ADHD, Actually: The Struggle is Real

Research reveals how life-altering ADHD really is… and what you can do about it

ADHD is about so much more than difficulty sitting still or paying attention

So. Much. More.

Despite decades of information being available to anyone and everyone, including doctors, teachers, and the general public, there is still a lot of misinformation out there.

It’s ironic — okay, a bit sad and frustrating too — that one of the most common childhood disorders is one of the least well understood. So misunderstood, in fact, we have an entire story series dedicated to challenging myths about ADHD.

The CDC (U.S.) indicates that 9.4% of children aged 2–17 years are diagnosed with ADHD. Statistics Canada states that 5% of school-aged children (presumably aged 5–17) are diagnosed with ADHD. The Centre for ADHD Awareness, Canada (CADDAC) states that ADHD is the most prevalent childhood psychiatric disorder in Canada and remains under-recognized and under-diagnosed, despite being the most treatable psychiatric disorder in Canada.

So, what is ADHD, if not a case of “the wiggles”? If it’s not simply a matter of needing to focus more or get more organized, then what exactly is it?

If you’re a Medium member, continue reading on Wholistique.

If you’re a News Break member, continue reading on NewsBreak.



Discovering My Neurodivergence Helped Me Rediscover My Passion

I returned to a career that I never thought I’d love again.

From the time I was in middle school, I told everyone that I wanted to be a social worker or a psychologist. I was determined and driven, and I never doubted what or who I wanted to become.

Read more on Preoccupy Negative Thoughts


Table of Contents for ADHD 2e MB Blog

Organized chaos, a.k.a., an easier way to find specific topics.

I have created a Table of Contents for my Medium blog to make it easier to find the story or subject you may be looking for.

I write about several different topics, but the three most common are:

Parenting and Childhood — including a story series about the perils of punishment

ADHD, Neurodiversity, and Mental Health

Education and Advocacy

See our full stories listing at twoemb.medium.com


O.D.D. DSM-V Diagnostic Criteria

We have recently posted two blog posts on this subject:

Stop Calling Children “Defiant”

ODD Does Not Exist

We have included the DSM-V criteria for an ODD diagnosis below for further information.

Oppositional Defiant Disorder is not a valid diagnosis approximately 99%* of the time 

I will explain how my research and experience combined have taught me that Oppositional Defiant Disorder (ODD) is not a valid diagnosis approximately 99%* of the time.

*Please note: 99% is an entirely made-up statistic based on my opinion, however I will provide evidence to explain how and why I have formed this opinion. 

Oppositional Defiant Disorder (ODD)

Also known as one stressed out kid lacking coping skills. 

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines ODD as a recurrent pattern of negativistic, defiant, disobedient, and hostile behaviour towards authority figures (American Psychiatric Association, 2013).

The DSM-V diagnostic criteria for ODD requires a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms of the following categories, and exhibited during interaction with at least one individual who is not a sibling.

Angry/Irritable Mood

  1. Often loses temper.
  2. Is often touchy or easily annoyed.
  3. Is often angry and resentful.

Argumentative/Defiant Behavior

  1. Often argues with authority figures or, for children and adolescents, with adults.
  2. Often actively defies or refuses to comply with requests from authority figures or with rules.
  3. Often deliberately annoys others.
  4. Often blames others for his or her mistakes or misbehavior.

Vindictiveness

  1. Has been spiteful or vindictive at least twice within the past 6 months.

(American Psychiatric Association, 2013).


References

Aggarwal, A. & Marwaha, R. (2020). Oppositional Defiant Disorder. In: StatPearls [Internet]. StatPearls Publishing. [https://www.ncbi.nlm.nih.gov/books/NBK557443].

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). [https://doi.org/10.1176/appi.books.9780890425596].

Barkley, R. A. (Ed.). (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed.). The Guilford Press.


For more about Positive Parenting and the Perils of Punishment, check out our story series:


When Disability Is Defined by Behavior, Outcome Measures Should Not Promote “Passing”

Masking is Harmful to Neurodivergent People

Many disabilities are diagnosed through biomarkers. Others can only be identified via behavior. Particularly in the latter context, clinicians and researchers often seek specialized instruments to assess service-provision outcomes. Measures are not neutral, however. They carry their creators’ value judgments” (Ne’eman, 2021). 

Unfortunately this is all too common with ADHD diagnoses. 

We supported a family whose older son was diagnosed very easily. The doctor prescribed medication without issue and referred to additional supports. 

When the same family asked for an evaluation for their daughter the following year, the doctor told them he would not prescribe her medication, and that their struggles were caused by a “parenting” issue. 

Apparently that doctor forgot that ADHD has a 75% heritability rate, meaning it is extremely common in families. ADHD often presents much differently in girls than in boys. 

This doctor must have been very out of date with his ADHD research because, while ADHD was long ago believed to impact only boys, that has long since been disproven. 

Clinicians must set their personal biases aside and make recommendations based on the best evidence and not on their opinions or assumptions. They need to keep up to date on the medicine they are practicing, or refer to someone who is more knowledgeable.

“In some conditions defined by behavior, a disturbing trend has emerged: researchers, clinicians, and paraprofessionals are using measures that prioritize reducing diagnostic traits that are neither harmful nor personally distressing, defining typical appearance as the goal of service provision.”

Oh my word, yes. Unfortunately this is much too common. 

Treatment must be focused on the individual, what *they* want, and supporting their improved quality of life. 

Treatment should never be about making the lives of others easier, and it most certainly should never be about trying to make someone appear as “normal” as possible. 

The goal is not conformity, masking, nor assimilation – all of which have been proven harmful to people with disabilities. The goal must be accommodation, appropriate supports, and meeting an individual’s needs.

As Ari Ne’eman writes, “Such thinking ignores the stress that passing for normal places on people with disabilities and fails to consider the ethical dimensions of behavior modification in response to stigma” (Ne’eman, 2021). 


Related Stories

Further stories about masking:


References

Ne’eman, Ari. (2021). When Disability Is Defined by Behavior, Outcome Measures Should Not Promote “Passing”. AMA Journal of Ethics, 23(7): E569-575. [doi: https://10.1001/amajethics.2021.569]. 


My ADHD Made me a Successful Entrepreneur

Originally posted on Medium.

Originally posted on Medium

Have you noticed a change in my posts over the past year? OK, with everything going on, it not surprising that pretty much everyone’s posts have changed, so you may not have noticed.

If you’re seeing posts from me both from Pawsitive Pet Care and from ADHD 2e MB and are wondering which am I doing? The answer is both. I’m doing both. Of course I am. Because I love both and right now I can do both.

If you’re interested in the background story, here it is. If you’re not… well, perhaps one of our other blogs will be of interest, depending on which page you follow:
twoemb.medium.com
PawsitivePooch.blogspot.com

Long story…. a little less long:

In 2006 I graduated (with Honours) from Humber College in Toronto, after completing a 3-year full-time intensive Child and Youth Work program and received my CYW diploma. I worked in a group home in Ontario for one year until we moved to Winnipeg in 2007, where I started my second degree, Psychology, with majors in both Child Psychology and Animal Learning (this will not surprise anyone who knows me).
While I was graduating in 2009 I had some health problems (all good now though!). Instead of heading into a full-time career in social services, I had to slow down and focus on taking care of my health at that time. I took a part-time job in a retail pet store because I love animals and because the store was close to home.

Retail Reality

I had forgotten what it was like to work in retail. For one thing, managers expect you to put your personal life on hold for a minimum-wage job. I love soccer and at that time was on a highly competitive soccer team that practiced three times per week, plus had one or two games on the weekends. When I had interviewed the manager said she was willing to work around my soccer schedule, yet when I asked them to do so they gave me a hard time about it.

The other difficulty I encountered was colleagues (even some managers) giving bad pet-care and health-related advice. ProTip: If you are working in a pet food and supplies store, you are not qualified to give dietary and health advice to pet owners. You can recommend products, share what you know about the different brands, and help customers find what they are looking for. You should not be practicing outside of your scope. Giving the wrong advice can be unsafe for pets, so please leave that to the professionals.

There’s got to be a better way!

With those challenges in mind, in May 2010 I started to offer dog-walking and pet-sitting services to families in my neighbourhood. It was small and simple at first, a free ad on Kijiji and a couple of flyers posted at the local park, but within three months it turned into a full-time gig. I loved it (and still do)! In 2012 I was ecstatic when I became pregnant with our son. As I neared closer to my due date I hired someone to cover for my maternity leave. Walking large dogs while very pregnant is challenging, to say the least! With that began the expansion of Pawsitive Pet Careinto a bonafide company. We registered with the province, purchased insurance, and I officially became a sole proprietor.

When I returned to work in Fall 2013 things continued growing and it was very satisfying to see our hard work pay off. We hired more staff and our client base grew. In 2017 we moved out of Winnipeg to just West of the city, in the R.M. of Cartier on a beautiful rural property. For about three years our growth continued.
In 2019 my son had a terrible experience at his former school. Like me, he is intellectually gifted and also has ADHD. Being gifted plus having a disability is called “Twice Exceptional” or 2e, hence the “ADHD 2e” in the name.
Not only were his needs not being met, but he was being treated badly. It was heart-breaking, stressful, and just plain awful. So, I dusted off my old child psychology textbooks and became his biggest advocate. We moved him to a much better school where he is so much happier and is flourishing, thankfully.

Originally posted on Medium

Then 2020 came along…

And we all know how that story goes.

In March 2020 the cancellations started pouring in, and like so many small businesses in Manitoba (and around the world), we were seriously impacted by Covid-19. Our clients couldn’t go to work or on vacation, so there was little need for dog-walking and pet-sitting services.

What there was a huge need for, though, were child advocates. Families of students with disabilities and exceptionalities often have to advocate and fight for resources for their children, to have their needs met, and for fair and appropriate access to their education. Add to that the stress and chaos of a pandemic, and these disparities grew worse. It is very hard to follow a student’s education plan when doing remote learning. Families were limited in their ability to access certain supports their children normally received at school, such as Resource, Occupational Therapy, Speech Therapy, Guidance Counselling, and much more. This is all unprecedented. Teachers, school staff, families, and students are all trying to figure this out as we go.

Most school staff are working in highly stressful and potentially unsafe conditions (improper PPE, unable to socially distance, not being made a priority for vaccines, being expected to teach both in person and online, the list goes on).

This is where people with my experience and expertise can help. I spent the past several years advocating for my exceptional child, in particular during the very challenging years while he was at his former school. I learned the Manitoba education system inside and out, gained and strengthened my advocacy skills, and updated my academic knowledge and credentials.

Why Am I Telling You All This?

As I mentioned in the beginning: If you’re seeing me post from both Pawsitive Pet Care and ADHD 2e MB and you’re wondering which am I doing… The answer is both. I’m doing both. Of course I am. Because ADHD. Because I love both and right now I can do both. Because I love my son and he has inspired me and re-ignited my passion for advocacy work. I have a fantastic staff team at Pawsitive Pet Care who help me keep things running smoothly (thank you!). I am also lucky to have a supportive and loving husband and son who support me in all my endeavours, no matter how ambitious (I love a challenge and never like to be bored… ADHD y’all, it can occasionally be a gift).

I promise I won’t spam my separate business pages with cross-posts, but I will on very rare occasions share posts that apply to both. I hope you’ll support me by liking and sharing ALL OF THE THINGS, and by referring anyone who you feel would benefit from our services (THANK YOU!).

We’ve been so lucky to have such wonderful and supportive friends, family, and clients these past 11 years (11! Pawsitive Pet Care turns 12 years old this summer!).
Thank you all for your support. Please stay safe and healthy. Stay home when you can, wash your hands, wear a mask, and get vaccinated as soon as you’re eligible. I cannot wait until things can start to return to some semblance of normal. I’ll settle for half-normal. Maybe even a quarter.

Stay well,

Jillian Enright, CYW, BA Psych., CPDT-KA
ADHD 2e MB and Pawsitive Pet Care

Related Stories

ADHD Qualities of a Successful Entrepreneur

ADHD: The Good, The Bad, and the Ugly

Impulsivity is a Neurodivergent Thing

ADHD, Actually: The Struggle is Real


Struggling in School?

Are you seeing your child struggling in school, yet the school doesn’t feel it’s “that bad“?  

I grow weary of hearing comments along the lines of “they’re not struggling enough to qualify for resources.” 

Based on whose measure of “struggling“?  

If a parent is expressing a concern, then the child is obviously struggling in some way, otherwise the parent wouldn’t be bringing it up.  It’s time that schools* started taking parent concerns seriously, rather than trying to sweep them under the rug, minimize them, avoid taking responsibility, or put up a fight in order to see if the parent is serious enough to push.  Not all parents know how to advocate for their child or know when it’s within their rights to do so.  

*Note:  This is absolutely not all schools, nor all teachers, nor all administrators.  Many school staff go above and beyond for their students and all schools in Manitoba are underfunded, under resourced, understaffed, and over stressed.  Unfortunately schools have been put into the position where they have to triage in order to ensure their very limited resources are available for the students who need them most.  

Our focus here is on the teachers and administrators who don’t take parent concerns seriously or think that a child is doing “fine” simply because there aren’t obvious behaviours or indicators that are easy to spot.  Some children are very good at “masking” or hiding their struggles, some students do very well on standardized testing and are still seriously struggling.

Masking can be a result of a child developing strategies to “fit in” with their peers, not wanting to stand out, or being afraid or embarrassed to ask for help when they need it.  It can also be a result of having behaviours punished repeatedly or being shamed for problems related to their disability (such as a child with ADHD behaving impulsively and speaking out of turn in class) to the point where these behaviours are suppressed.  Suppressing behaviours is not the same as providing support for the underlying causes and masking can have a serious negative effect on people’s mental health, self-esteem, and wellbeing.

When it comes to accessing resources and referrals at school, this usually means either the student’s behaviour is disruptive, or their struggles are made obvious on standardized tests.  

Those are not the only two ways in which children struggle and it’s long past time all schools recognize that and prioritize student mental health and social-emotional learning.

What Masking Can Look Like

  • The school reports that a child is doing very well, yet that child has has a meltdown when they come home from school, or is very emotional before and/or after school. 
  • Your child is struggling socially: expresses feeling lonely, describes being left out, and/or has frequent trouble with peers at school. 
  • Your child does well on academic tasks, but this comes at great cost.  They may spend hours on homework in order to get it right, show traits of perfectionism, and have a great deal of stress and anxiety about their school work or about school in general. 

Please note: These are general examples, but of course masking will not be the only reason for children experiencing these struggles at school.  It is even more challenging when a child with ADHD is also academically very bright or gifted, as their intelligence may also overcompensate for their challenges related to their neurodiversity.  (There are actually quite a few aspects of giftedness that overlap with ADHD, such as emotional intensity, but I digress…). 

If readers get nothing else out of this blog post, I want the following two points to be made abundantly clear:

  1. Academic success is not an acceptable reason or excuse to deny a child their right to accommodations and supports for their disability.  
  2. Social-emotional health is much more important than academic performance and children do not learn well when they are highly stressed, anxious, fearful, or working so hard to mask that they cannot absorb what is being taught.  

I repeat: Academic success is not an excuse to deny a student accommodations and supports for their disability.

And, perhaps just as harmful, please do not tell a child with ADHD or a learning disability “you’re so smart, you just need to work harder and apply yourself.”  They would if they could.  They very likely can, but first they need (and have the right to receive) the appropriate help to do so.  All students deserve to be able to show the very best of themselves, not just “good enough” based on the classroom teacher’s opinion.  Meaning: if a child is doing well academically, but it’s causing them significant psychological, emotional, or social difficulty, then they still require accommodations so that they can be their best self without it taking a toll on their mental health.  

Beyond assessment, we want to instil in students a love of learning and foster a joy in curiosity.  If a student is very bright, but school is a daily slog which they dread every day, then their chances of meeting their potential and pursuing higher education decrease every year that goes by without proper support.  

Beyond academics, the core subjects are not the only thing children learn at school.  In fact, there have been many studies clearly demonstrating that students forget a significant portion of the academic cotent they are taught in school.  What they do learn and remember meaningfully are relationships: Relationships with peers, teachers, and other school staff.  Public safety data in Canada indicates that 47% of parents report their child has experienced bullying in school.  Children with ADHD are 13% more likely to experience bullying and social challenges, that’s up to 60% of children with ADHD who might experience bullying (Unnever & Cornell, 2003).  

Much more important than memorizing multiplication tables, all children in schools need to learn about neurodiversity, disabilities, and celebrating individual differences in general.  When whole classes and schools are taught facts about neurodiversity, those students are significantly less likely to bully other children for being different, and are much more likely to be kind and inclusive toward those children (Cook et al., 2020).  Knowledge and understanding goes a long way toward fostering acceptance — acceptance from peers, and acceptance of ourselves and all the strengths and struggles that come with our neurodiverse brains.  

When students are given appropriate accommodations and supports they are less anxious, less stressed, and more able to engage with their peers because they feel more comfortable at school.  The CADDAC has some great suggestions for specific accommodations and supports for various ADHD symptoms that can impact children at school.  

In closing, I will reiterate the two most important points I wanted to make clear in this post:

  1. Academic success is not an acceptable reason or excuse to deny a child their right to accommodations and supports for their disability.  
  2. Social-emotional health is much more important than academic performance and children do not learn well when they are highly stressed, anxious, fearful, or working so hard to mask that they cannot absorb what is being taught.  

If you are concerned about your neurodiverse child and need help advocating for them, please do not hesitate to contact us.  


Further Resources

ADHD 2e MB has compiled an extensive list of Manitoba-local and online resources for ADHD.  

We also have a blog post with advice for advocating for your child:


For more on education, neurodiversity, and advocacy, visit our Back-to-School Series:


References 

Cook, A., Ogden, J., & Winstone, N. (2020). The effect of school exposure and personal contact on attitudes towards bullying and autism in schools: A cohort study with a control group. Autism : The International Journal of Research and Practice, 24(8), 2178–2189.

Unnever, J. D. & Cornell, D. G.. (2003). Bullying, Self Control and ADHD. Journal of Interpersonal Violence, 18(2): 129-147.


Visit ADHDMB.ca and facebook.com/ADHD2ePro to learn more.

An Open Letter to the Minister of Education

April 9, 2021

Dear Mr. Cullen,

Do not assume the parents who write open letters or express concerns about the proposed changes to our education system have not read the (sparse) information provided.  We *have* read the documents and we still have very serious concerns.  Stop insulting the intelligence of Manitobans.  With all due respect, Mr. Cullen, your open letter sets absolutely nothing straight.  In fact, it further highlights how out of touch our Conservative government is.  It showcases how little you have listened to the experts trying to advise you on how best to support the students in Manitoba’s public schools.

You claim the Conservative government has reduced child poverty by 25% since 2016.  That figure may sound nice when you offer it up with no context.  In fact, Manitoba’s poverty rate has decreased the least of any province in all of Canada, and we are still 10% behind the national average.  Not to mention, poverty rates in Manitoba decreased largely due to the Federal Child Tax Benefit program, which coincidentally was introduced in July of 2016, and had nothing to do with the Conservative government.  Manitoba still has second highest rate of poverty in Canada at 28.3%.  

I’m also wondering how our government can expect single parents to volunteer for Parent Advisory Councils (PACs) while working multiple minimum and low-wage jobs just to scrape together enough to provide for their families?  In Manitoba, over 60% of single-parent households live below the poverty line, but they should somehow “sacrifice” in order to volunteer at their child’s school?  Exactly which “sacrifice” does our Premier want these parents to make, I wonder?  Should they sacrifice buying groceries?  Paying rent?  Their utilities?  

In schools that have PACs, those councils are primarily made up of white, higher-income parents who have the resources, the time, and the privilege to volunteer at their children’s schools. This is in no way to devalue their hard work.  Unfortunately, Mr. Pallister’s comments made in question period on March 22 were based on faulty assumptions.  Due to systemic racism and ableism, most of the parents who work multiple jobs to make ends meet are Indigenous peoples, immigrants, people of colour, people with disabilities, and other minority groups that already experience systemic racism and oppression.  Most of the privileged families in Canada are white.  Because racism.  

So now, groups that are already struggling will have even less of a say in the way their children’s schools are run because the higher-income families will be taking up all the seats at the table.  

How will high-income, white, stay-at-home parents understand the struggles faced by those minority groups?  How will a parent whose children do not have any disabilities understand the needs of the families and students who do?  The parents whose children have disabilities are already busy trying to work to pay for therapies, taking their children to appointments, and meeting with teachers and school staff to advocate for their children.  Where are we supposed to find the time to volunteer?  And if we don’t, are we not making enough of a “sacrifice” for our children, as Mr. Pallister suggested?  

The only thing that we seem to agree on, Mr. Cullen, is that our current education system needs to change.  Yes, it needs a massive overhaul, but the Conservatives are clearly not equipped or qualified to do this and are not willing to listen to the experts who want to guide our policy-makers in the best interests of children.  

So, Mr. Pallister and Mr Cullen: Kindly step aside and let the experts do their jobs.  Perhaps there is room on your children’s advisory councils for you to voice your ill-informed, uneducated opinions with the other privileged parents?  

Sincerely,

Concerned Parents
and ADHD 2e Manitoba
CYW, BA Psych., Child Advocate

7 Ways ADHD is Misunderstood

Seven (of the many) ways in which ADHD is about so much more than difficulty sitting still. 

Originally posted August 13, 2020

But he can focus on things he enjoys for hours at a time!” 

That was my own reaction when the school psychologist gently suggested that we learn more about ADHD to see if we wish to have our son assessed.  

Despite my degrees in Social Work and Psychology, I actually knew very little about the complexity of ADHD and the myriad of ways it can impact peoples’ lives.  Having not been in University since 2009, it was certainly time to update and increase my knowledge. 

Fast forward a year and a half and both our son and myself have been formally diagnosed (me at age 36! – My son by the school psychologist and his pediatrician, and myself by a psychiatrist specializing in Adult ADHD).  

Little did I know that this hyperfocus was also part of ADHD and that hyperactivity and inattentiveness are just two parts of a very complex disorder that Dr. Russell Barkley explains is not actually a disorder of attention, it’s a disorder of regulation.

Following up on my previous post on the seven executive abilities that are impacted by ADHD, which Dr. Barkley reviewed in a recent podcast discussing Adult ADHD.  I wrote a separate blog post on this specific podcast, which you can read here.  

I have reframed and expanded on each of them below, relating them to struggles in children rather than adults.   

Continue reading on Age of Awareness.


ADHD Results in a Deficit in Executive Functions:

  1. Impulse Control.  The ability to STOP.  The ability to pause between the action and reaction.  The ability to pause before responding.  “Response inhibition refers to the ability to withhold a cognitive or behavioural impulse that may be inaccurate or maladaptive.” (Barkley, 2015). 

    Children are particularly vulnerable to this because their prefrontal cortex (important in decision making) is not yet fully developed, and even neurotypical children are impulsive.  Children with ADHD are thought to be approximately 30% behind their peers in PFC development, making the “stop and think” process even more difficult. 
  2. Hindsight.  The ability to think about previous relevant information and use past experience to guide your current response.  “Working memory deficits may adversely affect the social functioning of children with ADHD.” (Kofler et al., 2011). 

    “Hmm, last time I did this… and this happened…  so maybe I should try…  this instead?”

    While most children with ADHD have average or above-average IQ (many are twice exceptional), learning from past experiences is more challenging when there are differences in the way they store and later access information as memories
  3. Foresight.  Thinking ahead to longer-term consequences of your current behaviour before acting. 

    Children with ADHD have greater difficulty predicting possible outcomes of their choices and have greater difficulty connecting current behaviour with future consequences.  This means that delayed consequences such as detention, suspension, grounding, removal of future privileges, etc. are not likely to be effective in changing undesired behaviour.  Intervention, guidance, and support have to happen at the point of performance (meaning at the location and in the moment the behaviour is occurring). 

    Similarly, reinforcing positive behaviours must also occur at the point of performance, so we must make efforts to “catch” the child being good and not only be on the look out for negative behaviours. 

    Children with ADHD often struggle with low self-esteem and are often blamed for their disability.  Many children with ADHD internalize the constant negative messages from others, believing that it is their fault rather than being taught that their brains are wired differently.   

    So often I hear adults ask (and yes, I have heard myself say it!) “why isn’t he learning from these consequences?”  That is why.  Impulsivity combined with a deficit in both hindsight and foresight (also referred to as working memory) make it very difficult for children with ADHD to learn from past mistakes without compassionate, non-judgemental support and guidance. 

    This means that a neurological difference is responsible for difficulty learning from consequences, not a desire to be “bad“, and not from a lack of a desire to be “good“. 
  4. Self-talk.  Self-directed language to facilitate self-control.  (Also referred to as verbal working memoryor inner speech). 

    This is our inner monologue and refers to how we talk to ourselves inside our head to guide our decisions and remind ourselves of things we need to do.  Children start out having these conversations out loud when they are very young and as they mature these conversations gradually become internalized. 

    Each person’s experience with ADHD is different, however ADHD experts such as Dr. Russell Barkley explain that the capacity for self-talk is less-developed and also develops later in life in people with ADHD.  The ability to talk to oneself in a positive and helpful way impacts one’s self-esteem, memory, motivation, and decision-making.  Challenges with this executive function can have a significant impact on daily functioning. 
  5. Emotional regulation.  The ability to manage one’s emotions to make them more socially acceptable. 

    Our emotions are our motivation. 

    So, if a child with ADHD has “big feelings” (or emotional dysregulation), then they cannot entirely control the resulting behaviour.  They first need help with managing the feelings and developing self-regulation skills, only then can the behaviour change follow. 

    We don’t hand a kid a basketball and expect them to sink a basket their first try, we teach them skills first.  Why, then, do we expect children to have the skills to manage their emotions if they haven’t been taught? 
  6. Self-Motivation.  Children with ADHD are dependant on the environment and its immediate consequences.

    This means that we, the adults, have to help them develop tools for self-reinforcing, especially (hopefully only – more on why below) for tasks they find less desirable.

Addressing the presenting behaviour only “trains” a person to comply and do what is being asked of them, completely ignoring the underlying struggle that really needs to be addressed.

For example, if we start a token economy system in the classroom or at home, it’s highly important to involve the child(ren) as much as possible and give them as much ownership and control over the program as possible.  It is even more important that we gradually transition complete ownership and control of the program over to the child(ren) or students, once they are ready for this step. 

Children and students need to find what is reinforcing for them, not have the adults decide what their rewards are, and they eventually need to be able to run this program for themselves so that they can do it on their own when they no longer have a teacher or parent’s support.  

Sound a little strange?  Think about the ways you do this for yourself in your own life.  

I had a good workout today, I’ll reward myself with a beer

I got in all my steps today, I think I’ve earned a little dessert

After I finish this chore, I’ll put my feet up and read a book” 

Author’s Note:  In my opinion, token economies should be used sparingly, and should only be used for undesirable tasks such as chores or homework, and should never be used to address behaviour challenges.  

The reason for this is because behavioural problems come from a lack of skill, a lack of coping strategies, and/or underlying issues or concerns.  Addressing the presenting behaviour only “trains” a person to comply and do what is being asked of them, completely ignoring the underlying struggle that really needs to be addressed.  It’s a bandaid solution because it does not teach skills or provide emotional support, and it puts the onus on the child, rather than on the competent adult with a fully developed prefrontal cortex. 

For more on the problems with behaviourism and behaviour modification, Alfie Kohn wrote a blog post on the topic, as well as books on the subject called “Punished by Rewards” and “Unconditional Parenting“.  

But I digress….  Back to the List…  Now, where was I?  Oh yes!

  1. The ability to plan and problem solve.  The ability to simulate multiple possible future options is the highest executive function in humans. 

    The ability to quickly run through multiple “hypothetical situations” in our mind, and then the ability to quickly change course when we run into a problem or when one of our options fails. 

    A lot of children (and adults) with ADHD struggle with cognitive flexibility(or flexible thinking).  When we have our mind set on something happening a certain way and that changes, it can be very difficult for us to adapt.  This is also a common struggle for people with anxiety, a comorbid condition with ADHD (meaning they commonly occur together).  Sometimes people with anxiety need to mentally prepare themselves for a situation, then if circumstances change this can greatly increase their anxiety because they haven’t had an opportunity to mentally prepare.  

Important to note:  Children with undiagnosed, untreated, or inadequately treated ADHD are 30% behind their peers when it comes to executive functioning.


For more stories and articles debunking myths and misconceptions about ADHD, check out our story series:


References 

Barkley, Russell A. (2015). Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis & Treatment. The Guilford Press.  

Kofler, M. J., Rapport, M.D., Bolden, J., Server, D.E., Raiker, J.S., & Alderson, R.M. (2011). Working memory deficits and social problems in children with ADHD. Journal of Abnormal Child Psychology, 39, 805-817.