ADHD is NOT a Disorder of Attention

Yes, you read that correctly. 

A disorder of attention occurs when an individual suffers a traumatic brain injury that leaves him or her incapable of attending to an object, person, conversation, game, or anything. If you’re reading this article, that description likely does not describe your child or student.

I often hear parents say, “He can focus when he wants to.” Or, “he can play video games for hours on end, but when it comes to homework…”

The “attention” part of attention-deficit hyperactivity disorder, or ADHD, is not simply about focusing on one thing in one context or even about focusing on all things in all contexts. It is about the capacity to manage one’s attention. To paraphrase my former supervisor, the late, great Dr. Rita Haggerty, “ADHD is about obligatory attention. Can the child attend to things he or she is obligated to attend to?” 

Let’s take it one step further. 

Dr. Russell Barkley, a renowned psychologist and ADHD researcher, wrote in his paper, The Important Role of Executive Functioning and Self-Regulation in ADHD, that ADHD is a disorder of self-regulation. This idea, that ADHD is better conceptualized as a deficit in self-regulation, is approximately forty years old but is still misunderstood by many.

Let's say it's homework time. Your child first has to be aware that he has homework to do and perhaps a place and time to complete it (self-awareness), he has to restrain himself from playing video games or hanging out with friends (inhibition), he re-directs his attention away from tempting objects such as the TV or Facebook (executive attention or attentional management), he holds relevant information in his head while solving complex problems (organization and working memory), he reviews his work and catches mistakes (monitoring), and he copes effectively with temptations and reaches his goal (problem-solving). 

You might have noticed that your child struggles with these or other mental activities involved in self-regulation. These skills are clearly more encompassing than attention alone; however, children (and adults) with ADHD often struggle with many or all of these skills.

You also might have heard the fancy term “executive functioning” in conjunction with ADHD. Although there is still some debate about the exact definition of executive functioning (EF), I prefer Dr. Barkley’s definition: “those neuropsychological processes needed to sustain problem-solving toward a goal.” To simplify, EF is what you need to get from point A to point B. Whether it's completing schoolwork, holding a conversation, or making a sandwich, executive functions are the skills needed to achieve a goal.

As you can probably guess, the self-regulation skills listed above are all required to sustain problem-solving toward a goal and can also be considered executive functions. Dr. Barkley and many psychologists argue that the core deficit in ADHD is a diminished capacity to self-regulate, or trouble using one’s executive functions.

What does this mean for you and your child?

First, when looking for signs of ADHD, keep an eye out for difficulty with self-regulation/ executive functioning skills, not just attention and hyperactivity.

Second, know that your child may struggle with some executive functions but may not have ADHD. Children with learning disabilities, language delays, or social-emotional problems may exhibit EF weaknesses as well. (But that's a blog post for another day.)

If you are concerned that your child may have ADHD, please seek the assistance of a professional, such as a pediatrician, clinical psychologist, or neuropsychologist. These experts can conduct evaluations to clarify your child's strengths and weaknesses, as well as assist you with getting your child any help he or she may need.