It is now taken for granted that individuals diagnosed with ADHD need “point of performance” treatments. The accepted view asserts that those with ADHD are unable to recognize the future “in their mind’s eye.”  They require others to bring the future to the present so that they can be aware of the longer-term consequences of their actions.

This directive necessitates others to construct a management system that manipulates consequences so that they are immediate. The person diagnosed with ADHD can achieve, but only one small step at a time. As soon as the support system is revoked, the individual will fall back into the short sightedness of ADHD. He or she will operate only for immediate gratifications and longer-term safety and adjustment will be compromised. So let’s examine this view and identify some of its problems.

First, we expect that people subjected to “contingency management” will fall back to old behaviors when the system is revoked. When people learn to do behavior under conditions of coercion, they are not as likely to do those behaviors when the coercion is withdrawn. Whether the manager doles out rewards or punishments, the system induces pressure, and the behaviors are unlikely when the prodding stops. There is nothing unique about the failures of the ADHD population when “point of performance” intervention ceases. 

Second, what is the basis for asserting that individuals diagnosed with ADHD cannot see the future? Perhaps we are simply confusing their pattern of being less attentive to what others want with this supposed disability. People diagnosed with ADHD show behaviors that eventuate into impressive longer-term achievement without “point of performance” intervention quite often (e.g., learning guitar and auto mechanics), and they often show punctuality and time management when the goal is something desired (e.g., planning and coordinating with friends). They might not be doing their homework or chores, but their behavior is very different for activities that they initiate and enjoy.

People diagnosed with ADHD might be able to see the future just fine. But they might not be reinforced to do the behaviors that other value. People often avoid when activities are associated with negativity, and frequently, they continue to do behaviors that lead to future problems when the activities are pleasurable (e.g., over eating, smoking, not exercising, etc.). It seems incongruous that a child with ADHD can scheme and sneak to not get caught, but not see the future enough to recognize the problems associated with not doing homework.

Conclusion: It is not that people diagnosed with ADHD require “point of performance” intervention; it is that once we start that kind of treatment, we must continue to use it. This is true for most people, and it says nothing about whether people diagnosed with ADHD are unique in this regard. Moreover, when we assume that people diagnosed with ADHD need “point of performance” intervention, we are essentially dooming them to that limitation. If we do not socialize them to do actions and achievements valued by others without contingency management, we cannot expect them to behave in that way.     

When constructing the ADHD diagnosis, researchers essentially say, "Let's study a group of people who do particular hyperactive/impulsive and distracted behaviors associated with chronic and pervasive problems in school, social life, and work. If the person is an adult, the problems must be present in childhood and consistent throughout development. We can then call this group "ADHD" and study correlated biological characteristics and other associated difficulties. Of course, this is a work in progress, as the criteria can always be tweaked to the researcher's preferences.  

While not everyone in the designated group has each and every correlated problem and characteristic, sometimes researchers find that people assigned to the ADHD group also have other problems in common (i.e., driving problems, anxieties, executive functioning problems, fine motor difficulties, learning problems, failures to complete schooling, “hotheaded” dismissals at work, problems doing homework, and atypical patterns of brain biology and particular genes, etc.). But there are no dysfunctions or biological traits that can be used for diagnostic purposes. 

What goes unnoticed, however, is that the ADHD category of people gets transformed into people "having" ADHD. Qualifying for the criteria, magically converts into "having" something (even though nothing in that regard is identified).     

So when people say that ADHD is a chronic and pervasive developmental problem, of course it is. The criteria require it to be. And when we find that people qualifying for the criteria have other problems in common, why are we surprised. Quite often people behaving in similar ways, share other problems and traits in common. For example, cab drivers in London are more likely to have a larger visual-spatial cortex because navigating the streets throughout the day develops that aspect of biology. And it would not be surprising if they shared other problems in common as a function of dealing with traffic for long periods of time.   

Conclusion: While we are willing to say that people “have” ADHD, it seems peculiar to say that people “have” cab driving. ADHD is a category name, not an explanation even though people use it in that fashion.


Always remember, there might be a variety of precise and coherent ways to account for why a person might qualify for the ADHD criteria, and all of those accounts are theory not fact.  

 

Some ADHD experts theorize that children diagnosed with ADHD can perform well when playing video games because these activities provide "immediate reinforcement" or "instant gratification." The activity supposedly side-steps their inherent problem of not being able to identify the longer-term advantages that come from doing activities such as schoolwork. But this is only one way to understand the problem, and the understanding is flawed. 

First, many people respond differently to a task depending upon whether it is assigned by others or self-initiated. Think of the difference in the kind of reaction you might provoke when forcing someone to eat as compared to inviting the same person to have a taste of a food he might like.

Second, if video games "provide" immediate gratification, why do so many people avoid playing, stop playing quickly, or report very little pleasure when they play? Depending upon many different factors, people may enjoy a particular activity or dislike it (even if the people designing the activity put in a great deal of effort to make it pleasurable).  

Third, activities such as schoolwork can "provide" instant feedback, but people might still avoid, give up quickly, or rush to finish. And many people can be fully aware of the negative longer-term consequences of their actions, yet still continue to behave in those ways (e.g., smoking, over eating).     

An alternative explanation: Depending upon a child's history of reinforcement, some tasks will trigger ADHD responding. But it has nothing to do with a task "providing" instant feedback. Tasks associated with success and personal control are unlikely to trigger ADHD, while tasks associated with adversity, failure, negative evaluation, and loss of authority are more likely to evoke ADHD reactions.     

Yes, you can give a child extra rewards and threaten punishment, and those changes can get ADHD behavior to stop. But that does not mean that the absence of those "extra consequences" causes ADHD responding to occur. 

Helpful tip:You can also eliminate ADHD by increasing success with a task so that it triggers pleasurable associations. Threatening or offering a gift reward is not your only option.