ADHD and Time

problem is ADD/ADHD is also likely to be a wrong dx, such that person still has LD, but maybe the root cause is something else (sorry I don't mean to side track over/under dx which you said you wanted to avoid).

for instance, my son has been DXed with ADHD, Bipolar, depression (the whole gambit), these lead to behavioral patterns that are learned, and unlearning them can be harder than fixing the anatomical or biochemical connection.

So, even if brain "catches up", unlearning coping behaviors is going to be very very hard. Even if in clinical test situations (which are not life), they are able to show abilities have been gained, whether they gain them in real life is a completely different issue.

and for ADHD, I have never figured out how extra time helps. I would love to see data on that, because from my own experiences (as an adult ADD person) and as a professor, and parent of child with significant mental illness, extratime serves to cause more anxiety and therebye exacerbating not alleviating the problems

I agree completely with testing students at a university level because students with ADD who have access to Adderall and other focus medication are at a clear advantage over other students, especially when these students don't need this medication as much any more.

I know people who have this medication prescribed to them, and when they don't have it, they behave almost identical to everyone else. The effect that the medication does give them puts them at an unfair advantage to other students. Also, the over prescribing of these medications puts these pills out there to get abused and distributed to eager college students who are not diagnosed with ADD.

It's sad how big of a problem it really is.

Timed exams are stupid to begin with.

I'm going to agree with Physioprof here,timed exams are evil. I am so glad I'll never have to do another one again, I can't write terribly fast (another reason to love computers, I can type fast) so I was always pressed for time on exams.

And then there's the larger question of medicalizing every observed "difference". As we peer into our black box with increasing clarity, we'll come to see that those three pounds of gelatinous meat hide enormous individual variation. It won't be easy figuring out which variations require accommodations and special treatment, but that's a conversation we're going to need to have.

Indeed. One might ask why being poor at concentrating counts as disability that deserves protection under federal law and advantages while taking tests while just not being that bright deserves neither. Some differences are more equal than others, it seems.

really Alice, you think so? I think you are probably very much wrong.

Agreed with commenters that timed tests are bad, agreed with blogger to shelve the issue of overdiagnosis. My two cents - Yes, the brains of ADHD kids recover physiologically by the time they reach adulthood, but I strongly suspect there is more to the condition than the physiological. There may be a learned element to short attention spans. My evidence is anecdotal, but I see it all the time, probably because I don't travel in very scholarly circles. I see in most "normal" people a pathological inability to pay attention to anything they are not truly interested in. People that memorize sports information and dialog from sitcoms can't remember what was said in a class they took two hours ago. If normal people can be that inattentive, it's probably from practice. I know my own memory isn't what it once was and I'm only 33. Somewhere in my life I started unconsciously prioritizing what I remember, and ended up worse with names. Could it be that children accustomed to having no attention span retain the way of operating (software) even after the hardware fixes itself?

I think you raise an interesting question about this issue but I agree with rb that the first issue is understanding what we are looking at. ADD/ADHD is different from the learning disability that is mentioned in your example of the lawsuit.

Its been about 5 years since I graduated college as an LD student, so I can't speak to how things are done currently. At that time I was retested every 3 years from grade school till I graduated high school and counselor and myself developed coping stagegies once a year, and during my freshmen year of college. Constrast that to my brother who was dx with ADD in grade school and never had that dx updated though high school. He didn't attend college so I don't know how that would change it.

With the question you raise here, ie time, I don't really know how time would be something that AD/ADHD students would need on a test. Since I would think that more time would really just be more time to let their brains wonder. Thou I coped without it I know several LD students who would not be able to function without the extra time they were given. When the words don't sit on the page or letter and words take a long time to put down correctly on a page we need that time to be able to have answers comparable to the student we are testing against.

(As an example I had to check if I was using the correct spelling on about 85% of the words I used here and none of them are words I don't use daily; even then I am sure I missed a few, I'm guessing, but I think that my comment took much longer than the other here to write.)

Hm. I find the idea of taking one little piece of research and apply it to the real world without taking other research into account very scary.
This is *one* paper, which only shows correlational results. That means, kids with certain symptoms display a certain brain anatomy. It doesn't tell us anything about causality, about what actually causes the kids to present with symptoms that lead to ADHD diagnoses.

To progress in science, we make experiments, analyze data, think it through and publish. But one publication is always ever one piece, a building block that gives us some indication as of where to look next. A scientist who says something different is not a good scientist.

As long as we cannot prove that a change in brain anatomy causes ADHD symptoms to go away, we cannot judge people for their behavior. It's classified a disease, and whether or not a person has said disease is currently classified via symptoms, - why not suggest to test students for symptoms rather than for a mere correlate of the symptoms?

I definitely wonder about where we draw the line between what deserves 'help' and what doesn't, the comment someone's made about people 'just not being that bright' not getting help.. the point of tests usually is to see how people score compared to each other, i'm not saying that's fair, but it's usually the point. If you start getting to the stage where only the very best and brightest don't get help, the tests become pointless. I think what needs to happen is that as a society we need to address the actual things we are testing for. maybe giving people a broader range of tests, so we come out with scores against, eg, a speed test, a test of memory, etc etc.. and rather than one exam grade, which in the end tells us more about someone's exam sitting skills than it does about their intelligence, or knowledge..we could have a range of grades in different areas, allowing particular strengths to shine through.

As an adult who was not diagnosed with ADD until college, I can say that time restraints on tests was never a problem. My problem was being able to maintain focus during lectures long enough to follow trains of thought. I failed tests because I had no idea what the hell the questions were in reference to.

On a vaguely related note, I don't think the students with ADD are the main source of the Adderall floating around college campuses. During my first senior year, after years of barely staying in school, I became desperate for answers. I knew there was no way that what I was experiencing (and had been experiencing for 22 years) was normal. I went into the school's health center and asked if there was any sort of ADD testing available. The doctor asked me why I felt that I might have ADD. I replied that I have the attention span of a fruit fly and can't hold a thought in my head for more than a few seconds. He whips out his prescription pad and begins to write me a scrip for Ritalin. I must have had a horrified look on my face, because he stopped, stared at me for a second, and then said, incredulously, "I think you really want to KNOW if you have ADD, don't you?" Umm, yes, but thanks for letting me know how to get Schedule II stimulants, Doc.

Usually I comment under my own name. I am the parent of a bright and successful college student who was diagnosed with dyslexia (reading disorder) in 2nd grade. Technically, at her last triennial psychoeducational evaluation (required by her college for accommodations) she lost the DSM-IV diagnosis of 315.00: Reading Disorder, and gained the DSM-IV diagnosis 315.9 Learning Disorder Not Otherwise Specified).

I suspect you are reasoning from a lack of experience:

Or do we continue to rely on a probably obsolete diagnosis, made years earlier?

Children with learning disabilities in public schools are served under IDEA (Individuals with Disabilities Education Act). The act mandates that the child's eligibility for services be evaluated not more frequently than annually and must be evaluated every three years.

One elephant in the room is the College Board's requirements for accommodations on the SATs (and other high-stakes tests). They have quite clear procedures on the steps students must fulfill in order to have accommodations such as extra time on exams. Among other things, a complete psychoeducational evaluation is required at least every five years. Interested readers may start here:

http://www.collegeboard.com/ssd/student/accom.html

An individual who has gone through k-12 education being in some areas years behind his/her peers in various social and academic functioning doesn't magically achieve parity at age 18 (or 21).

In terms of college students (or post-graduate students) with ADHD and accommodations -- I'd really like to hear from both successful students with ADHD and from professionals (psychologists and psychiatrists) whose practice includes young adults diagnosed with ADHD in childhood.

rb, DGM: When the post refers to evidence that the brain 'catches up' in development, Jonah wasn't just speculating from his armchair. He's alluding to recent scientific results -- very real, anatomical studies -- showing that ADHD differences are quite visible and measurable in the physical structure of the brain up to a certain age. And then these differences seem to go away.

So the question remains (even though your personal situation makes you understandably protective of your and your child's position) -- as we start to find physical analogues to DSM-sanctioned, developmental disabilities, doesn't it make sense to start to bring our policies into rational agreement with relevant physiological evidence?

Well, first of all, it is well known that ADHD is much more common in children than adults, hence, "adult ADHD." Any casual research will tell a person this.

Secondly, one must have a current diagnosis for any reputable school to give accommodations.

Thirdly, the testing system in general is archaic, if not draconian. This is the beginning of a change.

Finally, any individual mental propensity to fail in spite of comprehension or intelligence should be accommodated.

Disappointingly under-researched and not well thought out, from someone who supposedly has published in some very reputable places?

Well, I am going to be quite strict on this subject while at the same time I want to call for a bit more leniancy in athletics.

When I applied for college in the very early 1980s, fees and tuition were much lower and more egalitarian. The Republicans had not yet made every college student an indentured servant to the student loan bankers. Fees and tuition need to be lowered and public support for colleges needs to be increased.

Nevertheless, few accommodations were made for the SAT's or the GRE's that followed 4 years later.

That's the way it should be. Those who can perform are separated from those who can't.

Yes, there were ADHD students in my high school. They were the class disruptors and despite being loud in school, they got weeded out before they had a chance to get into a 4-year school. Jeff C., hope you enjoy the work at the gas station!!

There was no such thing as ADHD meds. Of course there was marijuana etc. around.

I believe that allowing Ritalin, Adderall etc. in the classroom is WORSE than allowing the baseball team or the football team to take steroids. Big muscles don't usually translate to economic success the same way that A's in the classroom do.

I really don't care whether athletes take steroids and get big muscles. They are welcome to it if they want, in my book. They are nothing if they can't express themselves cogently or cooperate in a workplace.

I DO care if people take a drug that falsifies their performance with academic and employment-related tasks.

I think ADHD meds need the same and more restrictions/confiscations that the BUSH administration directed against steroids.

I do wonder whether anyone has done serious studies on attachment style and ADHD - in other words the developmental disorder as defined strictly by the environmental conditions in which optimal brain dev can occur. ?

Even though many people with ADD/ADHD "catch up" eventually, how long does that take? A college freshman could be as young as 17, and maybe her brain hasn't finished maturing yet. Everyone's brain matures at a different rate, and I've heard that it might take some people up to age 25. So even if they will grow out of their ADD eventually, it's possible that some college students just haven't reached that point yet.

There is also the serious problem that ADHD will not get these students more time to complete their work after graduating.

sentient meat, what part of my post did you not understand? obviously it was the part that said that the brain catching up does not fix a learning disabilty which due to its developmental nature leads to many behavioral problems. Fixing behavior takes more than fixing brain.

For instance, I just check my son out of in patient care due to overpowering suicidal thoughts, brought on more by behavioral choices than by brain structure and chemistry.

Anyone who is relying on meds alone is taking a wrong path. Students need to learn behavior skills, unfortunately depending on nature of mental illness or disability (there are many comorbid conditions) this can be very challenging, as most people, healthy and unhealthy, make choices that are not always in their best interest long term to alleviate short term stresses.

Pricilla you too are an idiot who has no FUCKING idea what the FUCK you are talking about.

My concern is that by medicating we're not TEACHING coping strategies that may spur growth in the pre-frontal cortex. Working memory skills & behavioral inhibition can be taught.
We're also allowing poor habits and behaviors to become ingrained so that if the brain does eventually catch up the behaviors remain and forever "disable" the person.

jlg, I agree folks must be very careful as using meds as the magic bullet, I would argue this is true for many chronic conditions (e.g. high cholesterol and diabetes) where pills are used to offset poor behavior and skills. That said, meds can make it possible for behavioral interventions that would be impossible with out the meds. unfortunately in most states the budgets are not there for the behavioral support, so pills are thrown at them.

and as much as you would like to TEACH coping skills, these are not easy to learn in people with brain issues, but earlier rather than later interventions are key. they know what to do, they find that they can't do them, and this often helps lead to more anxiety stress and sense of failure, teaching these individuals is an amazingly difficult and person intensive (expensive) process. (and there is no one size fits all strategy)

Folks who trivialize ADD/ADHD (not saying you do, others in comments have) have no idea of the diversity with which this disability manifests itself as in addition to the complexity of other mental illnesses that are often associated with it.

I'm a special ed teach and parent with a very ADHD (among other things) teen. I worry about what happens to kids in the real world. I don't see the boss giving extra time to finish a project or other accommodations because her employee has ADHD. Life is timed. We all have to learn to cope with our weaknesses and play to our strengths.

The study on cortical thickness is certainly interesting, but until it's replicated I don't see why it should be taken as the foundation of ADD/ADHD science. Worth pursuing? Hell yes. Worth potentially not making some simple and cheap accomodations for those who need them? No.

What I found interesting about the study is that it repeatedly claims the ADHD kids "catch up"--lose their developmental delay. I don't know that thinking about things like ADHD (or autism, similarly) as a "delay" is a good idea. Developmental difference, certainly. But while many who are diagnosed as children learn to control their impulses, it is a learned behaviour, not necessarily their innate predisposition. Although their brains may look similar to neurotypical adults, the adults who have had ADHD probably have also learned behaviours related to their attention spans--and, if they have been taught how, they may have learned how to cognitively overcome their impulses.

I'm unclear why extra time would help a kid with ADHD. Breaks might (supervised to prevent cheating), so if the student could take their exam in sections it might improve concentration. Frankly, I think that would help most students.

sbs, I don't disagree with you and in fact have asked for very little accommodations for our son despite major mental illness problems (and as I have said before, extra time rarely the accommodation ADHD kids need, I agree with Ali on this), but that said, School is very artificial compared to "real life" where one does have a little more ability to focus on strengths. For instance, taking exams and comps in grad school is not nearly the same as doing benchwork or writing grants and papers. The number of great scientists who are likely ADHD (or OCD or bipolar) is probably very high.

Well, it seems that you are assuming that ADHD is a development disorder that establishes as the pacient gets older. This is not completely true. Many pacients recover with age, but, from 1992 to now, science has shown that most of them still suffer from one or another problem characteristic of ADHD and those are considered as being in partial remission. One third of the children diagnosed with ADHD still manifest the same symptoms on adulthood. Either way, it wouldnt be fair to say that, only because some of the pacients recover with age, there shouldnt be a special accommodation for the ones who continues to deal with the condition

@priscilla_driver:
" believe that allowing Ritalin, Adderall etc. in the classroom is WORSE than allowing the baseball team or the football team to take steroids. Big muscles don't usually translate to economic success the same way that A's in the classroom do.

I really don't care whether athletes take steroids and get big muscles. They are welcome to it if they want, in my book. They are nothing if they can't express themselves cogently or cooperate in a workplace.

I DO care if people take a drug that falsifies their performance with academic and employment-related tasks.

I think ADHD meds need the same and more restrictions/confiscations that the BUSH administration directed against steroids."

As an adult who has struggled with adhd all of my life but only knew what the problem was and had it diagnosed and medicated at the age of 37, I feel that you know very little about how both ADHD and Ritalin work. Steroids give an athlete a competitive *edge* over baseline "normal" athletes because they allow a rate of muscle growth that is not achievable in normal circumstance. Therefore, they have a physical *advantage* over other non-steroid-taking players.

ADHD is a neurological disorder that impairs frontal lobe "executive task" functioning - and you can disbelieve it all you want but those of us that suffer with its myriad effects know that if you experienced one week of life with a severe form of ADHD you wouldn't be making these snap judgments. ADHD is not a baseline "normal" that is made into a mental *advantage* with the magical addition of Ritalin. Ritalin is not going to make an ADHD sufferer more competent or smarter than a neurotypical person with the same IQ.

I lived unmedicated (and undiagnosed) for 36 years and now take medication. The difference between being medicated and unmedicated is not a difference in a leap in my intelligence. I don't become magically endowed with superability to focus and cogitate. It simply becomes less overwhelming and fundamentally exhausting to do simple things normal people take for granted like: controlling simple urges (like to blurt out things) without sustained effort, being able to concentrate fairly well for medium burst of time on the task at hand instead of using ALL of my mental energy to think through things and do things neurotypical people take for granted as "easy". I would describe being on medication vs. being off medication as having overwhelming variable random "noise" in your head all the time while you're trying to think - it keeps changing so you can't accustom to it to tune it out; vs. just thinking about something without sustained effort and 3 cups of coffee.

And btw, Ritalin leaves the body fairly quickly - we don't have a constant "advantage" over neurotypicals not using stimulants. We have at most part of the day in which we can think clearly and make well-weighed decisions without struggle. It's you, the people with neurotypical brain function, that have the so-called "unfair advantage", if that's the way you want to look at things. It takes me a lot more effort to do things you take for granted.

ADHD is vastly misunderstood and while a brain with it might look physically more normal in adulthood, its internal connectivity and frontal lobe function patterns are not the same. A schizophrenic may have the same brain thickness as you or I but that doesn't not mean they don't have a neurological disorder that impairs their functioning. I find that most people who dismiss or don't believe in ADHD have no first-hand experience of what it is like to live with it. Constant life-impinging symptoms are not necessarily "learned" - some of them are indeed biological.

Living with it for 36 years without drugs was really, really hard. Living with it with drugs isn't easy. It's just less difficult. I really just don't understand why people are so against someone with brain function problems getting help so they can try to approximate normal functioning for as long as they can each day. Why is that "unfair" to everyone else? I think you should be grateful, instead, that you have never had to experience mental problems - which can be awful to live with and completely invisible and "non-existent" to everyone else.

I actually don't think extra time on tests would have been very useful to me. Probably much more useful to anyone with ADHD is simply being diagnosed correctly and given some information about how to cope with it. That and not having people who dismiss and belittle mental impairment because it isn't physically obvious to them like a malformed limb is.

@priscilla_driver: If you actually understood what the disadvantages of ADHD are, you would understand that medication for it lends no advantages to those who need it.

It sounds like you have a lot of your own insecurities that need dealing with. This attitude is one of projection. The unfair thing is that you get to wake up and feel self righteous, whereas I get to wake up and deal with an ignorant stigma, a freighter full of issues, and constantly present self-doubt surrounding every single thing I accomplish.

I find it disheartening that "invisible" disabilities are treated so poorly. If I were raving at the air in front of me or if I were in a wheelchair, people would know instantly that something wasn't right and that I required help.

To the casual observer I am:

- Educated
- Eloquent
- Informed
- Rude (say things without thinking)
- Messy
- Disorganised
- Lazy

Having spent my entire education wondering why I struggled when I understood everything so clearly, of being told off for making "careless mistakes", being told I wasn't trying hard enough when I'd spent all my effort on my work to only get an average (or slightly above average, if I had help) result, only get into the workforce and find that the same task takes me 3x as long as it does everyone else and wonder why it is that I just can't seem to get the hang of things...

Being diagnosed with ADHD answered all that. Taking medication means that I can complete a task at work in about the time it would take a "normal" employee. It means that I don't have to work 3x as hard to achieve the same result as your average person.

People don't necessarily grow out of ADHD. I didn't, and neither have many others. Intelligence and learned coping strategies can mask it, but it's still there and it still makes lives extremely difficult.

The medication does not give me any kind of "edge" over anyone else; it just evens out the playing field for me.

I see the last Comment is from 3 months ago but I needed to add my comments anyways.
@luminous I could have said it any better myself as an Adult that has been diagnosed at the age of 40.

I also find it quite disheartening that it is suggested that most kids out grow it and catch up when most estimates say the opposite, that only about 30% out grow it and my personal opinion is that they are not out growing it but they have just adapted enough that by the time they reach adulthood they are just better at dealing with it then others and may just simply not need medication anymore.

Interesting that they found the children's early development to be slow. I have been diagnosed with ADHD (when I was a child it was ADD, but more recently, Adult ADHD)but as a child I learned very quickly and had top grades. The only issue was that I was disorganized and therefore occasionally needed to be probed about getting my homework done. However, I did like a lot of the work I did in elementary. I loved phonics and math; all of it came to me easy and naturally. So it was often that I would work on it during my free time.

My parents denied the diagnosis when I was young because it was around that time that everybody was getting diagnosed. I am proud of my parents for refusing to medicate me. As is more common in females with ADD/ADHD, I was not a nuisance child in the classroom. In fact, I was generally quiet and very shy.

A few years ago I returned back to school after seven years out. I wanted extra privileges for exams because I was reading very slowly due to my inability to keep my mind on what I was reading. They sent me to get a psychological assessment done at a private firm, to obtain proof that my problem was real. My results came back and they were very good. It was during the follow up that I learned the assessment was the combination of an IQ test and personality profile. She said I was in top shape, recommended going "all the way" with my education, and stated that I had no learning disorders. While flattered, I was disappointed because my problem would not be acknowledged. I told her that, despite my results, my problems still exist and I need the extra time. She approved and suggested it in the final summary that I was to bring to the school for records. I wrote exams in isolation and used the extra time provided, but it only helped for a while. During one final exam I recall getting distracted by the clock! There was a little window outside the isolation room (I presume to monitor students who might otherwise cheat), and I would get up every 2-5 minutes to look at the clock out the little window. I paced, my heart raced, and I was overwhelmed with panic. It was definitely test anxiety, but it was provoked by the fact that I couldn't focus and didn't have time to deal with the problem. I went home and bawled, thinking I failed. When I got my transcripts, I was astonished to find I had received 88% despite not having even finished the exam.

Now a university student, things have only gotten worse. During my first year, I was getting isolation and extra time, but I stopped because I found the woman that worked in that department was rude and very condescending (no, I am not disabled) and I could never remember to sign up before the deadline (classic ADHD!!).

I am far above average when I am able to focus, but I lose my focus so frequently that I have have actually failed or withdrawn from courses that require daily homework, since I just don't do it. Also, my working memory scored incredibly high, explaining why I was once able to get by just cramming (learn everything in one night and ace my exam the next day); however, this has changed since beginning university because it is much faster paced, and often I will end up with overlap of exams and assignments from each course due on the same day. I feel as though the stress of trying to keep up has had a very negative effect on my ability to think clearly. Furthermore, I find I do really well learning online but they force us to attend classes (with in-class graded projects) which I get very little out of due to getting distracted (one interesting topic takes my imagination for a ride until I snap out of it and realize the class is almost over), then I must go home and sit for hours over homework, my ability to concentrate diminishing completely the more tired I get. I feel tired as soon as I sit down to do homework. Trying to concentrate for hours consumes a lot of energy and I often get so exhausted that I fall asleep early without getting anything done. It's torture, especially knowing that my comprehension is very high (clearly higher than the ignorant poster priscilla_driver!). I think things have gotten worse for me because I now deal with chronic stress due to the energy I have to put into focusing to succeed in school. Before I went back to school, I was doing what comes naturally to me: painting, writing, laughing. My tardiness and disorganization were issues, but I am innately easy-going, so it didn't affect me much. In a sense, my attention problems had been in a dormant state prior to starting school again. It was only after starting school that I developed such severe anxiety problems (which have now affected my physical health).

I think that Luminous's post was written flawlessly. I 100% relate to it based on my experiences with this problem.

The results of the findings of the study you cite may be problematic: ADHD is/was commonly misdiagnosed (especially in children) and it may be possible that the results were typical of a disability group similar to those of the ADHD category - or mixed- and therefore not necessarily reliable. I'm pointing out a potential confounding variable - not disputing the results. I didn't read the study, but I do wonder if the researchers had the experimental group screened by a single institution for consistency between diagnoses. Perhaps early development was found to be slow because when a child cannot focus, he isn't able to establish strong connections in his brain as quickly.

Anyway, too long to proofread all of this; this entire thing was written while I was supposed to be doing homework! I tend to look up info on ADHD when I am stressing about not being able to focus.

Thanks for the article and thanks to all you great people and your valuable two cents:)

Erin