From a Neurodivergent perspective, many core ADHD traits reflect an adaptive neurotype that evolved to help families survive during the long hunter-gatherer period of human development. Being attuned to minor changes in the environment and having a high energy level were highly adaptive traits for hunter-gatherer societies, but are not as valued by societies that make their children sit at desks for much of the day. Like most disorders, when ADHD characteristics are extreme and overwhelm other characteristics that would be more adaptive in certain contexts, they may be reasonably considered a disorder. That doesn’t mean that ADHD characteristics are always going to be problematic or that they can’t be strengths in the appropriate context. People with ADHD are often highly creative and talented at designing efficient ways to get things done and they can bring a lot of positive energy to any endeavor they believe in.
From the medical perspective, ADHD is one of the most common neurodevelopmental disorders. It is usually first diagnosed in childhood and lasts throughout the lifespan, though it may present differently at different stages of life. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active. Most people with ADHD symptoms also have broader difficulties with executive abilities and self-regulation in modern, highly structured societies.
ADD/ADHD symptoms can be caused by many different brain-based differences. Difficulties listening may be related to auditory processing, working memory, executive functioning, and processing speed. Hyperactivity might be related to problem with basic arousal or it could be anxiety. Impulsive behavior might be related to over-activation of the short-term reward system or it could be insufficient cognitive inhibition skills. Losing track of instructions and failing to follow through on assigned tasks can be related to a limited working memory, or internal distractions related to salience that derail performance.
Cold EFs Whether it happens at school, in the home or at work, people with ADHD frequently have problems with sustained goal directed behavior. This is due in part to differences in cognitive executive functioning (EF). These may include difficulties estimating salience and prioritizing, planning, initiating, maintaining effort, monitoring, attending to details, staying organized, estimating time and effort requirements, inhibiting off-task impulses, and completing work. Sometimes, working memory problems, processing speed deficits and word retrieval problems are included in these lists of cognitive abilities associated with ADHD.
Hot EFs Cognitive EFs don’t tell the whole story about ADHD though. We know that executive functioning circuits in the brain also run through emotional processing centers and have connections with emotional circuits throughout. People with ADHD are often impatient and irritable when their own goal directed efforts are frustrated. They are prone to strong emotions and are often more sensitive to judgement, rejection and injustice than other people. Difficulties regulating emotions plays a strong role in issues like hyperactive behavior, impulsive behavior, boredom and procrastination. People with ADHD are more susceptible to abusing mood altering substances, over-use of electronics and over-involvement in other behaviors that offer immediate and/or repetitive positive feedback. Areas of the brain most commonly associated with these emotional issues have to do with regulating pleasure and rewards and inhibiting impulses.
ADHD is sometimes thought of as a minor condition, but those who have it often suffer significant negative outcomes, particularly when it goes untreated. Children with ADHD often have trouble behaving appropriately in the school environment and they have difficulty completing school work and chores. They are often frustrated and confused about their inability to show how smart they really are. Under-achievement is common all the way into adulthood. They are frequently called lazy, stupid, crazy, scattered, impulsive and any number of other insulting names, and that has a very negative impact on self-concept. Kids with ADHD very frequently feel like they are bad people. They are punished, shamed in front of others, bullied and rejected more often than other children and that just confirms their negative self-beliefs while also further harming their reputations among both peers and adults. People with ADHD are more likely to have difficulty with social relationships and fall in with antisocial peers even though they are typically not antisocial themselves. They are more likely to engage in risky behavior and suffer the consequences. These difficulties usually persist well into adulthood where work performance suffers, relationships are more problematic and emotional problems become chronic. Add/ADHD is not a minor problem in the modern world.
Many different neurological processing problems can cause ADHD symptoms. Understanding how your basic neurocognitive abilities like memory, processing speed, auditory and visual processing, language, thinking skills and general knowledge interact with your ADHD is necessary to understand your individual type of ADHD. Assessment of the full range of executive function abilities helps understand not only the core problems associated with ADHD, but also other problems regulating thinking, emotions and behavior. It is crucial to understand what is causing the ADHD symptoms in order to make good treatment choices, behavioral interventions and appropriate accommodations at school. You just can’t know these things without a good assessment. That is why a comprehensive assessment is so important for anyone with suspected ADD/ADHD or similar problems.