ADHD in Ann Arbor: What is ADHD? Evolution in Understanding Over Time

Many individuals are confused about what is attention-deficit/hyperactivity disorder or ADHD. At CNLD, we utilize the work of various researchers in the field to help explain. One individual who provides clear and concise explanations of ADHD is Joel Nigg, PhD. He has written two excellent resources for parents and professionals: Getting Ahead of ADHD: What Next-Generation Science Says About Treatments That Work-and How You Can Make Them Work for Your Child; and What Causes ADHD? Understanding What Goes Wrong and Why.

In these resources, Dr. Nigg explains that ADHD was initially viewed as a problem of attention, then of executive function, and now it is seen as a problem with self-regulation. Self-regulation is similar to executive functioning but broader.

Dr. Nigg defines self-regulation as the following: the capacity to optimize our behavior, thinking and attention, along with our emotional experience and expression (thoughts, actions and emotions). Optimize means the ability to suppress or inhibit an impulse or control an emotional outburst, but also the ability to activate or energize and persist when needed.

Examples of inhibiting would include controlling blurting, resisting temptation, and not acting in ways you regret. Activating could involve any of the following: getting started, initiating and maintaining effort over time. We sometimes hear about adults or children who hyperfocus on activities, such as videogames. Hyperfocus refers to individuals who cannot optimize their attention, can’t really control it, and their attention controls them.

ADHD (particularly individuals who are impulsive) is characterized by an inability to get out of a spontaneous, excitable, or “highly reactive” state even when the situation calls for it. These individuals have trouble interrupting the path from internal thought or feeling to action leading to poor impulse control. In general, impulsivity is viewed as doing something for an immediate reward or trigger that defeats one’s established goals.

Individuals who are inattentive also have a problem with self-regulation (remember that regulating means optimizing). You may have heard of the term “sluggish cognitive tempo”. Individuals with sluggish cognitive tempo struggle with poor activation or may be underactive. They can’t get activation up to where it belongs, cannot initiate or raise their activity level effectively. In short, they are “too low and slow”. Overall, these individuals have poor self-regulation of their action but on the opposite side of impulsivity.

Dr. Nigg presents interesting ideas and suggestions for ways to help individuals diagnosed with ADHD. At CNLD, we utilize this information to help our clients receive the most effective and cutting-edge diagnostic assessments and interventions. For more information about ADHD, see our ADHD Clinic, ADHD Testing and Executive Function/ADHD Coaching webpages. You may also contact our office for more information as well.