From CH.A.D.D.ER, Fall/Winter, 1989, Vol. 3, No. 2
We are just beginning to appreciate the debilitating and possibly handicapping role attentional difficulties can play on the course of a child's personality development. Make no mistake about it, attentional deficits, particularly when accompanied by hyperactivity can threaten developing personality integrity on a multitude of levels including: 1)parent / child attachment 2)development of accurate cognitive-affective maps (internal representations of the world, 3)acquisition of internal structures relating to empathy, self-soothing and self-regulation, 4)construction of a positive self-esteem system capable of providing assurance that one is wanted, worthwhile, and resilient, 5)development of age-appropriate values and competencies, 6)obtainment of effective learning and organizational strategies, 7)mastering age-level social skills and experiencing pro-social fun, and 8)development of a family role that increasingly recognizes responsibility, mutuality, change and ability to successfully resolve conflict.
How is it that something as minor as a "little attentional problem" can reap such havoc? The answer is as simple as it is complex. Attention resides at the very heart of the learning-motivation process. A smoothly flowing attentional stream is critical to successful adaptation. To cope well, one must atend well; its just that elementary.
One way, perhaps a fashionable way, to comprehend the effects of ADHD is to visualize the baby's / child's mental apparatus as a computer with multiple hard discs of extraordinary capacity. These discs receive the continuous input of experience. The inputted data is then assembled into cognitive-affective (emotional) maps representing the juvenile world. Such informational maps not only guide the child but provide emotional signals regarding general and specific features of the environment. In short, these cognitive-affective maps enable the child to contend with an ever-broadening and demanding world.
Now what happens to these internalized informational and emotional systems when the child's behavioral style differs from parents and sibs? Typically, patterns of poor listening, high-strung mood, unpredictable behavior, withdrawal, lack of cooperation and failure to profit from experience bring a fairly steady supply of feedback colored by fatigue, frustration and worry. It is inevitable that this life shaping feedback reflects the realities of a family coping with a child whose responsiveness, tempo and orientation frequently differs from that of other family members. Though it frequently appears that parental feedback goes through one ear and out the other, the child does store bits and pieces of the input. Over time, this information, always with collateral emotional components, gradually establishes the internal frameworks of "self" including: self-in-relation-to-others, self-esteem, self-image, self-control, self-gratification, self-skills, self-knowledge and self-in-relation-to-learning.
The feedback ADHD children receive comes from a variety of sources including their own problem solving efforts and from teachers and age-mates. Some strands of the feedback will almost certainly be positive because high energy and intensity levels, particularly when accompanied by brain power or motor prowess, lead to creative flares or impressive athletic showing. However, when negative feedback is abundant, pockets of hurt, anger, negativity and anxiety are left which will characteristically be played out in relation to authority, cooperative tasks, and specific learning contexts.
Of great concern is the development of failure expectations regarding specific learning settings and / or specific learning domains and self-statements declaring "stupid-me" or "bad me." Instead of approaching learning situations with expectations, of at least some success, ADHD children are often emotionally signaled by shots of anxiety and associated thoughts of alarm which warn that they cannot handle a certain task, are going to fail, or once again will look dumb or ridiculous. The response to this emotional and cognitive arousal invariably is some form of task withdrawal, be it direct avoidance (e.g., "It's boring, forget it,") irritability (e.g., "why are you making me do this?"), distractibility, escape into daydreaming or an impulsive outburst. The bottom line for many ADHD children is that some vital forms of learning become aversive or punishing and are to be avoided at all costs.
Attentional deficits can interfere directly with auditory information processing, task approach (trying), incremental learning (the proverbial learning curve so common in today's parlance), persistence, learning from trial-and-error, sequential thinking, cause-and-effect reasoning, social understanding, judgment, acquisition of an adequate social skill repertoire (including a sense of being socially embedded and impulse control) and integrated personality functioning. Gaps in these critical adaptive operations increasingly hamper functioning as the child grows older and explains why the growing ADHD child becomes a higher risk child with each passing year unless expertly managed medication regimens, specialized parental interventions, and detailed effective educational plans are implemented OVER TIME. The good news is that with the right combination of interventions all revolving around loving, limit-setting, invested parents who appreciate the good times and never give up, we can keep attention deficit children in the developmental ball park.