adhd

The original learning for ADHD consists of two processes: attentional depletion and attentional avoidance. While there are no pure cases of depletion or avoidance, attentional depletion tends to happen first with avoidance following that. For the purpose of clarity, I will discuss them separately. The first section describes the usual, but not rigid, progression in the development of attentional depletion. Following that will be a description of attentional avoidance.

Note: There are several alternative terms for attentional resources showing up in the popular press that you should be aware of and know that they describe the same concept. This includes executive function and working memory. When your child uses up attentional energy, this is the same as saying he is using up working memory. If he has less working memory (attentional resources), he will show less executive function (guiding his attention and behavior volitionally).

attention depletion

Children, much like people on a diet, usually understand what is required of them and want to comply. However, when under stress, the person on the diet is more likely to break their diet just as the child is more likely to misbehave or stumble at reading. The research is very clear that all of us have much more difficulty staying on diets or exercise programs, and are less able to control drinking, drug use and smoking during periods of stress.

Likewise, a child under stress is more likely to exhibit behavior problems, social skills deficits or learning difficulties. These problems result from the very limited amount of attention that we humans have to devote to a task when negative emotions drain our attention. In essence, our attention is “depleted” by emotional arousal.

This phenomenon is illustrated by an experience familiar to all of us. Have you ever been in an argument, but you felt you didn’t “perform” very well? Then, an hour later, when you were calm, and your heart had stopped pounding, you were suddenly inspired and thought of all the clever things that you could have said in the heat of battle? Given that you have the same brain and the same knowledge in your brain, why were you so much more brilliant an hour later than in the middle of the argument?

During the argument, emotional arousal was using up all of your attentional resources so little was available for clever thought. You are brilliant later because emotions were no longer draining your attentional resources. You are able to think clearly when you are calm about what you could have said.

Few of us can respond well when we are emotionally aroused, be it from an argument or, for a child, by the anxiety and frustration of homework.  There is nothing left to search your mental database for clever retorts. Your attentional resources are depleted. This is exactly the same problem that many children face doing school related work. The emotional arousal is so strong that there are no resources left to access the skills they have.

The other thing that happens when attentional resources are depleted relates to the “hyperactivity” part of ADHD. In addition to stress affecting thinking, when emotions drain attention from more rational processes, self-control sometimes flies out the window. At extreme levels, one gets crimes of passion, road rage, suicide, etc. In those circumstances, there is no rational thinking, only acting out. At a lower octane level, it is breaking a diet, getting short tempered with loved ones, or, for a child, it may be running around a classroom when asked to do math problems that make him anxious.

When stressed, people  are much more likely than when not stressed to escape noxious stimuli by escaping into fantasy or acting out in anger, or eating or whatever immediately decreases the stress.

When such lapses of control happen in adults, we consider this “acting out” as a temporary “being out of gas” or “burnt out” for attentional resources. When it happens with children, we assign them a pathology by saying they have ADHD, a behavior disorder, a learning disability, or a social skills deficit. These latter descriptions imply that with children, these lapses in attentional resources are more or less a permanent steady state: a disability or disorder.

There is a big difference in how we relate to someone whom we see as experiencing temporary problems vs. having a permanent disorder. We can all relate to experiencing stress at one time or another and the feeling of “losing it” when we are stressed. When we perceive something as a permanent disorder, we blind ourselves to how the situation is causing the stress. Thus, we assume the problem is a characteristic of the person and they would act that way in any situation: i.e., the disorder is what makes them act the way they do. To illustrate what I am talking about, let’s look at the following scenario to put ADHD attention resource depletion in perspective.

ADHD: Adult reality check

Imagine for a moment, as an adult, heading off to spend a six-hour day in a small unpadded seat, year in and out, listening to someone talk about something that you did not ask to hear about and are not interested in? You only get half an hour for lunch and if you are lucky a 15 minute break mid-afternoon.

You cannot talk to those around you when you want to. You cannot go to the water cooler when you are thirsty or want a social break. You sometimes cannot go to the bathroom when you need to. You cannot pull a snack out of your bottom drawer, make a phone call at will, send email or cruise the internet from time to time.

The boss is constantly looking over your shoulder and correcting the details of your work. At any moment you may be asked to speak extemporaneously in front of your co-workers. The pay is nonexistent. It is not a job you ever wanted, but you cannot quit. Oh yes, and you have the bodily energy and the need to run of a race horse in the starting gates. If you cannot conform to this regimen, you will be spoken to harshly, blamed, and possibly diagnosed and drugged.

While the above description may be a bit harsh, it is not too far from the reality of many classrooms. Would you swap jobs with your child? Would you likely be stressed and thus attentional resource depleted if you did his job? Think about it. It is no wonder some of them quit in the only way they can. ADHD is their mental resignation. It could stand for Adios Hellish Dungeon.

Diagnosing a child with a disorder is a cleverly disguised way of blaming the child for being the problem rather than having to look at how the situation itself might be provoking the child’s problems. Diagnosing the child serves to shift the responsibility for correcting the problem from those who control the child’s situation and what he does, i.e. parents and teachers, to the child, who often has no control over the stressors that are in his life. This is certainly not to say a child is helpless or blameless, but change must rest squarely with the adults involved and how they deal with the child’s problems.

Most children do intend to behave well.  The problem is that these intentions are foiled in the same way the dieter’s intentions are foiled. Emotional arousal prevents them from doing the intended behavior and often provokes acting out instead. When a child is forced to be in a school situation that he experiences as frustrating and confusing, controlling his behavior is as difficult as it is for a dieter trying to stay on the diet at a Christmas party!

Steps from depletion to avoidance

What follows describes the usual progression of the development of attentional depletion described above.

1. Arousal

For ADHD kids, the process begins with some situations in the classroom and at home causing emotional arousal. This could be related to particular teachers, school subjects, peers, etc. The emotions could be fear, anxiety, anger, happiness, excitement or grief etc. Though any arousal uses up attentional resources, negative emotions cause more depletion than positive because bad emotions are stronger than good ones (85, 86). This is why children from violent or chaotic homes have so much difficulty in school. Their emotional arousal from their personal lives saps all the available attentional resources so that little is available for schoolwork.

2. Behavioral Avoidance

When the negative arousal increases or is repeated on many occasions, the child quits “trying” to do something and begins to behaviorally avoid the activity. An example might be postponing homework, or making excuses why it cannot be done, such as “I forgot my book,”  “It’s too hard,” or “The teacher did not explain that.” At this point, he is still aware of what he needs to do, but attempts to get away from the aversive stimuli.

3. Inefficient work

When he finally tackles the task, he still makes some effort to complete it, but his attempts are very inefficient and often fail. He appears to be working at a task, but makes little progress and/or the quality of work is poor. Typically, the child will stare at the assignment, make a few marks on their paper, erase their work, or turn pages in their book.  The harder he tries or is pushed by someone to perform, the less successful he is.

There may be an increase in emotional intensity, irritability, anxiety and depression. This may be expressed in negative self-descriptions, such as: “I am stupid,” or “My brain is munched.”

4. Exhaustion

Eventually the child may appear dejected, hopeless, helpless and depressed. This is usually the result of mental exhaustion (attentional depletion) rather than true depression.

Because of the rising discomfort that is caused by depletion, the child may move from depletion where he is still attending, but ineffectively, to attentional avoidance where he mentally abandons the situation. Avoidance begins to replace depletion.
By eight years old, most children are developmentally able to shift from attentional depletion to attentional avoidance. After age eight, children learn to conserve their attentional resources by becoming skilled at avoidance. I call this process ADHD is a Conditioned Attentional Avoidance Loop (CAALM). Thus, the prevalence of the hyperactive-impulse subtype of ADHD decreases dramatically after 8 years of age and the Inattentive, CAALM driven, type is more common

5. Attention conservation

Shifting from depletion to avoidance is an attention conservation strategy. Why does this happen? Our minds are implicitly aware of the need to conserve attentional resources for future needs. When you anticipate the need for future self-control efforts, you automatically reduce the amount of attention you expend on a current self-control task to conserve for future needs.

For the ADHD child, avoidance serves an immediate purpose. It is an effective adaptation that decreases attentional depletion by reducing the drain on attentional resources. We observe this process and thus the label of the “attention deficit” part of ADHD.

When tasks are experienced as aversive, futile and debilitating, an effort is made to tune out the experiences that cause the distress. Spacing out allowschildren to avoid squandering all of their attentional resources on what appears to be a futile and exhausting effort. By doing this, they can preserve their functioning for other areas they do find enjoyable such as games, sports, drawing, socialization, or creative activities.

Transition from depletion to avoidance

The transition from depletion to avoidance is not consistent, uniform or permanent across times and situations. Children may be depleted at one time and avoidant at another, though the avoidance usually follows a period of frustration and “getting nowhere” with attempts to attend that result in depletion.

The scope and seeming increase of children’s attentional problems is being exacerbated by a number of cultural trends. We are pushing our children to be more productive and stay in contact with academic tasks longer. Recesses and physical education are fading from school curricula, forcing more continued academic work without physical release. In addition, many children extend the schoolwork day by participating in after school tutoring and lessons.

In past generations, kids had more physical outlet time, both at school and at home. My generation always had ample recesses and a long lunch hour that concluded with playground time. In addition, kids in the past would have free run of the neighborhood after school. Current concerns for safety often keep children tethered closer to home and in some situations such as dangerous inner-city areas, stuck in their homes with no available outlet for their physical energy.

Children are responding to this decrease in “break” time and thus increase in forced attention to academics and inactivity in the same way adults are responding to the increasing onslaught of advertising. The more advertising that is hurled at us, the less we notice it .  Children who are forced to attend to schoolwork with few breaks for long hours become attentionally depleted and can no longer absorb information.

More efficient, and certainly more pleasant for the child, would be less, higher quality, more focused and better timed input as well as more recesses and physical activity breaks. Because more attentional resources would be available during learning time, this would garner more  efficient learning and compliance.

Attentional Avoidance: advanced stage of disengagement.

As we have seen, conditioned attentional avoidance is the advanced stage of disengagement. This causes the classic ADHD lapses of attention. At this stage, a child may be described as being “in his own little world” or “spaced out.”

Since kids cannot escape physically, they find that if they escape in a daydream about skate boarding or hanging out with friends, physically being in math class does not feel as bad. Over time, children’s minds become well trained to quickly shift focus away from schoolwork and homework and toward more pleasant images. This is a highly sophisticated, efficient, effective, and well trained defense system that is crafted to deal with the aversive feelings that school and homework cause. It is not a defect or deficit, but a useful skill  that makes the child more comfortable.

At this point, the child appears to have given up and makes few attempts at doing his work. He may just wander off in an absent minded fashion. While it may seem odd to watch, he is behaving in the same automatic fashion that you use to drive your car to work while you think of weekend plans. One parent described her child’s behavior in the classroom as “constantly getting up and walking around at odd times.”

When in this fantasy state, the child feels little pain and is quite agreeable if you do not interrupt his fantasy world. He may become disruptive or grouchy if you interrupt his fantasy life because it forces him to experience the aversive situation that he has learned to escape. His negative response can also result from the negative tone adults use when attempting to get him back on task.

If you question him in a non-threatening, non-judgmental way, and you do not have a threatening judgmental history with him, which most parents and teachers have, he can often describe the fantasy world that he retreats to when spaced-out.