Toward an understanding of ADHD: a developmental delay in self-control - includes related articles on attention deficit hyperactivity disorders

Camping Magazine, Jan-Feb, 1999 by John Durall

Josh can't keep his hands to himself when waiting in line. Seth seems to act irresponsibly. Megan never completes an arts anti crafts project. These campers' behaviors may have a common link - attention deficit hyperactivity disorder.

Attention deficit hyperactivity disorder (ADHD) is one of the most studied and controversial disorders in child development. This disorder, which is present in approximately 4 to 7 percent of the childhood population in the United States, is characterized by behavior difficulties such as inattention, impulsivehess, and hyperactivity. The child, or adult, with ADHD has problems starting, staying with, or completing tasks. The result is a life that may often be chaotic.

Characteristics of ADHD

Current research theorizes that ADHD is a developmental disorder of self-regulation. A person's ability to exhibit self-regulation or self-control flows along a continuum. At one end, a person would have all the internal arousal, motivation, and persistence needed to self-regulate toward his future best interests. In the middle of the continuum, a person would have a great deal of selfregulation and self-control but still need outside performance or compliance incentives or consequences, such as laws or rituals.

As the person moves toward the other end of the continuum, he begins to exhibit less self-control. As the person moves even further down the continuum of self-regulation, his or her life begins to appear chaotic and disorganized or without direction to one's future best interests. The person may show little hindsight, forethought, or preparatory action. This level of interruption causes serious impairments in social, academic, or vocational functioning. ADHD is a diagnosis for those at this lower end of the continuum.

A Developmental Delay

These difficulties in self-regulation represent a delay in development rather than a halt in development. This means, that with age, people diagnosed with ADHD will always be improving, but they will always be behind their same-aged, non-ADHD peers. The ADHD person does not, age appropriately, gain the progressively internalized capabilities of self-control.

As a person matures, his capacity to self-regulate his own behavior comes more from internal or selfimposed neurological processes. At birth a child has practically no internalized mechanisms to selfregulate. He relies entirely on regulation or guidance imposed by others. After a few years of normal development, the child gains more internalized processes of behavioral self-control, while still needing lots of externally applied rules, guidelines, and incentives. With adulthood maturity comes behavior that is controlled via one's own internalized self-regulatory mechanisms.

The developmental delay in the person with ADHD is in the internalization of the ability to selfregulate his behavior. It consists of a problem of "behavioral inhibition" interacting with what developmental psychologists and neuropsychologists call "executive functions." These functions are operations within the brain that promote and allow for self-regulation or sclf-control. This includes nonverbal memory, verbal memory, selftalk, emotions, motivation, arousal states, problem analyzing, problem solving, and thought and behavioral sequencing.

Living in the Moment

The ADHD person, in the presence of stimuli, is less able to stop or prevent an immediate, powerful, or automatic (helpful or harmful) response. This diminished behavioral inhibition then interacts with and leads to diminished functioning of the other brain operations dealing with self-regulation.

The combination of these factors cuts or blocks the connection that leads a person's thoughts to action and his knowledge to performance. It prevents the person from using the past to work toward or maximize his future. The person is often called a repeat offender. He commits the same error over and over again. This is because the inhibitory response system has not allowed for the effective employment of the thinking and problem-solving processes of self-regulation, so the person does not plan or apply new strategies that would normally result from processing one's past mistakes. Therefore, the person's behavior often appears disorganized, irresponsible, chaotic, and ill directed.

A person with ADHD may have difficulties waiting in line or taking turns. Their brain functioning leads them to anticipate and feel that the time period will last excessively and unbearably long. Thcy then show high levels of impatience or frustration with the delay and sooner or later act to escape from it. The delay is seen as boring or bothersome and, therefore, escape behaviors become difficult or impossible to prevent.

Difficulty Remaining Focused

Another very important part of the executive functioning of the brain is the utilization of arousal, motivation, and persistence in goaldirected behavior. Through normal maturational development the brain shifts from being dependent on external incentives to being independent through internal self-generated arousal, motivation, and persistence. This is seen when an adolescent carries out the decision to go to college, continue with graduate school, and survive a long internship training. This represents goal-directed behavior aimed over a prolonged period of time.