ADHD: Putting the Why Before the What

I have often seen this pattern on a first encounter in my office. A parent comes to the session with a child or adolescent and laments that their obviously bright offspring is underachieving, refuses to do or acknowledge the importance of schoolwork, and seems most comfortable and satisfied in isolated games and activities that started as a source of fun, moved quickly to a passion, and are now properly thought of as a borderline addiction. 

There may or may not be friends who enjoy similar activities, sports, or games, but the connector is whatever the prospective client finds interesting in the activity rather than other peers. 

Often, the young person literally neither knows or cares about what time our clocks tell us it is, and outside of a handful of interests, there is a general absence of curiosity about most other pursuits. 

How is it that many children and adolescents referred for underachievement seem to exhibit this array of symptoms among others? The purpose of this piece is to address one of the causative circumstances from the perspective of that person. The reason I believe that that makes the best starting point is that it highlights the fact that all of us make more sense if we have a better idea of how each of us makes sense. 

ADHD information processing tends to be more centered on personality and preferences than the types of processing found in most others. It usually comes with a clear preference for internally- originated ideas over ideas that come from other (social) sources. Part of the reason for this is that ADHD perception does not have an easy connection to the nuances and subtleties of social cues. If the signal is indirect or requires some non-obvious interpretation, it may not register at all. In other words, it doesn’t get properly processed because it is silent and invisible to the prospective receiver. 

It might therefore be useful, before social cues are given, to begin by explaining why the cue that is about to be sent could be important and what its value could be in the younger person’s value system. Once that has been accomplished, the “what” message has a much better chance to be received and interpreted, and if appropriate, followed.  

Steven Clarfield, PhD