
If you are concerned that your child, teen, or young adult may have ADHD that is interfering with their life, or if you are a young adult yourself and suspect you may be struggling with ADHD, please reach out to the team at Mind Chicago.
Authored by Mind Chicago neuropsychologist David Meyerson, PhD and therapist Lee Wells, PhD, LCSW.
