1. Developmental Disorder - Failure to Develop

Chronic delay in developmental traits - quantitative differences Failing to develop on schedule

1.1. Inhibition

not suppressing irrelevant behaviour
cognitive impulsiveness
symptom - restlessness - gross motor activity and cognitive restlessness - internal restlessness
affects emotions - emotional impulsiveness - not a mood disorder -
mood disorder - generating too much emotion

ADHD - display emotions quickly - failure to regulate normal emotions - self regulation issues - to self sooth to self calm - quickness to emote
modify the emotion to be more acceptable for the context - socially acceptable less damaging
inability to manage frustration impatience and anger

closely linked to oppositional defiant disorder (ODD1.1.2 inability to make close friendships
Impact -
inability to make and keep close sustained friendships with other children

caused by emotional impulsiveness - quickness with which one emote - inhibitory issues

1.2. Attention Deficit - Executive Deficits

3 interacting attentional problems - better to be taught of as executive deficits and not attention deficits

there are at least 6 or 7 kinds of attention and supporting networks in human brain. they are all not disrupted by this disorder.

We need to know which one… ADHD is not the only attention deficit

1.2.1. Failure to Develop Persistence towards a Goal

Attention disorder in ADHD is well defined as failure to persistence

It involves
behaviour
motivation and
the future

It is not lack of Perception, Filtering, Processing etc.
these are other types of steps involved in attention that is not affected in ADHD.

nature of inattentiveness in ADHD is unique - failure of persistence

problem with motor part of brain

1.2.1.1. Motivation

can you sustain action towards a goal adequately to attain it

1.2.1.2. Failure to Direct Behaviour forward in time

failure to direct behaviour foreward in time
can not presist towards these delayed end points in life

1.2.2 Resist Distraction

Not a perceptual issue - a motor issue.

A person with ADHD have no problem perceiving a distractors compared to others but they respond to distractors more than others - inhibitory failure

compelled to react

distraction provoke a response and the response can not be inhibited

1.2.1. Ability to Reengage / Working Memory

person with ADHD is far less likely to reengage the incomplete goal

This is not of attention, this is a working memory disorder.
there is more than inattention

Working memory is one of the 5 executive functions

Working memory - remember what we were doing.. forget what the goal was.. working memory helps in reengage with the goal

ADHD forgets the goal and anything else compelling will capture their behavious

hence the symptom - skips from one incompleted activity to another

2. Self Regulation

ADHD must be looked at as Self Regulatory Developmental Disorder - this is a serious issue

A lot of profound human traits are not developing

What is self regulation?
Ability to
consciously and wilfully
choose to inhibit your behaviour and then
engage in series of self directed actions

actions to - long term self improvement .. long term welfare… delayed consequences

Self Control
is not learnt
not from parenting
it is neurogenetic

Our capacity to regulate ourself is a neurobiological trait and not socially learnt

not due to lack of training.. it had to do with brain development.

training can enhance / shape them but these do not originate in training

inability in self directed activities follows from the impairment in following 5 executive functions

2.1. Inhibition

Can you stop / wait / pause btw event and what you plan to do about it - response | stimulus response - dont you think

2.2. Non Verbal Working Memory - Visual Imagery

Mental imaginary - recall past - visual imaginary system - can not visualise relevant past - lack hindsight - no foresight - not thinking ahead

2.3. Verbal Working Memory - Self Speech

Can not talk to yourself - voice in head - help control oneself - at age 5 child start talking with oneself out loud and over time the speech is internalised and made private and mental - tells one what to do - they can not follow instructions, can not follow rules cannot internalise the rules

2.4. Emotional Control

Ability to manage emotions - to be more socially acceptable, consistent with goals and not conflicting with welfare - ADHD child easily frustrated, quick to anger, more emotional more excitable - minds heart

Emotions are the source of Motivations.. if you can not manage your emotions you can not manage your motivations - self motivation is the fuel tank for future directed behavious

So they can not rely on self motivation for their actions - can not motivate themselves

Always dependent on the environment around them and its immediate consequences for how hard and how long you can work

if there is not consequence you can not work - can not persist

video games provides 100% external continuous consequences

Consequences are delayed in real life - failure

this is not a choice, not wilful, this is an internal neurogenerative executive failure

2.5 Planning and Problem Solving

minds play ground
how many solutions can you think of to circumvent a problem
stimulate multiple possible future options

How quickly in your mind can you think of multiple ways to overcome the problem you just encountered

These 5 things are impacted

ADHD leads you to act on impulse, not resist distraction, less able to think back etc.. live in the moment

rob you of sense of time

disorder of time management

3. Types of ADHD

DSM is not accurate..
2 types

  1. with conduct disorder
  2. without conduct disorder

differentiation from SCT - Sluggish cognitive tempo (SCT)

ADHD is productivity disorder

4. Causation

all biological

social factors

One third acquired - not generic
mainly during pregnancy
disrupt development of frontal lobe
5% due to causes that affect ongoing brain development - trauma infection

lead poisoning
steps bacteria
lukemia

frontal part of the brain is small
some brain regions are smaller

5 regions impact ADHD
right frontal lobe
basel ganglia
cerebellum
anterier cingulare
corpus callosum

these regions are 3% to 10% smaller in children with ADHD

⅓rd males might have acquired the disorder

Profoundly genetic

5. Important Insights

5.1 Time Blindness

live in the now

the now is more compelling than the information you are holding in your mind

frontal lobe - organise behavious across time in anticipation of future

nearsightedness to future
only deal with things near in time
only deal with last minute

5.2 Build Pyramids of Behaviour

can not hierarchialy organise behavious
can not create bigger goal to biggeer goal
inability to organise behaviour across time into a hierarchy
ability to look ahead - intention
IDD.. intention deficit disorder
inability to organise around the intentions not insincierity / not intent

brain
back - acquire knowledge
front - performance .. use knowledge
ADHD - performance disorder

have all skills but can not use them

what to do?

all behaviour modifications are equal to ramps in the building

behaviour modifications are not for teaching / not instructional they are motivational

they will need more frequent consequences around them

care givers are the most important part of the treatment

chronic disorder
goal - to manage it; create reduction in symptom.. reduce secondary harm

Consequences

Results of untreated ADHD
undereducation