ADHD is Bigger Than Good Intentions
by Ari Tuckman, PsyD., MBA

Everyone has a gap between what they would like to do and what they actually do. Sometimes this means that we don't do as much of some things, sometimes it means that we do too much of others. For folks with ADHD, this gap can feel even bigger.

In a way, we could say that ADHD is a disorder of actualizing good intentions. Even though their performance may sometimes suggest otherwise, ADHD folks almost always mean well. After all, why would someone bring these kinds of troubles onto themselves if they could avoid it?

Living the life we feel we should takes hard work and hard choices. Doing the right thing requires the ability to resist temptation and distraction in the moment. When we don't do the right thing for ourselves, we are seen as self-indulgent. When we don't do the right thing for others, we are seen as selfish.

Resisting temptation involves sacrificing a small immediate reward for a larger later reward. For example, eating a salad rather than a cheeseburger in order to feel and look better in the long run. Or filing papers rather than watching TV. It's this ability to see beyond the temptation of the moment and into the future that allows adults to be successful-and is something that we work hard to train our kids to develop as they get older. This could be as simple as, "Put your jacket on before you go out," to "You can borrow the car if you get all your homework done first."

Russell Barkley, PhD, the world's foremost ADHD expert, created the response inhibition theory to explain why people with ADHD have the weaknesses that they do. In order to make that better choice that will benefit us in the long run, we need to first resist the more immediate temptation. By inhibiting that immediate response, we have created a moment to think about what is the best course of action. This is where folks with ADHD run into trouble-their brains aren't as good at creating that moment of reflection, so they tend to respond more based on what is right in front of them or whatever pulls harder. Unfortunately, the stimuli that pull hardest on us are usually not as good for us. For example, a cheeseburger will almost always taste better than a healthy salad; watching TV will almost always be more fun than filing.

So even though ADHD folks mean well and want to do better when it's hypothetical (i.e., "I should order a salad at lunch today,") in the heat of the moment, that cheeseburger will pull really hard on their decision making process. What this means is that, especially for folks with ADHD, if you want to do the right thing, remember the old adage of "lead me not unto temptation." It's much easier to do the right thing if you don't have worse options pulling on you. To tilt the odds of doing the right thing, keep these tips in mind:

• Don't put yourself into situations that require more self-control than you're likely to be able to muster. For example, just don't go into that favorite store that you tend to spend too much in.
• Eliminate distractions that are too likely to pull you off track. For example, turn off your email alert when working on something more important.
• Make the better choices loom larger in your decision making process. For example, if you're trying to lose weight, tape up a picture of someone in good shape or hang on the wall the outfit that you're trying to get back into.

Research Abstracts
Sam Goldstein, Ph.D.

Volkow, N.D. (2007). Depressed dopamine activity in caudate and preliminary evidence of limbic involvement in adults with ADHD. Archives of General Psychiatry, 64, 932-940.

Adults with ADHD and comparison controls were scanned with positron emission tomography using radioactive isotope sensitive to endogenous dopamine after placebo and intravenous methylphenidate administration. The nineteen adults in this study had never been treated with medication. The author concluded her study revealed depressed dopamine activity in subjects with ADHD, particularly in caudate and limbic regions of the brain. This pattern was associated with inattention and with enhanced reinforcing responses to intravenous methylphenidate. These findings suggest that dopamine dysfunction is involved with symptoms of ADHD and may also contribute to substance abuse comorbid with ADHD.

Thorell, L.B. (2007). Do delay aversion and executive function deficits make distinct contributions to the functional impact of ADHD symptoms? A study of early academic skill deficits. Journal of Child Psychology and Psychiatry, 48, 1061-1070.

The present study examined the distinct properties of executive functioning in relation to ADHD symptoms as well as functional outcomes associated with ADHD. Executive function deficits and delay aversion were independently related to ADHD symptoms. However, when the authors conducted separate analyses for the two ADHD symptom domains, only the executive function deficits were independently related to symptoms of inattention whereas only delay aversion was independently related to symptoms of hyperactivity/impulsivity. The authors concluded that their findings provided further support for the notion that executive function deficits and delay aversion are two possible pathways to ADHD, that these two phenomena can be differentiated in terms of their relations. The two ADHD symptom domains and the two processes of a dual pathway model may also be differentiated in terms of their effect on functional impairments associated with ADHD.

Thorell, L.B. (2007). Do delay aversion and executive function deficits make distinct contributions to the functional impact of ADHD symptoms? A study of early academic skill deficits. Journal of Child Psychology and Psychiatry, 48, 1061-1070.

The present study examined the distinct properties of executive functioning in relation to ADHD symptoms as well as functional outcomes associated with ADHD. Executive function deficits and delay aversion were independently related to ADHD symptoms. However, when the authors conducted separate analyses for the two ADHD symptom domains, only the executive function deficits were independently related to symptoms of inattention whereas only delay aversion was independently related to symptoms of hyperactivity/impulsivity. The authors concluded that their findings provided further support for the notion that executive function deficits and delay aversion are two possible pathways to ADHD, that these two phenomena can be differentiated in terms of their relations. The two ADHD symptom domains and the two processes of a dual pathway model may also be differentiated in terms of their effect on functional impairments associated with ADHD.

Dr. Goldstein is Editor-in Chief of the Journal of Attention Disorders.

Below are some interesting articles on ADHD and related topics:

• Children's Diet Not the Main Cause of ADHD
• AAP And American Heart Association Clarify Statement On ADHD And Electrocardiograms
• Increased Risk Of Smoking, Substance Abuse In Bipolar Adolescents Confirmed

Visit myADHD.com and use the follow tools this month to help children with ADHD establish household routines and to promote responsibility:

• My Daily Jobs
• My Morning Jobs List
• My Bedtime Jobs List
• Using a Home Token Economy Worksheet