ADHD: Alternative Views

The Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV) describes four subtypes of Attention Deficit/Hyperactivity Disorder. These subtypes, excluding the NOS (not otherwise specified) variety, are based on observable behaviors. The criteria for diagnosis, which include the necessity for six or more symptoms to constitute a diagnosis of either the Inattentive or Hyperactive/Impulsive Type and the need for symptoms to cause some impairment prior to the age of 7, have been repeatedly challenged.

Preliminary reports indicate that there will be many changes made to the diagnostic criteria for Attention Deficit/Hyperactivity Disorder in the forthcoming DSM-V when it is published in May 2013. These changes include reducing the number of symptoms that adults must exhibit in order to meet a diagnosis, changing the age of onset criteria from 7 to adolescence, and separating into a distinct category those individuals who display signs of inattention but not of hyperactivity.

There has been longstanding controversy as to whether ADHD, Inattentive Type should be a diagnostic category distinct from the other Attention Deficit/Hyperactivity Disorders that include signs of hyperactivity and impulsivity. Due to the ADHD, Inattentive Type controversy, there have been many alternative views expressed. Russell Barkley, Ph.D., a preeminent scholar on attention problems, describes many children who are frequently inattentive, day-dreamy, and slow-moving, but do not fit the typical profile for youngsters with Attention Deficit/Hyperactivity Disorder, as having a “sluggish cognitive tempo.” Clinicians have noted how these children differ in many other subtle ways from the “typical” ADHD child.

Attention Deficits and Executive Functions

Children with attention problems are often characterized by deficits in executive functions. They may have difficulty getting started on tasks and sustaining their attention and effort levels at home and in school. They also have problems following directions, keeping things in mind, and effectively managing their time. Having difficulty regulating their feelings, easily becoming frustrated, and readily giving up when a task becomes too difficult are issues also observed in these children. Researchers, led by Russell Barkley, Ph.D. and Thomas Brown, Ph.D., have begun to characterize attention deficits as a problem of executive functioning. Problems shifting attention and exercising short-term working memory, difficulty in guiding behavior toward the future (planning), and an inability to inhibit responses are the core components of Attention Deficit Disorders when viewed as a Disorder of Executive Functioning. These symptoms tend to be chronic and to cause great impairment in youngsters with attention problems. While children may be able to perform some of these executive skills “if they are interested,” their consistent difficulty in applying them appears to be brain-based rather than motivational in nature.

If this alternative view of attention problems describes your child, then you are encouraged to learn more about executive functions and attention difficulties. To learn more, click on the links to the Executive Functioning pages of this website, or explore some of the following links:

LearningWorks for Kids: The best website for learning how to use innovative technologies to help your child with ADHD. LearningWorks for Kids is one of the preeminent websites about Executive Functions and Thinking Skills in Children.

Dr.Thomas E. Brown: Thomas Brown’s website describes ADHD as a Disorder of Executive Functioning.

Help 4 ADHD: Information from the National Resource Center on ADHD.