ADHD & Executive Functions: Emotional Control!
So, here is the DSM-V diagnostic criteria for ADHD. We are pretty familiar with these symptoms and recognize the impact they can have on a child’s life. Look them over for a quick review, and then we’ll discuss whether there is something missing from this list?
The diagnostic criteria for ADHD:
Six or more:
__ failing to pay close attention to details or making careless mistakes
__ problems sustaining attention in tasks or play activities
__ often not appearing to listen
__ having trouble following through with directives or fails to finish tasks
__ being less than well-organized and poor time management
__ reluctant to engage in tasks requiring sustained mental effort
__ losing things
__ being easily distracted by extraneous stimuli
Hyperactivity and Impulsivity
Six or more:
__ being fidgety or taps hands, squirmy
__ often leaves seat when remaining in seat is expected
__ often runs or climbs when not appropriate to do so
__ Unable to play quietly
__ moving around excessively and always being ‘on the go’
__ talking excessively
__ blurts out answers
__ having problems waiting for turns
__ having a tendency to interrupt and intrude at times
These signs need to be seen prior to 12 years of age and notably impacting a person’s life.
The missing piece!
It is becoming increasingly apparent that emotional dysregulation is such a primary aspect to ADHD that there is consideration of adding that specific symptom to the list of criteria. We don’t often think of emotional outbursts being related to ADHD symptoms, but they are. In fact, a secondary though related symptom is also very common; a hypersensitivity to rejection or redirection. I’ll be many of you are all too familiar with that aspect of ADHD even though it’s not part of the criteria.
Interesting impact of medication and behavioral modification
Medication often helps to improve attention and concentration, but an interesting additional effect is that kids often appear calmer and more at ease, even when faced with being told ‘no’ and when frustrated. That’s a reflection of the medication’s impact on that specific executive function of emotional control.
Hope that helps
It’s important to understand the scope of symptoms and executive functions associated with ADHD. If not, then we tend to feel confused, we can’t target treatment, and may even pursue unnecessary secondary diagnoses. If we know what we’re looking for, it’s easier to grasp, and then it’s easier to treat. God bless you and your kids.
Dr. John Carosso
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