ADHD is not a simple behavior disorder

ADHD was once widely understood and still is by some today, largely as a behavior disorder, where a child is “bouncing off the walls”, unable to sit still and pay attention in class, constantly interrupting others. However, as Dr. Thomas Brown points out, the more we learn about ADHD through research and science, “specialists are recognizing that it is a complex syndrome of impairments in the development of the brain’s cognitive management system, or executive functions.” The executive functions include the ability to:

• Organize and get started on
tasks.
• Attend to details and avoid
excessive distractibility.
• Regulate alertness and
processing speed.
• Sustain and, when necessary,
shift focus.
• Use short-term working
memory and access recall.
• Sustain motivation to work.
• Manage emotions
appropriately.

In order to illustrate the complexity of the executive functions, Dr. Brown uses the metaphor of a symphony orchestra composed of talented musicians: “Regardless of their expertise, the musicians need a competent conductor who will select the piece to play, make sure they start at the same time and stay on tempo, fade in the strings and then bring in the brass, and manage them as they interpret the music. Without an effective conductor, the symphony will not produce good music. In individuals with ADD, the parts of the brain that correspond to the individual musicians often work quite well. The problem is with the conductor, with those executive functions that, in a healthy individual, work together to accomplish a task. ADD impairs neural circuits that function as the conductor of the symphony.”

Dr. Brown’s model of executive functioning (ADD/ADHD) is comprised of six core executive functions:
Activation – organizing, prioritizing, and activating for work.
Attention – focusing, sustaining, and shifting attention to tasks.
Effort – regulating alertness and sustaining effort and processing speed.
Emotion – managing frustration and modulating emotions.
Memory – using working memory and accessing recall.
Action – monitoring and self-regulating the pace of action.

Dr. Brown continues: “In daily life, these clusters of cognitive functions operate, often without our conscious involvement, in integrated and dynamic ways to accomplish a wide variety of tasks. They do not continually work at peak efficiency for any of us; everyone has difficulty with some of them from time to time. However, those diagnosed with ADD…are substantially more impaired in their ability to use these executive functions than are most other people of the same age and developmental level.”

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