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The Link between Cognitive Skills and ADHD

The Link between Cognitive Skills and ADHD

Have you heard that a child has ADHD and you think “hmmm, my child is nothing like my neighbor’s kid,” or “my child is nothing like my brother.” Or … fill in the blank. That’s because there are seven different cognitive profiles associated with ADHD.

As October is ADHD Awareness month, health experts continue finding the need to educate and debunk myths associated with Attention-deficit/hyperactivity disorder (ADHD).

So, you think your child may have ADHD but you're skeptical. Well, the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) provides three different categories associated with ADHD: hyperactive-impulsive, inattentive, and a combined inattentive hyperactive-impulsive. Research suggests that these three categories are still oversimplified. The reality is that there are seven different cognitive profiles associated with ADHD.

The definition and label of ADHD imply that attention is the primary cognitive deficit among children with the diagnosis. However, in looking at over 5,000 cognitive profiles of people diagnosed with ADHD, attention was not the most deficient cognitive skill. Instead, the largest deficits were found in working memory, long-term memory, and processing speed for both children and adults.

Your child can have a weakness in working memory, which is the ability to hold information for a brief amount of time such as doing mental math or remembering the page number to turn to in a book. Or your child may have great working memory, but if you ask him/her to layer more information, then you’ll get the wide-eyed, lost deer in the headlights look. This layered memory is called long-term memory. Or your child might also have a weakness in processing speed, meaning, your child does things slowly. Psychologists sometimes refer to slow processing speed as “sluggish cognitive tempo”.

So, to recap, your child may be diagnosed with one of the three ADHD profiles (hyperactive-impulsive, inattentive, and a combined inattentive hyperactive-impulsive) and have relative weaknesses in one of three cognitive skills: working memory, long-term memory, or processing speed. Or working memory and processing speed. Or working memory and long-term memory. Or processing speed and long-term memory. Or ALL three skills. And that’s where you get the seven cognitive profiles of ADHD, which is why your child’s symptoms and behavior may not resemble those of another child who has ADHD.

Okay, if your brain is spinning with this litany of information, imagine what it’s like for kids who may have ADHD. The brain is a very complex organ and one of the key points to know about ADHD is that the condition is not just about attention.

Cognitive skills other than attention contribute to the challenges of functioning in life for the estimated 8.4% of children diagnosed with ADHD. What we’re learning is that if you just focus on the attention piece of ADHD, then you’re not really addressing attention deficit. You must treat ADHD holistically. What does that mean? Before you can answer that question, you first must ask yourself the real questions:

- If my child has attention deficit, which type is it?
- And what is the best approach to strengthen the cognitive weaknesses?

Here’s why that matters. The child who has the inattentive type of ADHD with poor long-term memory and slow processing speed is a very different child than the one who has poor working memory and is bouncing off the walls or, as we like to say, has a lot of energy. What works for the energizer bunny will not work so well for the child who has slow processing speed and who, by the way, is likely inattentive. So, people must understand that what may work for one child with ADHD, may not help another child with ADHD. More importantly, if we want to address the challenges associated with ADHD effectively, we have to look beyond attention.