Helping a child with ADHD develop social skills - Mayo Clinic Health System

Dr. Russell Barkley is an international authority on ADHD. His lectures and writings offer a somewhat different theory on ADHD than generally described in the popular literature. He states that ADHD is actually “… a disorder of performance”. He theorizes the ADHD child to be delayed in their development of self-regulation and self-control. Specifically, the ADHD child cannot effectively pause and think before responding to situational demands. Under developed brain neurology impairs the ADHD child’s ability to delay impulsive responding to immediate “here and now” environmental events.

This deficit in behavior inhibition disrupts the ADHD child’s performance at the point of responding to expectations. Noticeably absent from this symptom description are the deficits in attention commonly regarded as the primary disruption of ADHD. Dr. Barkley clarifies that problems with inattention should be characterized as an information processing disorder as opposed to the impairment regarded as ADHD. He states that an information processing weakness is a qualitatively different disorder of attention that should not be confused with ADHD.

In Dr. Barkley’s opinion, ADHD is over simplified when it is described as a disorder of attention. Instead, he understands ADHD as the inability to inhibit behavior long enough to self regulate, control, manage, and organize oneself so as to meet situational expectations. The mental mechanism controlling these abilities is often referred to as executive functioning. This mental mechanism that allows a person to self-control and self-regulate is the core ability that separates humans from other species. Self control allows the individual to pause, think, and consider different behavioral choices to various situational circumstances.

In contrast, the ADHD child lives in the moment governed by the impulse to immediately gratify their needs and interests. An impulsive, uninhibited, and under regulated ADHD child fails to demonstrate thoughtful, planned, and controlled behavior. This tendency is commonly observed in the egocentric behavior of the younger child. In the ADHD child, the development of behavior inhibition is substantially delayed similar to the egocentric behavior of the younger child. The ADHD child has difficulty at the point of performance, the point in time when they must respond to a behavior expectation. Under developed self-control and self-regulation interferes with the ADHD child’s ability to function an effective manner.

Dr. Barkley theorizes that the ADHD child is typically 30% delayed in their ability to self-manage, self-control, organize, and plan for their future. He suggests that the developmental level of the ADHD child can be estimated by subtracting 30% from the child’s chronological age (i.e. a 10 year old ADHD child functions more like that of a 7 year old). Although the ADHD child may have knowledge of the skills and abilities to better control or manage their behavior, they have difficulty demonstrating their skills due to deficits in inhibiting their own impulsive behavior.

The ADHD child is lacking in the internal restraints necessary to regulate their own behavior. They essentially have less capacity to self-direct and persist on a task in order to satisfy a future oriented goal. Future oriented and goal directed behavior is disrupted by their here and now orientation. Their under developed internal guidance and regulation tends to function inefficiently especially without external reinforcement and structural supports in their environment.

The 30 percent lag in the development of self-control and inhibition remains evident even as the ADHD child grows older. It is unlikely to anticipate a full recovery in the ADHD child’s ability to inhibit behavior. Yet it is still possible for the ADHD child to learn the strategies and modifications necessary to become higher functioning individuals. When we compare one person to the next, do we not recognize a great deal of variability in self control and self management across the normal population? Do we not recognize some individuals as characteristically disorganized and “scattered” personalities? Do we not hold high regard for those individuals who are masterful in organizing and “juggling” a number of activities at once?

A simplistic understanding recognizes the adhdchild to fall at the low end of the self management continuum. This suggests that most non-ADHD individuals likely fall somewhat higher on the same continuum demonstrating improved behavior inhibition and self management. Inherently, this notion appears to enjoy some good face validity especially as we recognize the tremendous variability of self management skills in the general population. In fact, many individuals will continually strive to improve their self management skills so as to be more competent and successful in their daily functioning. Most individuals place high value on orchestrated goal directed behavior. While some people are quite accomplished in focusing their energy towards quality performance, others will struggle in reaching higher performance expectations due to weaker ability to focus mental energies and persist towards goal achievement. Here we can recognize the ADHD child to be least accomplished in demonstrating behavior inhibition and managed goal directed behavior.

Dr. Barkley theorizes that deficits in behavioral inhibition disrupt the ADHD child’s demonstration of skills and abilities due to impulsive and unregulated responding. Despite enjoying a repertoire of life skills and abilities, unregulated behavior at the “point of performance” disrupts their efforts to demonstrate what they know.

George Gallegos is a licensed clinical psychologist practicing in the Sate of Colorado. He has maintained a private practice for over twenty five years during which time he has developed a long developing expertise with ADHD children. His current work with ADHD assessment and identification is conducted cooperatively with a large pediatric practice. Dr. Gallegos has more recently developed a 78-item test for ADHD entitled the ADHD Pre-Diagnostic Assessment (PDA). The PDA is an ADHD test for parents to use when initial concerns arise about their child. The PDA is intended as a primer measure when considering the possible need for a professional evaluation. The PDA can be used to discriminate essential factors that are predictive of ADHD or alternate conditions that interfere with classroom performance including learning.