ebook_ADHD2019_engl.

The World Federation of ADHD Guide 115 tion. 7 Playing videogames or in other highly motivating situations, individuals with ADHD frequently can focus pretty well. The problem in ADHD is the ability to focus and inhibit motor response or mo- vement in day-by-day activities where the level of stimulation is not high enough to keep the brain activated as needed. A 10-year-old typically developing child can pay attention in class even when the topic is not tremendously interesting for him/ her. In other words, his/her default brain mechanisms associated with attention do not need a high energetic state to operate, although they might operate even better when stimulated. Individuals with ADHD do not achieve the energetic level to execute functions without moderate to high motivation due to impaired brain structure, function and/or neurotransmitters unbalance. More important, since these mechanisms cannot be voluntarily turned on, we are not dealing with an issue of willpower. The idea that people with ADHD should just try harder might be compared to ask someone with poor eyesight to try harder to see well. Another aspect that gives families the impression that ADHD is a problem of willpower is that people with ADHD might work better under some optimal level of stress. Thus, it is not uncommon for hyperactive children to sit still in the doctor’s office during the whole appointment or extremely inattentive adoles- cents might focus for studying at the end of the school year. Several investigations have documented that an optimal level of activation/stress helps pre-frontal cortex work better due to discharge of a brain substance called noradrenaline. 8 Again, under these circumstances, individuals with ADHD might achieve the energetic threshold needed to execute things that they cannot achieve under normal cir- cumstances. For this reason, we did not rule out a diagnosis of ADHD just based on the lack of hyperactivity/ impulsivity or inattention in the doctor´s office. That said, it´s important to recognize that some level of effort is always needed to overcome obstacles imposed by disorders. Even if the impaired brain mecha- nisms could be improved with medication, a level of effort will always be needed. Here, we can use an analogy with a situation where someone has a mild stroke in brain areas commanding left hand movement. Without physiotherapy exercises, the patient will probably not recover hand movement. This is the reason why com- bined treatment in ADHD, even if it is just in the format of psychoeducational interventions, is important in ADHD. ADHD IS A DISORDER CAUSED BY MODERN SOCIETY DEMANDS In the last two or three decades, sufficient knowledge was accumulated clearly indicating that ADHD runs in families and that genetics play a major role in the transmission of the disorder. 9 As discussed in a previous chapter, we now have sufficient research data to even indicate the first sequences in our DNA that is responsible for a very small part of this genetic susceptibility. 10