From The Quarterly, Spring 2012

Attention Deficit-Hyperactivity Disorder (ADHD) is a disturbance of self-control, of what we call response inhibition, or delay of gratification. What happens is that these children are motivated to apply themselves, but they have trouble sustaining the effort. They start things and don’t finish them. They are easily distracted; they are inattentive; they give the impression they are not trying.

This is why ADHD was misunderstood for a long time—a confusion about willful control. If a child with ADHD is very interested in something, he or she will often pay attention. What people don’t appreciate is that we all have a threshold for effort, for attention, for our ability to apply ourselves, and the threshold for these kids is much lower. It’s not that it’s absent, but it’s lower. In addition, there are problems related to impulsivity, which gets them into a lot of difficulty. They interrupt, they talk too much, they have to have what they want now, they’re impatient, they rush into things; they don’t ask for things, they grab. But what we identify as the major symptom in ADHD is difficulty in sustaining attention.

If you say to a kid with ADHD, “Look at this,” the child will look, most of the time—but after a few minutes the child will drift away. The child will also have what I call an aversion to mental effort. If it is hard, mentally, they can’t stay with it. We all experience that, at a certain point—we say “forget it, I can’t do this!” But these young people repeatedly take the line of least effort. If they have something to do that requires application, they just do anything and move on. This used to be interpreted as ‘poor motivation’ or not caring about what people want from you. And that’s why it wasn’t recognized.

Although there is good evidence of genetic predisposition, we do not understand the biochemistry of ADHD. But that is not unique to this brain and behavior disorder and it is not something that should stop us from trying to help those who need help. All these symptoms interfere with the child’s ability to function up to his or her capacity—socially, interpersonally, and academically. These are children who should be treated.