Self-Regulation and the Many Faces of ADHD

Many Kinds of ADHD

One thing scientists and clinicians have learned over the years is that there is no single manifestation of ADHD. The condition shows up in different ways for different individuals.

Dr. Joel Nigg, a Professor of Psychiatry and Behavioral Neuroscience at Oregon Health & Science University, explains why there are many kinds of ADHD. At its core, the condition is a problem with self-regulation that has three different dimensions to it: emotion, attention and energy.  Where you are with respect to each dimension of self-regulation can determine what kind of ADHD you exhibit.

What is Self-Regulation

Self-regulation is generally considered as the means by which you manage yourself in order to attain your goals, You have to be aware of your environment, your feelings, and the actions you need to take. And you need to be flexible in case the situation changes. For those with ADHD, that can be a challenge.

The Dimensions of Self-Regulation

Dr. Nigg breaks down self-regulation into 3 dimensions.

Emotion – A child or adult with ADHD can be prone to depression or anger. Thus they have trouble regulating these emotions, they can be susceptible to angry outbursts, or be overly sensitive to any perceived criticism or rejection. On the other end of the emotion spectrum, the individual with ADHD might be exuberant, outgoing and prone to risky behavior.

Attention – This dimension of self-regulation also has a spectrum that goes between an individual being easily distracted and unable to focus even on important tasks, to being hyper-focused on some activity that captures their interest. Often, an individual with ADHD can go back and forth between the different ends of the attention spectrum

Energy – The two ends of this dimension relate to problems inhibiting behavior and problems activating behavior. In the first case, an individual may be hyperactive and impulsive. In the second case, an individual may be sluggish and have trouble initiating any activity. As with the attention dimension, an individual may sometimes flip between both extremes levels of activity.

You can think of each combinations of emotion, attention and energy self-regulation as representing a different kind of ADHD.  Where you are in this 3-dimensional grid determines what kind of ADHD you have and what sort of treatment plan might be most effective.

Personalizing Treatment

This has implications for the treatment of ADHD. Most treatment plans involve medication, therapy and / or coaching. But genetic science and neuroscience are not yet able to predict which medication or treatment is right given the specific kind of ADHD an individual is experiencing. Until that time comes, Dr.Nigg recommends combining the best professional advice with some trial and error and common sense. The key, he says, is recognizing there is more than one kind of ADHD. There is no “one-size-fits all” solution.

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