This account was put forward to address concerns that individuals diagnosed with ADHD were showing focused attention in a variety of situations and circumstances. Since this was true, ADHD could not be an “inability to maintain focus”. ADHD then became an inability to “regulate attention.”

The problem is that "inability to regulate attention" is assessed when people show inefficiencies in response to work. It is interesting that hyperfocus occurs during pleasurable activities, while failures to maintain focus occur in response to assigned activity (i.e., what others want them to do).  

 A learning paradigm (as compared to neurological delay) may be a more reasonable way to account for ADHD data. Individuals may hyperfocus to maintain involvement with activities they like and they show distractibility (i.e., escape, avoidance) and other inefficiencies (e.g., rushing, carelessness, desperation) when dealing with stipulations, evaluations, and other adversities. 

Why introduce a neurological account when a psychological account has not been ruled out???       

Many people seek diagnoses (this is true for ADHD and other diagnoses). Researchers seek diagnoses to help them organize their investigations of etiologies and treatments. Drug companies seek diagnoses so that they can coordinate medicinal treatments with diagnoses. Schools seek diagnoses to justify extra services and to justify achievement scores that do not meet performance expectations. Insurance companies seek diagnoses to substantiate medical necessity.  Individuals seek diagnoses to justify failures, to access accommodations and services, and to direct them to particular forms of treatment. And doctors (and other practitioners) seek diagnoses so they can recommend appropriate therapies.

People who struggle want to know why they struggle and they want a remedy. The diagnosis is supposed to provide the "why" and the hope of a "remedy". However, with ADHD (and with other psychiatric disorders) the diagnosis is a "category name" for a list of behaviors (not an explanation) and the recommended "treatments" that coordinate with the category name have been less than stellar (particularly in the longer term).

Since a diagnosis justifies access to particular medications and services (and those have the potential to increase performance), of course there will be many people claiming the diagnosis as it will give them access to the performance enhancements. And the more people hear and talk about a diagnosis, the more they see it.



 

Traditional View

In the accepted view of ADHD, we tell people that they have a permanent disorder. They learn that their brains are less capable of doing self-management. This developmental delay called “ADHD” renders them less able to organize their behavior for longer-term success. They will always be more dependent on external forms of assistance when trying to meet expectations.

                The Benefit

When told about their disability, the expectation is that the “afflicted” person will have a grief response. He or she will go through a mourning process. But in the end, they will know why their life has been in shambles. That awareness will comfort them. They will know that ADHD is not their fault, and they can seek the necessary assistance from medicine and other forms of compensation. Impaired Individuals can accept the view that they are “unable”, and they can abandon efforts to self-manage without regret.    

Psychological View

In the alternative view, ADHD responses have psychological meaning; the responses are not “defective"or “lacking in control.” The responses are ways to deal with discomfort, and they occur in particular situations. Yes, the responses can lead to many unwanted consequences, but they also yield advantages that are difficult to ignore. People with ADHD may have all kinds of disorders and problems, but ADHD behavior is not “disordered.”      

                The Benefit

There is a presumption of competence, and the anticipation that those diagnosed with ADHD can alter their ways of coping. Instead of mourning the presence of a disability, psychological sense is made of the socially unacceptable responses. Rather than infer incapacity, treatment changes responses to adversity. Increased familiarity with the situations that trigger the reactions and alternative ways to handle the problematic circumstances become the focus of therapy. The inadvertent reinforcement of the behavior comes to an end, and self-reliance and cooperation is fostered.  

Conclusion

People with ADHD learn that the behaviors are frequent due to reinforcement; the label does not imply defect, disruption, or delay.  There is great power in this understanding. When people recognize that they are doing ADHD, they can learn to do something else.       

ADHD responding is a way to cope with not having what you want and not liking what you have. Those diagnosed with ADHD can learn to handle these situations in a socially acceptable fashion through the introduction of new learning.

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.        

No one is debating that some people behave in ways that result in longer term problems. The issue is how to account for their atypical behaviors and is the ADHD “inhibitory model” believable. Let’s take the example of a person diagnosed with ADHD “blurting” out something inappropriate that leads to his getting terminated at work. The ADHD “inhibitory model” says that he wasn’t able to suppress those unacceptable behaviors because of his ADHD. His ADHD kept him from promoting his longer-term future success.

However, when a non-ADHD person does not act out inappropriately when upset with his boss, does he first have to suppress the angry response to remind himself that he could get into trouble, or does he immediately (when feeling threatened by his boss) respond with deference because he has been conditioned over time to do whatever it takes to keep his job.

Patterns of deference to those in authority in the workplace may develop in relation to what has happened during many years of socialization in particular situations and circumstances. The person who shows deference at work may come home and yell at his children (despite the fact that this also leads to longer-term problems), and the person diagnosed as ADHD may not “blurt out” at all when being pressed by someone to admit wrong doing. However, if ADHD prevents suppression and awareness of longer-term consequences, why doesn’t his ADHD prevent him from suppressing in that situation?

Many factors may come into play when accounting for whether a person is careful or behaving in ways that result in getting fired. For example, does the person behaving inappropriately have a history of others providing support or rescue when he gets into trouble, is he happier not working, does his boss trigger an intense unresolved problem, and is he accustomed to fighting back when others are difficult or insulting rather than conditioned to submit?

There is yet another important problem with the ADHD “inhibitory model.” If you have to suppress to identify longer-term problems and solutions, how do you (or your brain) know when to suppress? This dilemma renders the “inhibitory model” untenable. It would seem that people must already know that a situation is problematic when they pause, and that is what stimulants them to pause in the first place.Their  brain activation during the pausing interval reflects what they are doing. It does not establish evidence of a suppressing response.       

Rather than adopt the ADHD “inhibitory model”, let’s assume that people have immediate associations in certain situations (in relation to their learning history). Yes, unlike other animals, people may have associations about more distant events. However, these associations may occur just as immediately as associations about more current time events and do not require a pausing response to take place (e.g., seeing a store and immediately remembering items bought at the store many years ago, etc.). If or when a person is aware that a short-term or long-term problem exists, he or she might have a pausing response; it is not that the pause helps the person become aware.

Biological delay is not the only way to account for the fact that some people keep doing behaviors that produce longer term problems. Their history of living in the world might account for their actions quite well. For example, when a 12 year old female diagnosed with ADHD overheard that her therapy session was going to be scheduled on a Friday, she immediately protested because she had the time distant association that her appointment was going to interfere with the possibility of having a sleep over party. The debate in not about data, the debate is about the interpretation of data and the problematic ADHD "inhibitory model" is quite inadequate to account for the behavior of those diagnosed with ADHD.