ebook_ADHD2019_engl.

66 Rohde, Buitelaar, Gerlach & Faraone clusions. People with ADHD also report problems in self-monitoring for the context in which they are interacting. They fail to notice when other people are puzzled, hurt, or annoyed by what they have just said or done and thus fail to modify their behavior in response to specific circumstances. Often, they also report chronic difficulty in regulating the pace of their actions, in slowing themselves down or speeding up as needed for specific tasks. THOSE WITH ADHD FOCUS WELL IN A FEW SITUATIONS, BUT NOT IN MANY OTHERS Impairments of ADHD vary from one situation to another. Virtually all those diagnosed with ADHD have a few activities or tasks in which they have no diffi- culty exercising those same executive functions in which they are consistently im- paired for most other tasks they encounter. For example, students who chronically struggle to sustain attention in school may have little or no difficulty in sustaining focus and effort for hours to play a particular sport or to make art or music, to construct with Legos, to play video games, or to do mechanical tasks. Often parents or teachers challenge those with ADHD asking “If you can focus so well and work so hard for this activity, why can’t you just make yourself focus and work that way for your schoolwork and other tasks that you know are impor- tant?” Usually the response is “I can focus well for activities I’m really interested in. I can’t focus like that well for tasks that are just not interesting for me.” This can make ADHD appear to be a simple problem of failure to exercise “willpower” when the disorder is really not a problem of willpower. It is a result of inherited problems in the dynamics of the brain’s chemistry. One college student once explained this with a sexual metaphor: “Having ADHD is like having ‘erectile dysfunction of the mind.’ If the task you’re faced with is something that really interests you, you’re ‘up for it’ and can perform. But if the task is not interesting to you, you can’t get up for it and you can’t perform. It’s just not a willpower kind of thing.” ADHD IS USUALLY INHERITED AND TENDS TO RUN IN FAMILIES Many twin studies have shown that one out of four individuals with ADHD is like- ly to have a parent with ADHD; those who do not have a parent with the disorder are likely to have a sibling, grandparent, uncle or aunt with ADHD. These family members may not have been diagnosed because this disorder was not adequately understood in earlier years and, even today, many medical and mental health pro- fessions are not adequately trained to recognize and diagnose it. ADHD is not due to any one gene; it is related to multiple genes.