ADHD Behavioral Patterns

by Joseph M. Carver, Ph.D.

(Page 3 of 6)

The following patterns have been found in Attention-Deficit Hyperactivity Disorder (ADHD) children and adults. The patterns are identified through a combination of professional research and twenty-seven years of clinical experience with ADHD.

Difficulty Understanding Sequence
Life moves in a series of sequences, one event connected to another and to another as our activities continue. ADHD children/adults have difficulty with understanding sequences, creating a variety of problems. For example, if you have an appointment in your hometown, you anticipate the amount of time needed to prepare, drive to the office, park the car, and register - perhaps 60 minutes. For ADHD Johnny, the short attention span makes understanding sequences very difficult. Getting ready for school is a nightmare as ADHD children don't understand that time is involved in every activity. They somehow figure you can get out of bed at 7:45 am, shower, eat breakfast, brush their teeth, gather their books, and get dressed -all before the bus arrives at 8:00 am.

The inability to understand sequences is the cause for the amazing ability of ADHD children/adults to always get caught when doing something wrong. ADHD children/adults are unable to be "sneaky" due to this trait. As a parent, you can watch the ADHD child grab a cola from the refrigerator and sit in the next room to watch television. You walk in, notice the cola is spilled, and question them about the spill - to which they reply "I didn't do it!" ADHD children can't figure out how you know the sequence of events that allows adults to figure out who did what. They can't project sequence forward or backward.

This inability to understand sequence and time creates many problems for the ADHD teenager. Told to be home at 7:00 pm, the ADHD teenager leaves at 6:00 pm to visit a friend. They walk to the local video store where they meet a friend with a new game. They follow the friend home to check out the game. A contest follows and the friend's mother provides soda and snacks so the ADHD teenager doesn't get hungry. Eventually, the friend's family bluntly tells the ADHD teenager to go home - it's 10:00 pm! Upon returning home, the ADHD teenager is at a loss to explain why he's three hours late, didn't call, and was rude to stay too long at the friend's home. Despite grounding, the same behavior is repeated within a few days.

"I don't know"
When confronted with a misbehavior and asked "Why did you do that?", the number one response from an ADHD child is "I don't know!" This response is a combination of two behaviors in ADHD children, the lack of sequence understanding and the presence of tangential behavior. In geometry, a tangent is the single point at which two separate objects touch. Due to a short attention span, ADHD children jump from one activity to another, the two activities often linked together by a glance. If asked to clean the top of their desk, they wipe a bit, examine the lamp, read a comic, staple a few things, pull tape from the dispenser, and reprogram the phone - one behavior leading to another as they look around the desk. Asked why the desk isn't cleaned off or why the phone is now reprogrammed to call only video stores - "I don't know" is the reply. ADHD children can't remember the sequence of events that ended with a reprogrammed phone. It's not unusual to send an ADHD student to the garage for a hammer, finding him/her 45 minutes later in the process of disassembling the lawn mower. Asked why - "I don't know!"

Hyperfocus and Outbursts
ADHD Children have very low levels of attention, focus, and concentration. Normal concentration/attention allows us to listen to conversation or watch a television program with extra attention to spare - to monitor the environment, listen for the oven buzzer or others in the house. ADHD Children may only have half the concentration of non-ADHD individuals. For this reason, if they intensely focus on a television program or play a computer game, they have no extra attention with which to monitor their environment. When playing a game, they don't hear calls for lunch because all 50% of their attention is on the game.

Both research and clinical experience tells us that ADHD Children can exhibit a type of "hyperfocus" - intense concentration and single-minded focus when the activity is very interesting. This situation is most often found when ADHD Children play computer games. ADHD Children may have an amazing ability to hyperfocus on a computer game, one of the few things that moves fast enough to maintain their attention, unlike homework or routine chores.

The hyperfocus found in ADHD Children is not a normal type of concentration or focus. Remembering the neurochemical aspects of Attention-Deficit Hyperactivity Disorder (ADHD), hyperfocus requires the child to use the maximum attention and sustained concentration available. For parents and teachers, imagine trying to thread a needle, in low light, while sitting in a row boat in the ocean - the waves tossing and rolling all the time. The amount of concentration required to thread that needle makes us anxious, tense, and irritable - as if somebody were asking us questions while we were trying to thread that needle. This is way ADHD Johnny is so fidgety while trying to listen to your conversation or correction.

In ADHD Children, hyperfocus allows them to participate in computer games or watch high-action movies - but at a cost. The amount of energy being used makes them very irritable. If a parent interrupts the computer game or movie with a question, a call for lunch, or a request - the ADHD Children is likely to explode in a burst of verbal or physical aggression. His or her concentration has been broken and that neurochemical activity spills out into the room, or is directed at the interrupting source. It's not uncommon for ADHD Children, upon losing a computer game, to throw controllers or objects, stomp, scream, or behave in a way that tells us they are very upset. As a parent or teacher, we are shocked at their overreaction to such a minor situation. To see it from the viewpoint of an ADHD Children - imaging trying to thread that needle for 30 minutes - then accidentally dropping the needle overboard. We'd have a few choice words or a bit of behavior problem as well.

Dealing with hyperfocus requires patience and a minimal reaction to their overreaction. Interrupting ADHD Children who are hyperfocusing will always bring an inappropriate reaction, typically a verbal outburst. Parents are advised to not focus on their overreaction but remain on the topic. For example, interrupting ADHD Johnny's videogame to ask for help in the kitchen is likely to prompt a loud reaction such as "Why do I have to help! Sally never does anything! It's always me!" and so on for about five minutes. After the outburst, the parent might address the comments superficially but stick to the request as in "If you think I treat you unfairly, we can get together in an hour after lunch and discuss it. But right now, I need you to help me set the table."

"I think my child is possessed!" - Neurochemical Excitability
Of all Attention-Deficit Hyperactivity Disorder (ADHD) behaviors that bring ADHD Children to the attention of professionals, severe behavioral outbursts must be ranked in the top three complaints. One parent described the wild look in her son's eyes, the aggressiveness, kicking holes in the wall, and the physically threatening behavior with the summary "I think my child is possessed!" ADHD Children are normally more aggressive, pushy, argumentative and talkative. When upset, as when confronted or in a heated discussion, their neurochemical system explodes in a burst of energy and aggression that is far in excess to the situation.

Let's review what happens in a routine discussion or argument, as if it were being videotaped. If adults are in a discussion, the issue is first reviewed. If a disagreement is present, both sides present their opinion, normally at first, then more aggressively. As the discussion continues, we notice signs of neurochemical excitement - loud voice, an aggressive or resistive posture, name calling, references to past arguments, and often what I call the "adrenalin finger" - that pointed forefinger shaken at the other person. In healthy adults, as the neurochemical excitement increases, there is a sense that the discussion or argument is getting out of hand. Often a truce is offered as "We don't need to be yelling at each other. Let's take a break, get a cup of coffee, and talk about this later."

ADHD Children are already more excited and excitable than most children and adults. When upset or angry, the neurochemical excitement of anger or distress is added to the already-present high level of aggression and excitability. Imagine being very angry or upset, then suddenly receiving an injection of stimulants. At that point, you'd be out of control, talking and yelling nonstop, posturing, and physically aggressive. The upset ADHD Child rapidly goes from "hyper" to out of control. Parents often find that normal "rough-housing" with the child or between siblings, prompts the ADHD child to become very aggressive and unable to settle down after the event.

Signs of neurochemical excitement and outburst:

- Verbally loud, threatening, screaming, and talking excessively. In psychiatry, we use the term "pressured speech" to describe an aggressive, nonstop talking that is difficult to interrupt. The ADHD Children are almost totally unreasonable at this point.

- Physical aggression is strong. The neurochemical excitement becomes so strong at times that arms wave, feet stomp, objects are thrown, furniture/walls are hit, and the ADHD Child closes the physical range and may be intimidating or "in your face". Repeated cautions to calm down have no effect.

- Aggressive pursuit is often present. Recognizing that the situation is out of control, a parent typically offers a truce or attempts to disengage from the argument. The enraged ADHD Child suddenly can't break off their attack. If you walk away, they pursue you - following the parent through the house - still yelling, intimidating, and hitting the walls as they go.

- A major component of an Attention-Deficit Hyperactivity Disorder (ADHD) is impulsivity, acting before thinking. ADHD Children have difficulty understanding consequences of their behavior, a component related to their problems understanding sequences. For this reason, enraged ADHD Children can be very dangerous and threaten or engage in high-risk behavior. They may destroy their favorite possessions, run out the door, strike at parents/teachers, curse, or threaten suicide. Amazingly, all those behaviors can surface simply because you've asked the ADHD Child to take out the garbage.

- Normal parenting techniques used for discipline or behavior are totally ineffective during these episodes. After the outburst is over and the ADHD Child does settle down, they are always remorseful and apologetic but the parents are traumatized.

Dealing with this excessive chemical reaction involves several components.

Address the ADHD Child in a calm manner. A loud voice will only increase their reaction to being interrupted or addressed.
Expect a verbal reaction. Attention-Deficit Hyperactivity Disorder (ADHD) children have "quick-draw mouth" - a verbal reaction and reflex anytime they are addressed or interrupted. I often encourage parents of ADHD children to become deaf for ninety seconds after asking the ADHD child a question. A simple comment such as "Jimmy, can you take your glass into the kitchen for me" produces an aggressive "Why!? Jennifer leaves her glass in here all the time! I'm not the only one with an empty glass around here! You never tell Dad to take his glass to the kitchen! He can do anything!" Expect an overreaction to your comments or requests.

Don't take the verbal reaction personally. Parental focus on the ADHD Child's overreaction will often prompt an emotional and behavioral explosion. When the comments include such gems as "I wish I didn't live here!" or "Jennifer is the favorite around here!", the natural tendency is to defend yourself or address the comments. Addressing their reaction only side-tracts the original discussion and raises their agitation.

Ignore the reaction and stay on your original topic. Often a comment such as "I'm sure there are times you don't like our family rules. If you want to talk about that, we can get together after you take your glass into the kitchen."

About the Author

www.drjoecarver.com
This handout was written by Joseph M. Carver, Ph.D., a Clinical Psychologist. Dr. Carver is in private practice in Southern Ohio.