[Understood for learning & attention issues]

What we know as ADHD,

[Thomas E. Brown, Ph.D. — Associate Director,]

[Yale Clinic for Attention and Related Disorders]

attention-deficit hyperactivity disorder—or

some people still call it "ADD," attention-deficit disorder—

has been recognized by some doctors

since way back in 1902. But from 1902 until 1980,

it was all about little boys who couldn't sit still,

couldn't shut up, and were driving everybody nuts.

It was just behavior problems.

The name of the disorder was changed

a number of times. There were different formulations.

But it was all about behavior problems.

Since 1980, which is when they first changed the name

of the disorder to include the words "attention deficit,"

we've realized that this is not so much

a behavior problem but far more a problem

with the brain's management system—

its executive functions.

And we also learned that there are many people

who have ADHD who've never had

any significant behavior problems.

And that even for those who have,

that's usually the least of it. It's the attention problems

that tend to make more trouble for people,

particularly as they get a little bit older

and more is expected of them

for being able to manage themselves.

One thing that's important to be clear about

from the very beginning is that ADHD has nothing to do

with how smart a person is. There's some people

who have this who are like super, super, super smart.

Others, high average, middle average, low average, slow.

I treat people for this who are like university professors

and doctors and lawyers and big shots in business.

A lot of people who are regular folks.

Some people have trouble doing the basics.

You could be anything along the IQ spectrum

and still have ADHD. It has nothing to do

with how smart you are. The other thing to know

is that this is a problem—a set of problems—

that include a wide range of characteristics,

and what I'd like to do today is to describe for you

some of the characteristics of what we call ADHD,

give some examples of them, and then talk a little bit

about what we know about what's involved

in the brain in the course of ADHD.

One thing that's important is that people—

one of the main things that people with ADHD

complain about is trouble staying tuned.

That when they're listening or reading or working

on something, they get part of it,

but then it sort of drifts off, and then they're back,

and then they drift off, and it drifts off again,

and then they're back.

They have difficulty staying tuned.

It's similar, in a way, to the problem you have

with a cell phone where you're in an area

where you don't have good reception. You can get

part of it, and then the message keeps fading in and out.

The other thing is that they often have a problem

with being distracted. Like anybody else,

they see and hear things that are going on around them.

They have thoughts going through their head.

But most people, if they have something they've got

to focus on, can push that stuff out of the way and focus

on what they've got to do. People with ADHD—

it's real hard for them to do that. They'll be sitting

in the classroom trying to listen to what's going on,

or perhaps they'll be in a meeting or sitting down

trying to read something or write something,

and somebody drops a pencil, and they have to sort of

check and see, where did the pencil go?

Then they'll be back on task again

for a couple of minutes. Then they're thinking

about some TV show they saw the night before.

And then they're back on task again for a minute,

so they're thinking about some conversation they had

with somebody two hours ago. And then they're back

on task again for a few minutes, and then they're looking

out the window like anybody else will from time to time,

but they're likely to sit and watch the squirrel go up

the tree a little longer than somebody else

and be checking out the traffic and the cloud formation,

the guy who's mowing the lawn.

Then they're back on task again for a few minutes,

and they'll be thinking about what they're going to do

when this is over and how soon is this thing

going to be over anyhow. I've got things I've got to do.

And what am I going to have for supper tonight?

And I wonder what's on TV tonight?

All these things are coming in all at one time,

and it's almost like you're trying to watch TV

and you've got four different stations all coming in

at the same time on one channel, and it gets kind of hard

to separate the signal from the noise.

But the thing that's puzzling about this,

that really makes it very difficult for people to understand,

is for people who have ADHD, it's like that

almost all the time, but not always.

Everybody I've ever seen who has ADD—

and that's a lot of people—has a few things they can do

where they have no trouble paying attention,

no trouble focusing.

Let me give you an example. Sixteen-year-old boy

I saw—he was the goaltender for his school's

ice hockey team. And it just happened

that the day his parents brought him in to see me

was the day after his team had just won

the state championship in ice hockey, so they're bragging

a little bit at the beginning about how great he was

in the tournament the day before. And apparently he was

a very good goalie. They said when he was in there

playing hockey, he missed nothing. He knew

where the puck was every second of a fast game.

Totally on top of it. The kind of goalie every team wants.

Smart kid. Tested way high up in the superior range.

Wanted to get good grades. Was hoping to go

to medical school. But he was always in trouble

with his teachers. And what they'd say to him is,

you know, once in a while you'll say something

that shows how smart you are.

We'll be talking about something. You'll come in

with some comment that's really very perceptive,

and it's quite impressive. But most of the time,

you're out to lunch. You're looking out the window.

You're staring at the ceiling. You look like

you're half-asleep half the time. You don't even know

what page we're on. And the question they kept asking

him was, "If you can pay attention so well

"when you're playing hockey, how come you can't pay

attention when you're sitting in class?"

Here's another example. A lot of times parents will bring

in kids for me to see, and they say, "You know,

"the teacher says this kid can't pay attention

"for more than five minutes. We know that's not true.

"We have watched her play video games.

"And she can sit and play those video games

"for three hours at a time and not move.

"And the teacher said she's easily distracted.

"That's nonsense. When she's playing those games,

"she's locked on that screen like a laser,

"and the only way you're going to get her attention

is to jump in her face or turn off the TV."

So again, it's like, you can do it here.

Why can't you do it there? Now, it's not always sports

or video games. There's some people with ADD—

they're not good at that stuff. They might be into art,

and they're sketching and drawing and really getting

into it. Somebody else, when they were little,

they're creating engineering marvels with LEGO blocks.

And then when they're older, they're taking car engines

apart and putting them back together

or designing computer networks. But everybody

I've ever seen who has ADHD has a few things

they can do where they have no trouble paying attention,

even though on almost everything else, they've got

a lot of trouble paying attention. And if you ask them

about it, you say, "What's with this? How come

"you can do it here and you can't do it here, here,

and here?" Usually what they'll say is, "It's easy.

"If it's something I'm interested in, I can pay attention.

If not, I can't." And most people hear that and they say,

"Yeah, right. Congratulations. That's true for anybody.

"Anybody's going to pay attention better for something

they're interested in than for something they're not."

Which is true. But here's the difference.

People who don't have ADHD—if they've got something

they've got to do and they know they've got to do it

and it's important, they can usually make themselves

pay attention, even if it's pretty boring,

just because they know they have to do it.

People with ADD—it is incredibly difficult for them

to be able to make themselves pay attention

unless the task is something that's really interesting

to them, not because somebody told them

it ought to be interesting, but just because it is interesting

to them for whatever reasons. Or if they feel like

they have a gun to their head and something

very unpleasant is going to be happening very fast

if they don't take care of this right here, right now.

Under those two conditions, no problem.

They can focus very well. Anything else,

it's really difficult for them to focus.

But the problem is, this is not something

that's under voluntary control. It makes it look

like it's a problem with willpower. "If you can do it here,

why can't you do it here, here and here?"

But it's not a problem with willpower. It's a problem

with the way the brain is wired. All the characteristics

of ADHD, which I'm going to be describing here,

are things everybody has trouble with sometimes.

It's just people with ADD have a lot more trouble with it.

So in that sense, ADHD is not an all-or-nothing deal

like pregnancy, with, either you are pregnant

or you're not pregnant. There's nothing in between.

It's more like depression, where everybody

gets bummed out once in a while. But just because

somebody's unhappy for a couple of days doesn't mean

we're going to diagnose them as clinically depressed.

It's only when those depressive symptoms are persistent

and pervasive and making a lot of trouble for them,

we say, "Yep, that's a depression.

We ought to do something about it."

So all the characteristics of ADHD are problems

everybody has sometimes. It's just, with people

who have ADD, they just have a lot more difficulty with it

more of the time. And the problem is,

it is not under voluntary control.

It's not something you can do with willpower.

But let me tell you about some of the other things

which we see with people with ADHD.

One is they often have trouble getting organized

and getting started on things. For many, it's difficulty

organizing their stuff—their backpack, their desks,

their notebooks, their filing system, their living space—

bigger mess than most other people most of the time,

unless somebody else is helping them take care of it.

Other people have no trouble at all with their stuff.

They have a lot of trouble with their time and their work.

And what they'll tell you is, "If I have a bunch of stuff to do

"at one time, it's really hard for me to look at it and say,

"'OK, that should be first. That should be second.

That should be third.'" But even when they get

their priorities straight, which often doesn't happen,

they tend to have a lot of difficulty getting started.