Where does AD(H)D come from- and how

?does it work
David Jesselson
Understanding Diverse Learners
Prof. Jeffrey Glanz

Azrieli Graduate School of Jewish Education and

Administration
Yeshiva University

ADHD is the most commonly diagnosed psychiatric condition in

children and is a major reason for testing- often looking for a way to
make things easier for the child1. An estimated three to five percent
of school-age youngsters are affectedmore than two million
between the ages of 5 and 18. According to the American academy
of Pediatrics (2011), a significant number of them display associated
learning disabilities.

So what exactly is ADHD? The idea of innate sensitivity to the

development of emotional disorders is not new. Genetic factors are
known to be involved in schizophrenia, Bipolar Disorder and
Attention Deficit Disorder (Lahey Van Hulle , Waldman, Singh,
Rathouz 2011). Preliminary personality characteristics can be
identified in infancy and are usually described as temperament - the
first enterprise level with a baby is born; it reflects the potential for
personality traits such as activity level, regularity, openness and
others (Rothbart, 2007).

A person's personality is influenced by both innate and

environmental factors. Internalizing events in relation to personality

This would include referral to a pediatrician, family physician, pediatric 1

neurologist, child psychiatrist or psychologist- all in all, there are possibly
too many people who can determine in their own way what the child
.needs

includes self-image, a sense of continuity, coherence and perception

of characters and relationships. Personality development starts at
birth, and continues to be shaped and varied- depending on
different situations, when the first steps in life are the most
significant towards the basic design of one's personality. In essence,
inborn and environmental factors both influence and create an
integrated personality.

When understanding ADHD, it can also be described as a personality

trait that has innate components and is too influenced by the
environment. Attention disorders often can be seen beyond
personality difficulties and learning difficulties. When a diagnosis is
made, (which will also include emotional and psychodynamic
aspects) it will often identify situations with lack of coherence and
lack of internal continuity, these are expressed by "adopting the
partial objects", such as stories, sequences that come across as
unclear and damage self-esteem. Development of internal
coherence and continuity depends on the severity of the initial
disturbance (Nikolas and Burt, 2010), initial low levels of ADHD do
not nessacarily predict a problematic student in the future. In
simpler terms, a child has trouble concentrating on one object see
he fails to categorize it as a whole and has already moved on to the
next object.

ADHD has been described in different ways since the end of the
20th century, but in the 1980's (DSM) - III) it was initially considered
a neurological or psychiatric disorder. Massive diagnosis of children
and adults with the disorder has begun in the last two decades
leading to larger numbers of those with disorders. Some scholars
explain this change due to under-diagnosis of previous years or over
diagnosis in recent years, but there is no doubt that this is a cultural
change relating to low attention span disorder. Additional
explanations have to do with changing lifestyles and environmental
pollution that might explain this neurological disorder.

Another possible reason is a change in people's expectations of their

attentional functions. About 100 years ago the majority of the
population did not learn in schools, and most people could not read
and write. Illiteracy was the norm and lack of cognitive abilities was
not considered an "interference" with our abilities. Today, however,
there is a general expectation to strive towards education and
academia and the common understanding is that everyone needs
an education and even a higher education. These are seen as the
keys to success in life. With this of course comes the need to
concentrate in classroom settings for longer hours that what was
once expected, giving way to gauge one's ability to adapt to these
needs. If we take this into consideration, more and more children

will join the group of those not being able to meet these
requirements and thus the percentage diagnosed rises statistically.

Diagnosis of ADHD is not simple and in many cases there are signs
of Attention Deficit Disorder, but not a clear cut-off point for
interference. The APA has found significant differences among
people diagnosed with attention deficit disorder according to their
criteria (DSM-5, 2013) and those who are not diagnosed might suffer
.from the same problems

We must ask then, how is it possible that people with low attentional
functions -at the level defined as a disorder- manage to integrate
into society and succeed? How did people who grew up 20-50 years
ago succeeded without therapy or medication- while today, our first
resort is to try and "fix" the individual?

As mentioned, ADHD became popular in light of changing social

environment in recent decades, and has been categorized as a
"learning disorder". Treatment, such as "Ritalin" became a popular
culture as if it were 'educational medicine' that allows the child to
attend school without interfering with and without 'floating' during

class. Sometimes adolescents and young adults even ask for

medication to improve their academic achievements in the face of
increasing competition in academic areas, without even being
diagnosed as having any impairments. Rarely discussed is the
impact that ADHD has on other areas of life.
We need to ask why people who 'suffer' from attention deficit
disorder see it 'disappear' during the school holidays. Does it
disappear while driving or when performing other operations that
require attention? Does it disappear in complex social situations?
The answer is probably no. Therefore, it is not surprising that there
are many research reports that delve into the side effects of
treatments- especially depression and anxiety, but also delinquency,
substance abuse and personality disorders (Birbaumer, Fuchs,
Lutzenberger, Gruzelier, and Kaiser 2003).

There is a close link between a child's early environment - that

builds an initial construction of 'emotional power'- and its defenses.
According to Klein's theory (1946), one of the most important
transitions is the transition from the development of the split
(schizo-paranoid) to depressive phase- characterized by the ability
to hold together contrasting aspects of the same object or concept.
Difficulty in internalizing this stage is reflected in the difficulties of
integration and conceptualization. The difficulties can be
interpersonal, intellectual, personal and more. In other words, it is

difficult to hold a number of elements together and organize them

into a complete experience.

Theorists, such as Kohut (1971), Winnicott (1979) and Stern (1985)

refer to the mental development of a person with different concepts
but agree that the need to interact with our surroundings organizes
and regulates our ability to develop a self-coherent relationship with
the our surroundings.

The two main difficulties in understanding ADHD are organization

and regulation. Children with ADD need a different environment to
develop a self-organized experience, regulate themselves
emotionally and vice versa. Some children are born into an abusive
and neglectful environment where they are able to develop their
skills and emotional regulation and internalize correctly. In contrast,
there are children raised in a nurturing environment, but do not
succeed. Obviously, every child needs an environment adapted to
their individual needs, the discussion should be about the needs of
children who are often simply diagnosed later with ADHD.

For these children are born with sensory-perceptual difficulties

(Koziol & Budding, 2012) one can understand the distress in the face
of a world full of stimuli. These children absorb stimuli from the

external environment and find it very difficult to filter and organize

them. Sensory experience raises a terrifying sense of helplessness
and inability to bear it. It's easier to modulate emotions in the face
of a clear and organized experience, but attention difficulties make
it difficult to separate the works from different aspects (space and
time) and understanding of the relationship between these aspects.

These children need high levels of environmental organization. They

need constant practice of organizing experience including a timeline
organizing its various aspects - external and internal. Interpersonal
situations are complex, they require an understanding of the
sequence of events and their causality in order to understand the
situation as a whole and develop abilities. In other words, they need
to develop the ability to explain to themselves what they feel and
understand- why they feel that way and how it relates to their
surroundings.
Children with ADD have trouble regulating their sensory input. They
perceive stimuli and meaningless sequences as important and are
pulled in that direction. A teacher noticing this will assume that they
are not suited for the current "experience" and fail to create a
continuous and coherent experience for them which they can adjust
too. Their self-perception develops in this way, without a complete
and complex organization and unable to regulate their reactions
(often unsure whether to react or not.). Any event that occurs every

stimulus is received, comes by itself, without context and without a

hierarchical filtering system. This creates an experience of partial
flooding which makes the child feel out of place in different
situations.
A correlation has been made between attention deficits and
deficiencies in social understanding. This relationship can be
explained by the poor development of personality organization and
poor internalization of situations and relationships. In order to
understand complex interpersonal situations, we use social cues to
differentiate one situation from another and to asses meaning to
events. Once we can organize and understand the interactions
between social cues internal stimuli, this process requires high
levels of stimulation and separation ability organization - and these
exact skill deficiencies exist in individuals with attention deficit
disorders.

The impact of ADHD on social and emotional components is not a

lost cause. We can provide them with psychological assistance and
preschool-based treatment, assisting children to organize 'nonthreatening' experiences, allowing them to cope - even when the
characteristics of ADHD do not disappear. Treatment can ease the
"byproducts" of ADHD on personality development. When an
acquired ability and skill in organizing basic personal experience are
created, they can be used in many situations. It is like a child who

cannot learn to read without Ritalin: Many parents say that their
child learned to read only under the influence of Ritalin, but once
acquired reading skills and the process has become automatic,
there was no longer a need for Ritalin when reading.
Summary
It's easy to see today that ADHD has become one of the most
common disorders among children and adolescents. It may stem
from the attention requirements of the modern era, where in many
ways the classrooms have not changed in 100 years (Robinson,
2010).
The situation in which children and adults are faced with a so much
stimulation that enters our mental system simultaneously- without
the ability to effectively filter and organize them may lead to
distress in many aspects of life, not only within school and
education. These children need 'buffering" for internal and external
realities, so that they can develop a strong personality, with
protection mechanisms that allow them to cope in the face of
constant flow of stimuli.

As someone who was diagnosed with ADD when the term was
relatively unknown, I have often claimed that had I been offered
different educational experiences throughout my years in school- I
would have been a doctor today. My grades suffered as I had no

interest in cooperating with the system that seemed to have no

need for me. In an interesting twist of fate- I find myself today trying
to fix what wasnt done for me. Whenever I meet a student who has
been dumped by the system for not fitting in- I see it a great
opportunity to find a way to integrate the child into the system and
find the right place for that student. In a way, the system's failure
made me who I am today, a teacher trying to fix the system from
inside.

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