ADD


 * ADD is a disorder that is constituted by the interaction between individual and environment. If the environment is suitable, there won't be any deficit manifest

Executive functions

 * Will you do it, if so, how and when: motivation/activation, planning/organization, time/remembering
 * Comprehend the task at hand only incompletely and easily feel overwhelmed by the assigned task; since tasks aren't being structured, they change to other, more interesting activities
 * Poor ability to structure workflows and tasks readily leads to a feeling of being overwhelmed while the frequent changes in mood make consistent work and performance more difficult, resulting in a frequent debasement of the self
 * Subjectively boring tasks such as routine work on the job, regular tasks at work or activities that appear uninteresting evoke a higher distractibility and, in consequence, lead to more frequent task switching; important and unimportant things are on a par

Attention

 * There are at least two types of attention
 * Default attention: when we are interested in something; associated with default mode in brain
 * Directed attention: if you know you have a meeting at 4 in building A, a person will be there at 4 o'clock, irrespective of whether they are hungry, have a conversation or are reading something - they separate themselves rom that and move to building A; it's attention to self-regulate; associated with task mode in brain
 * Self-regulating means suppressing the default mode (sunny day vs. doing your taxes), which is achieved through executive functions
 * People with ADHD will create crisis situations because it is a means of forced prioritization

Symptoms & mechanisms

 * ADHD is a developmental impairment of the brain's self-management system, i.e. executive functions (see Wikipedia for an overview). Essentially, this system permits humans to self-regulate their behavior so as to sustain action and problem-solving toward goals specifically and the future more generally. 4 Components
 * Resist interfering information
 * Management of emotional responses in order to achieve goal-directed behaviors
 * Internalization of self-directed speech is used to control and sustain rule-governed behavior and to generate plans for problem-solving
 * Information is analyzed and synthesized into new behavioral responses to meet one's goals
 * A disorder that impairs your ability to function in multiple parts of your life

Emotional dysregulation

 * Mood liability/frequent mood swings
 * Low frustration tolerance
 * Emotional impulsivity and thin skin (easily offended etc.) - difficulty regulating the expression of emotions (i.e. insufficient inhibiting) and the experience of emotion (i.e. changing/modulating it)
 * Irratability
 * Anger outbursts and "short fuse" (acted out or just internally building up)
 * Premenstrual incrase of symptoms

Inattention

 * Forgetfulness & problems with working memory (see e.g. )
 * Distractability: difficulty listening (distraction can come from within -tuning out- or from without -environmental stimuli-), consequently difficulty to complete tasks
 * Mind wandering
 * Difficulty with punctuality (arriving too late or too early)
 * Temporary hyperfocus for highly salient tasks, but no control of attention when required or for many essential activities of daily life
 * Chaotic presentation
 * Difficulty organizing & planning tasks, getting lost in details
 * Doubtfulness/indecisiveness: unable to make decisions or solve problems
 * Deficits in ability to sustain focus for extended periods

Reward/Motivation system

 * Activation problems → difficulty arousing and sustaining motivation for activities that do not provide immediate and continuing reinforcement (because reward of a finished task lies in the future but future rewards are heavily discounted/much less enticing)
 * Difficulty finishing tasks (because toward end the challenge/kick is lower)
 * Those with ADHD tend to have abnormalities in the anticipatory dopamine cell firing in the reward system; this makes it difficult for them to arouse and sustain motivation for activities that do not provide immediate and continuing reinforcement
 * People with ADHD typically have a larger gap in their ability to stay motivated in situations that are understimulating vs. situations that are inherently rewarding, and that they are more prone to boredom
 * People with ADHD are frequently driven by excitement. They have deficits in the abilities of self-regulation necessary to stay focused on tasks they don’t find inherently interesting, so a thirst for the novel and engaging becomes their guiding light.
 * More trouble motivating themselves to do tasks they don’t find interesting and they're more averse to a lack of stimulation than most people.
 * People with ADHD do differ in the way they experience motivation. We have a much shakier ability to “force” ourselves to be motivated in situations that don’t inherently motivate us. Others are better able to still self-generate enough motivation to get by → the gap between what we look like when we’re motivated and what we look like when we’re not is bigger.
 * Problem to self-direct
 * Lose interest in projects (when they turn into a proper task to be completed) once they are near completion - a life of incompletion
 * People with ADHD require larger stimulus/bigger difference in the world; screens are perfect for that because the change maker is on the screen as opposed to a piece of paper where the change comes from you reading it
 * It's that the brain in a person expects things to change that solicits reward responses
 * Getting yourself to do something when you're not interested
 * Motivational problems also due to the inability to withstand frustration (Frustrationstoleranz) or reward that come only late
 * Having ADHD is like being bored all the time. Understimulation might explain the always searching for something else to do and, yes, the willingness to make bad decisions just to inject some interestingness into life

Impulsivity/lack of inhibition

 * ADHD impairs "response inhibition" → ADHDers make frequent errors of commission (acting when you shouldn't have) rather than omission (not acting when you should have)
 * Impulsiveness can be take several forms:
 * Motor: acting spontaneously without first reflecting on the action or planning the action, fidgeting, moving around on chair, playing with hands, leg shaking
 * Cognitive: unrelated spontaneous thoughts/"associative thinking" → a new thought just pops up and attracts attention automatically follows it instead of the inhibiting the thought, i.e. going of on a tangent in your head
 * Verbal: blurting out things without thinking beforehand or without waiting until it's your turn to speak
 * Impatience and difficulty waiting turn
 * Spending too much money on things
 * Walking out of jobs/frequent changing of jobs
 * Starting relationships quickly
 * Inability to postpone gratificatio
 * Sensation seeking and risk-taking behaviors (e.g. in traffic: speeding, breaking too late/little)
 * Binge eating

Hyperactivity

 * Physical or (for adults primarily) mental restlessness - e.g. frequent getting up and walking around during reading/listening activities
 * Constantly on the go, jumping and flitting, multiple thoughts at the same time
 * Difficulty relaxing
 * Pacing up and down
 * Talking too much and too loud
 * Fidgeting, rocking, tapping
 * Hyperactivity may possibly be a less specific pathology marker in high IQ.
 * In adults oftentimes converts into underactivity (which is why many thought ADD stops after childhood); maybe thinking about the task but not being able to get it going (i.e. an executive function where you can actually execute what you would like to do)

Diagnosis

 * ADHD that may be best perceived as extremes of dimensions of normal behavior, and defined as categorical disorders when symptoms are extreme and give rise to clinically meaningful impairments
 * Later diagnosis for some groups :
 * Employment & education: Those who had jobs and who had higher levels of education tended to have a longer duration of untreated ADHD
 * A history of depression: easier for doctors to misdiagnose ADHD, or mistakenly attribute ADHD symptoms to the other condition
 * Predominantly inattentive subtype in childhood
 * Family history of ADHD: those with a family history of ADHD were predisposed to go with untreated symptoms for longer → parents who have ADHD may be “so unaware of their dysfunctional core symptoms” that they also miss those symptoms in their children, instead mistaking the symptoms for typical behavior.
 * On the problem of distinguishing between fake and real ADD, see this study
 * Going from mild symptomatic to severe often depends on the challenge that you face

Underdiagnosis

 * Risk factors: IQ, cultural factors
 * Lack of self-awareness: Adults with ADHD may underestimate the impact of ADHD symptoms, and in many cases have learned to compensate for ADHD related impairments by choosing lifestyles that help compensate for symptoms → underestimate diagnosis when self-reporting: persistence of ADHD into adulthood is 5 to 9 times higher when based on parent accounts than when based on a self-report
 * Some adults with ADHD may appear to function well, however they may expend excessive amounts of energy to overcome impairments
 * High-functioning adults; demands on individuals become more complex only as people grow older
 * Impairment can also emerge later in life as the greater complexity of daily tasks coupled with a decline in family support structures may make previously hidden impairments more prominent and in some cases disabling
 * In contrast, for those individuals who faced ADHD-related impairments during childhood, they may find that adulthood gives them greater freedom to tailor their environment to remedy the difficulties they experienced when they were younger
 * Girls more under-diagnosed because less disruptive behavior that is then reported by parents + better coping → gender ratios converge as people get older
 * The danger is not in overdiagnosing, but in misdiagnosing

Self-awareness

 * Positive illusory bias

Self-esteem

 * ADHD symptoms elicit negative feedback from the environment from an early age on. The behavior is interpreted as scatterbrained, absent-minded, immature, dysfunctional family background, selfish, lazy, introverted
 * This develops negative mindsets yourself and other people, seeming unfair. This often leads to poor coping strategies

Therapy & coping

 * You don't treat ADHD in the therapist's room. You treat it at the point of contact: problem studying → join a study group etc.
 * Stimulants target dopamine/epinephrine in the task mode and thus enhance directed attention
 * Mindfulness: Why? Because it allows the person the moment of separation between responding to a default mode stimulus/event and redirecting attention to a task
 * Do you outgrow ADHD? Typically, people will grasp how their brain is actually working and will put in place strategies that work for them (marry/work for sb. who's organized)

Medication

 * Meta-analyses, systematic reviews
 * ADHS-Pedia

Coping

 * Problem with task persistence: allow yourself to keep moving and rotate through a variety of things. It's also not as easy to tell exactly when something is finished, so we like to finish something and then come back to it again to make sure it's finished and we become a little bit unconvinced that when we manage to go through something quickly or in order that it could just be that easy
 * Focusing on the first step of a task/project rather than the whole project. See this video
 * Reducing the number of decisions to make every day to avoid decision fatigue.
 * One way to do this is strong goal commitment. If you are focused on a goal and its attainment, you don't have to constantly ask yourself what to do today
 * Another trick are routines because they reduce the mental effort necessary for overcoming mood-related reluctance to start an activity and thus eliminate points of decision-making. Routines are the enemy of "don't feel like it" because your brain works on a different route: automatic instead of deliberative/conscious

Miscellaneous

 * Circadian rhythm, SAD etc.

Problems for society

 * For the full list, see

Videos & online sources

 * Thomas Brown on ADHD in general
 * Impairments on interpersonal lives Barkley
 * Russel Barkley on emotions
 * - Emotions and Motivation Thomas Brown
 * ADHS-pedia
 * Very good German-speaking resource
 * Understanding the Nuances of ADHD with Michael Manos
 * Thomas Brown Outside the Box: Rethinking ADD/ADHD in Children and Adults
 * 11 ADHD coping mechanisms
 * Documentary "ADHD: Not Just for Kids"
 * 

Memes etc.

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