Psychiatrist discusses “Real World Management” for ADHD

Amid current concerns in the media with the diagnosis of ADHD and the overuse of stimulants for its treatment, I thought it would be helpful to include an excerpt from a clinical article I read many years ago that explains the core of the ADHD experience for adults with the disorder in non-scientific language. In my practice I have encountered innumerable patients who have initially presented complaining of depression, anxiety, anger, frustration with daily life, or ruined interpersonal relationships. Following a thorough diagnostic workup, many of these folks have turned out to be primarily suffering from long-standing ADHD – and never knew it. Instead they have spent years desperately trying to compensate for the cognitive challenges created by the disorder, to the point of significant demoralization, frustration, shame, low self-esteem, and failure in their personal and professional lives.

NYC psychiatrist for ADHD

 Real-World Office Management of ADHD in Adults

By William W. Dodson, MD

Psychiatric Times. Vol. 23 No. 13 November 1, 2006

“The findings have led to the relatively new concept that ADHD is not a disorder characterized by deficits of effort, character, willpower, brain activity or size, or integrity. Neither is it caused by poor parenting skills or by diminished executive function, self-control, neurotransmitter levels, or intelligence. A newer, functional definition tries to understand ADHD as a genetically based neurologic disorder characterized by difficulties in engaging on demand in work, school, or personal situations. This difficulty in being engaged on demand explains why many patients with ADHD seem to function very well in some situations but are distracted and disorganized in others.

Unfortunately, school and work environments require the ability to engage on demand, and these are the environments in which people with ADHD often perform poorly. This disparity in attentiveness in different situations often leads parents and employers to make a moral judgment that ADHD represents a failure of will, effort, or self-control. Our new understanding that ADHD is a genetically based neurologic disorder challenges this view. It also sheds light on the management strategies that are most likely to help these patients. Because ADHD is a neurologic condition, we should not expect behavioral techniques to be any more successful as a cornerstone of treatment than they would be in the treatment of a fever, for example.


People who do not have ADHD have importance-based nervous systems. That is, the importance of a task helps them engage with it immediately, get access to their abilities, and persist with the task all the way to completion. They see the tasks that require completion, arrange them in order of priority, engage in them, and gain access to the skills they need to complete the tasks. Even when a task is more important to an employer, spouse, teacher, or parent than to the person himself or herself, a person without ADHD still manages to accomplish it.

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