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Research is showing us that AD/HD impairs the brain's executive function ability. It's as if the brain has too many workers but no boss to direct or guide them. When the brain's executive function abilities operate appropriately, we think, plan, organize, direct, and monitor our thoughts and activities. In essence, our brain has a capable executive or boss.

Of course, none of us is born being our own executive. We acquire these skills as our brains develop and mature. Until we are able to monitor and regulate our own activities and lives, we rely on people and things outside of ourselves to guide and direct us. Puberty marks the time when we become increasingly "brain-able" to be our own boss.

Our executive abilities also help us to concentrate longer and to keep track of our thoughts, especially those we need later. We are less distracted by our own thoughts and find it much easier to return to work after we've been distracted.

The brain's executive abilities also help us inhibit, or control, behavior. Inhibition is the ability to delay or pause before acting or doing. It allows us to regulate our thoughts, actions, and feelings. This self-regulation or self-control helps us manage or limit behavior. We learn to say "not now" or "not a good idea" to impulse. We learn to control our activity levels to meet situational demands. For example, to yell at a ball game is fine (unless we are shouting in someone's ear). Yelling in a classroom is usually not okay.

Thanks to our brain's executive abilities, we become driven more by intention than impulse. That means we pause and reflect before we act. For instance, we are able to consider the demands of a situation along with the rules. We can delay an immediate reward in order to hold out for a later reward that's more meaningful.

With AD/HD, the very brain areas responsible for executive function and inhibition are impaired. Children with AD/HD can be considered hyperresponsive, because they behave too much. They are more likely to respond to events that others usually overlook (Barkley, 2000). Their characteristic disinhibition often causes others to find them annoying, irritating, or exasperating.

Obviously, executive function difficulties can create distress and problems with daily functioning, including emotional control. In addition to symptoms of inattention, impulsivity, and hyperactivity, you may also see these types of executive function problems:

• weak problem solving,
• poor sense of time and timing,
• inconsistency,
• difficulty resisting distraction,
• difficulty delaying gratification,
• problems working toward long-term goals,
• low "boiling point" for frustration,
• emotional over-reactivity,
• changeable mood, and
• poor judgment.

It's important to remember that the self-control and self-regulation problems seen in people with AD/HD are not a matter of deliberate choice. These problems are caused by neurological events or conditions. People with AD/HD know how to behave. They generally know what is expected in a given situation. But they run into trouble at the point of performance-that moment in time when they must inhibit behavior to meet situational demands. Their troubles may show up in how they act in the outside world, or in their internal selves. They characteristically have inconsistent performance. This inconsistency is often mistaken for a lack of regard or respect, or as a lack of effort.

Because of inhibition problems, the disorder also makes it hard for the young person to follow the rules, especially if the rules are not crystal clear. Children with AD/HD usually need a lot of incentive to follow the rules, too. That doesn't mean that they are intentionally bratty or demanding. When a child's executive and inhibition mechanisms are not functioning fully or normally, then we need to provide external incentives to pump up the child's ability to inhibit thoughts, feelings, and actions.

Performance usually improves when external guides, rewards, and incentives are provided. These might include step-by-step approaches, extra praise and encouragement, and the chance to earn special privileges for better performance. More will be said about these approaches in Section II of this Briefing Paper.

How Do I Know For Sure That My Son or Daughter Has AD/HD?

At present, no laboratory test exists to determine if your child has this disorder. You can't diagnose AD/HD with a urinalysis, blood test, CAT scan, MRI, EEG, PET or SPECT scan, although some of these technologies are used for research purposes.

Diagnosing AD/HD is complicated and much like putting together a puzzle. You, as a parent, may think your child has AD/HD, but an accurate diagnosis requires an assessment conducted by a well-trained licensed professional (usually a developmental pediatrician, child psychologist, child psychiatrist, pediatric neurologist, or clinical social worker). This person must know a lot about AD/HD and all other disorders that can have symptoms similar to those found in AD/HD. Until the practitioner has collected and evaluated all the necessary information, he or she-like you, the parent-can only assume that the child might have AD/HD.

The AD/HD diagnosis is made on the basis of the observable behavioral symptoms listed in this document. The symptoms of AD/HD must occur in more than one setting. The person doing the evaluation must use multiple sources of information. Since symptoms of AD/HD can also be associated with many other conditions, be wary of any practitioner who makes a snap diagnosis either because you've said you think your child has AD/HD or because he or she has observed the child once. Children with AD/HD commonly behave well on the first meeting. Furthermore, personal observation is only one source of information.