(dr Welma Wehmeyer)
There is a growing awareness of the existence of adult ADHD (attention deficit hyperactive disorder). Although termed adult ADHD, adults with ADHD is generally not a separate condition to childhood ADHD but a condition continuing from childhood into adulthood. Advancements made in neuroscience over the last two decades brought a better understanding of the nature of attention deficit disorder and its debilitating effect on a person’s mental well-being. This article will look at what adult ADHD is, it’s effect on a person’s daily functioning, specifically executive functions and how an understanding of the neuro-science behind ADHD can lead to greater self-compassion, success in the workplace and overall wellness and life satisfaction.
What is adult ADHD?
Adult ADHD is a neurodevelopmental disorder of the brain’s self-management system. According to the Diagnostic and Statistical Manual (DSM-V) there are two main categories of symptoms, namely inattention and hyperactivity/impulsivity. To meet the diagnostic criteria an adult must present with five or more symptoms from either the inattention category or the hyperactive/impulsivity or both. If both categories are met the diagnosis is described as ADHD Combined type. If enough symptoms are met for inattention but not for hyperactivity/impulsivity, it is called ADHD Predominantly Inattentive type. If symptoms are met for hyperactive/impulsivity category but not enough symptoms for inattentive category the diagnosis is ADHD Predominantly Hyperactive/Impulsive type. Symptoms must occur in more than one setting (for example both at home and at work) and have a debilitating impact on a person’s functioning. Symptoms must also meet some exclusion criteria.
Greater awareness of ADHD results in adults identifying symptoms in themselves which they have been experiencing throughout their life without knowing that there are neurological causes for their behaviour. In most cases the onset of symptoms can always be traced back to childhood. As an educational psychologist I regularly see children or adolescents with ADHD. When I explain the condition of ADHD and how it plays out in the child’s functioning most often one of the parents will strongly identify with the symptoms and trace back their own history of failure to reach their potential at school, of being labelled (by themselves and others) as lazy, disorganized, inattentive, losing things, not completing tasks or missing appointments. They have been blaming themselves (and blamed by others) for lack of will power or motivation for their behaviour. I am always amazed how these parents, despite their lack of understanding that their behaviour was not a choice or lack of will power, and years of negative labelling and harsh self-criticism, could find a way to a work-environment complimenting their natural strengths, where they experience success, accomplishment and life satisfaction. Sadly, there are also those adults who were for some or other reason not able to escape work environments where there is a heavy demand on the individual to fit into a rigid structure.
Although research on the nature of adult ADHD is ongoing, ADHD is often only diagnosed in adulthood when an adult finds him/herself in a work environment or relationship where the demands for executive functions such as time management, organization, doing mundane tasks etc exceeds the necessary support and compensations in place.
ADHD and Executive Functions (EF)
Executive function (EF) is the ability of our brain to analyse information, organize, plan, set schedules and solve problems. It can also be described as your brain’s board of directors who helps you do what you decide to do. Although not all EF deficits can be linked to ADHD, all people with ADHD has a significant problem with EF. Following are the executive functions (EFs) most required for optimal functioning and well-being:
-Task initiation/activation (beginning a task or activity)
– Planning and organizing (creating and prioritizing order and structure)
– Focus (sustaining and shifting of focus)
– Effort (sustaining effort and speed of processing)
– Memory (utilizing working memory and accessing recall of information)
– Self-monitoring (controlling your own behaviour and direct future actions)
– Emotional regulation (managing anger, frustration and modulating of emotions)
Individuals with ADHD can have all the intent in the world to organize their workspace, be less impulsive, stick to schedules, manage time or any of the EFs mentioned above, without success. The reason for their failure in these areas of self-management is not a lack of intention, but it is rooted in the neurodiversity of their brain. If not understood and managed, deficiency in a person’s EF can have devastating impact on his/her work, relationships, and quality of life.
Understanding the neuroscience behind ADHD
The ability to regulate your attention (in other words, deciding what you focus on, for how long you focus on what needs to be focussed on), ignore distraction, constrain your impulses and holding information in the short term memory for processing (working memory) are foundation skills required for academic and vocational success and psycho-social well-being. These skills gradually develop into functional skills as a child grows older. For some individuals however there is a deficit in the development of these skills. The deficit is caused by a part of the brain called the prefrontal cortex (PC).
The work of the PC is to organize, control and execute information processed in the brain. The PC does not act alone thou. It is connected to other parts of the brain including the areas involved in motor control, emotional processing and motivation. EF is therefore the result of the PC’s intricate network with different brain regions.
Secretion of neurochemicals such as dopamine, noradrenaline and serotonin are all involved in the efficient function of these networks. A deficit of or malfunctioning in secretion of some of these chemicals can derail the network’s working, resulting in EF deficiency. Through careful analysis of behaviour, it is possible to establish a person’s specific EF strengths and weaknesses and the neural networks responsible for the EF deficiency.
Knowledge of the functions of these networks can help a person understand his/her behaviour and use strategies to manage debilitating behaviour instead of blaming themselves, trying harder to change their weaknesses without success. I like to think of the management of behaviour related to ADHD as driving a racing car. Driving a racing car on a gravel road, can make you feel frustrated and resentful towards the car if you do not acknowledge that a racing car is built for speed and not rough terrains. If, however you understand the car is not built for rough terrains you will have more patience and compassion with the car when driving on a gravel road is inevitable. On the other hand, you will make conscious choices as far as possible to use this car on a racing track or open tarred roads where you will experience the joy and satisfaction of speed and skill. Once a person is aware of his specific strengths and weaknesses, and are able to understand the neuro-networks behind their behaviour, he/she can manage the behaviour with a greater sense of compassionate self-awareness and steer his life according to his specific EF strengths and weaknesses.
Success with ADHD starts with acceptance and self-compassion
Years of repetitive failure to combat EF deficiency can lead to negative self-talk, inner criticism, and self-loathing. Turning towards yourself with compassion, empathy and support is the first step to winning with the debilitating behaviour associated with ADHD. Acknowledging that your behaviour is not the result of your unwillingness to change or laziness, but it is rooted in the neurodiversity of the human brain.
Get to know your EF strengths and weaknesses
The next step is to establish which specific EFs are deficient. As I mentioned before, it is likely that you will experience more difficulty in certain aspects of EF than others. Knowing and accepting your specific EF weaknesses can help you to find effective ways to manage and compensate for these challenges. There are evidence based diagnostic tools to help you refine the finding of your specific EF strengths and weakness. You can also look at the list of EF functions I mentioned above and evaluate which areas are specific challenges and rate the impact it has on your quality of work and life in general. Also make a list of well-developed EF functions. Once you know your own EF strengths and weaknesses you will be able to steer your working environment towards your strengths and manage the weaknesses. Management of your specific EF weakness requires strategies, compensations, and choices for steering yourself away from work environment and commitments where there the demand on your weaker executive functions exceeds your capacity for management and compensation.
So far medical treatment of ADHD has been proven to be the treatment option with the most radical improvements in quality of life for people diagnosed with ADHD. Recent research indicates specialised ADHD coaching for adults and adolescents as a successful treatment options (most often alongside medical treatment), to manage the deficit in EFs.
At Purposely Ignited we offer adults specialised ADHD coaching focussing specifically on everyone’s unique set of EF strengths and deficits.
For more information on our coaching packages, send us an email to: [email protected].