ADHD is expressed in many different ways
In Chapter 2 of “Getting Ahead of ADHD”, I emphasize that ADHD is not a one-size fits all condition. This is because ADHD taps into a more general process called poor “self-regulation.” Self-regulation affects everything from how we deploy our attention, to whether we are impulsive, to how we manage our emotions. So, if your child has ADHD plus a tendency to depression or anger, their struggle with self-regulation will mean they struggle more than many children with depression or anger also. If your child has ADHD plus a tendency to be exuberant and outgoing, then they may be extremely this way—in contrast to another child with ADHD. Some types of self-regulation problems lead to a problem inhibiting behavior—so a child is very impulsive. Others lead to a problem activating behavior-so a child is quite sluggish and cannot initiate their activity when they should. (That’s related to the old concept of ADD or pure inattention or the newer concept of sluggish cognitive tempo). As we all know, even if two people look the same, they can behave very differently.
Personalized plans are most helpful
Likewise, even though it’s usually impossible to trace the cause of ADHD in a specific child, we know that at a population level ADHD has many causes. It is influenced by perinatal problems, by maternal and paternal health, by genetic makeup, and by other factors. We see distinct profiles of brain organization in subgroups of children with ADHD in our studies, as one example. All of this suggests there are likely several ways to have ADHD and several forms of it, which science is still finding out how to describe. As a result, it is important to personalize the treatment plan for your child based on what works for your child and your family, in consultation with a professional. Ulimately, we hope to discover the right prediction models to know which personalized plan is right for each child. Until then, it is a matter of combining best professional advice with some individual trial and error.
Always Look For The Science
You can find it in Getting Ahead of ADHD and with every Dr. Nigg blog post:
Karalunas, SL, Fair, D, Musser, ED, Aykes, K, Iyer, S., Nigg, JT. (2014). Subtyping ADHD using temperament dimensions: Toward a biologically based nosology. JAMA Psychiatry, 9, 763.
Costa Dias TG, Iyer SP, Carpenter SD, Cary RP, Wilson VB, Mitchel SH, Nigg, JT, Fair DA (2015). Characterizing heterogeneity in children with and without ADHD based on reward system connectivity. Journal of Developmental Cognitive Neuroscience. Feb 11, 2015, p 155-174