Lecture Notes: ADHD as a Performance Disorder

Introduction

• Key Concept: ADHD is a disorder of performance, not of knowledge.
• ADHD involves executive functioning deficits, not a lack of knowing what to do.

Brain Functions and ADHD

• Brain Model: Simplified model of the brain as a two-part system:
  • Back part: Knowledge acquisition and storage.
  • Front part (Frontal Lobes/Executive Function Brain): Performance execution.
• ADHD Impact: Disconnection or dysfunction between knowledge (back of brain) and performance (front of brain).

ADHD as a Performance Disorder

• Knowledge vs. Performance:
  • People with ADHD have knowledge comparable to peers.
  • The issue is the application of this knowledge in real-life situations.
• Concept of Point of Performance:
  • Where and when knowledge should be applied, but often isn’t.
  • ADHD leads to ineffective guidance of behavior by knowledge.

Implications for Treatment

• Teaching Skills: Merely teaching skills to ADHD individuals is insufficient.
  • Knowledge acquisition doesn't translate into real-life application.
• Effective Treatment Strategies:
  • Designing "prosthetic environments" that facilitate performance.
  • Point of performance interventions are crucial.
• Medication:
  • ADHD medications work as they alter brain functioning to facilitate performance.
  • They are temporary solutions providing control over executive functions.

Behavior Therapy and ADHD

• Behavior Therapy:
  • Provides structure at points of performance.
  • Involves artificial stimuli (reminders, cues) and consequences (rewards, accountability).
• Motivational Aspect:
  • ADHD involves motivational deficits; therapies provide missing motivational cues.

Limitations and Future Directions

• Challenges in Training Executive Functions:
  • Current methods (games, EEG biofeedback) don't generalize well.
• Research Directions:
  • Potential in functional MRI feedback.
  • Emphasis on restructuring environments to support performance.

Conclusion

• Compensatory Measures:
  • ADHD interventions function as compensatory, not corrective.
  • Interventions should be maintained and adapted over time.
• Understanding ADHD:
  • Recognizing ADHD as a performance disorder aids in developing effective strategies and supports for individuals with ADHD.