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Kid's Chapter:

What Is this ADHD Thing, Anyway?

Martin L. Kutscher, MD.  © 2002
Assistant Clinical Professor of Pediatrics and Neurology, New York Medical College, Valhalla, NY.
See our patient offices in NY and NJ

Hey, What Happened to My Brakes?

Imagine this:  A kid is on a bicycle speeding downhill. The world is whizzing by.  He needs to avoid holes in the pavement. The road is curving. The wind buzzes in his ear, and makes his eyes tear.

Suddenly, there are rocks in the road. He goes to put on the brakes—but they don’t work!! As the bike speeds downhill, just staying on it seems overwhelming.  Too many obstacles call for the rider’s attention. So much seems out of control. Who has time to pay attention to the huge truck coming up?

That’s the life of someone with Attention Deficit Hyperactivity Disorder (ADHD).  It all comes from difficulty “Putting on the Brakes,” to borrow the title of a wonderful book by Patricia Quinn and Judith Stern.

Here’s what’s happening.   Your brain’s “boss” is located just behind your forehead.  These frontal lobes figure out where you want to go, and the individual steps of how to get there.  Like any boss, a large part of their job is saying “no.”  For example, your parents are supposed to be the boss in your house.  Think how often their job is to say “no.”  They’re always saying things like, “Susan, do not have a fifth scoop of ice-cream,” or “Bob, stop playing Nintendo so that you can do your homework,” or “Jill, don’t stay out past 10PM.”  Unless something puts brakes on our actions, we would spin out of control.

Well, at least that is how it is supposed to work.  In ADHD kids, the front part of their brains—the boss—doesn’t do a good job of putting on the brakes. This means that these kids may:

• Have trouble putting brakes on distractions. Their minds are pulled off the main topic by any competing action.  This leads to the “Attention Deficit” of ADHD.
• Have trouble sitting still rather than checking out those distractions. This leads to the “Hyperactivity” of ADHD.
• Have trouble putting brakes on any thought that comes into their minds. There is trouble putting brakes on frustrations and over-reactions. This leads to “impulsivity.”

No wonder things go out of control so often!

Why Don’t I See Problems Coming?

Let’s imagine another scene:   Jack is on a boat, happily fishing.  Reeling in the jiggling fish while still steering the boat captures all of his attention. 

This is what Jack sees:                                    This is what everyone else seems to notice:

Jack is so consumed by the experience of the moment (catching the fish) that he can’t look ahead to see the waterfall coming up. It’s not that he doesn’t care about the cliff. After all, he doesn’t want to fall off a cliff any more than anyone else.  It’s that he never gets the chance to see it. Just like the speeding bicyclist, ADHD kids often are stuck in the present moment. The future comes as a surprise. This is called a lack of “foresight.” So, people with ADHD:

• Have trouble stopping long enough to consider what is best for themselves in the future. This often gets misinterpreted as not caring.
• Have trouble stopping long enough to consider what is best for other people. This often gets misinterpreted as being selfish or mean.

What other Problems Are Common for ADHD Kids?

Teachers, parents, and friends may notice many other problems for kids who have ADHD. Often, these problems are not recognized as just being part of ADHD. These kids might also:

• Be very disorganized. They often don’t get the right assignments home. Even more amazing, they may do homework and then forget to hand it in!
• Find that other people seem to take forever to eat, shop, or get to the point! Time seems to move so slowly in these settings.
• Have trouble with arguing, blaming others, or even lying.
• Sometimes have “blow ups” over unimportant things.
• Yell at people who are trying to help them.
• Have trouble noticing how other people are reacting to them. After all, who’s got time for that?
• Have a sense of always being nervous or worried.
• Have trouble with handwriting, or sometimes with other school subjects.

What Can We Do About It?

Hundreds of books have been written about helping ADHD. Here’s some of the best advice:

• Just STOP.  Remember, the problem in ADHD is difficulty putting on the brakes.  First, we need to keep an eye out for the warning signs that our brakes aren’t working—and that we are spinning out of control. The warning signs include getting angry, sensing that we are getting overwhelmed, raising our voice, and tightening our hands.  When we first notice these warning signs of getting “over-heated,” we then need to try extra hard to STOP. Work out a code word or phrase, such as “I need a five-minute time-out” with your parents or teachers. Go someplace quiet, such as your room. Don’t worry about getting in the last words in the discussion. (You’ll get a chance later.)  Do something calm like reading a book, sorting cards, etc. Once you are calm, then come back for a useful discussion of the problem.  Your parents should do the same thing. Sometimes, you may not notice—or may not want to notice—the warning signs. Then please, please, please listen to your parents when they ask you to STOP and take a five-minute break.
• Make decisions when you are calm. You’ll be surprised how much easier it is to reach a good decision when you and your parents are calm. People cannot think clearly when they are over-excited. Returning to our bicycle example, wait until the bicycle coasts to a stop. Then, look around and calmly consider your options.
• Realize that your parents and teachers are usually good at preparing for the future. In the bicycle story above, your parents can be thought of as standing on the sidewalk, watching you speed downhill.  Since they are not overwhelmed just trying to stay on the bike, they have no trouble looking ahead to see the truck coming.  They’re screaming, “Watch out for the truck!” or “Watch out for that cliff,” or “Watch out for that book report due in two weeks.”  A parent’s foresight is typically much better than that of their ADHD child. Listen to them. Please.  If nothing else, it’s probably fair to say that your parents usually try to act in your best interest.
• Kids with ADHD typically need help with organization. Take it. When you get older, you can hire a secretary to help you. But right now, you probably can’t afford your own secretary. Do you know anyone at home that you can trust who is willing to help you for free?  Teachers at school may be willing to help with organizational skills, also.  Remember, it is not fair to yell at someone who is trying to help you!
• Your doctor may prescribe medication with “stimulants” (such as Ritalin, Concerta, Adderall or Dexedrine). These medications stimulate your frontal lobes, making them perform better. Let’s return to the bicycle story. Medications like Ritalin work by stimulating the stopping power of your brakes.  You find yourself in less trouble because you now have a high performance bike, which is complete with a braking system.  It does not work by making you too tired to move around.
• Read more about ADHD.
• See www.PediatricNeurology.com/adhd.htm for good advice for advanced readers and parents.
• Younger children can read Putting on the Brakes by Patricia Quinn and Judith Stern.
• Teenagers can read Adolescents and ADD: Gaining the Advantage by Patricia Quinn.
• High School and college students can read ADD and the College Student by Patricia Quinn.
• Social skills—such as how to make conversations and keep friends—can be improved with the very funny book How Rude: The Teenager’s guide to Good Manners, Proper Behavior, and Not Grossing People Out by Alex J. Packer.
• Keep a good attitude about yourself. Remember that ADHD kids also have many great traits. They know how to have fun and enjoy the present moment. They are often quite smart, very creative, and have a “why not try it?” attitude that is the envy of many people.  We always need to keep in mind all that is wonderful about you.
• Good luck!

                 The Doctors of                                         Martin L. Kutscher, MD, PLLC
Pediatric Neurological Associates (PNA)                           Practice limited
              Providing care to                                              to behavioral neurology
the full range of pediatric neurology                    such as ADHD, LD, Tics, Asperger's
                                                                                      
   Bruce Roseman, M.D.                                             
   Robert  R. Wolff, M.D.                    Martin L. Kutscher, MD
 Ronald I. Jacobson, M.D.                               

                 New York (914) 997-1692                                                 New York (914) 232-1810
                White Plains, Nyack, Fishkill,                                                   Rye Brook, Middletown,
               Middletown, & Poughkeepsie.                                              Wappingers Falls, & Nyack.
                New Jersey (201) 568-8687
                           Englewood

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  Drs. Roseman, Wolff, & Jacobson

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