You've been a psychologist since 1973. How has your profession evolved in relation to ADHD?

I've been involved in doing research since 1973. I've been a licensed psychologist since 1977, but I've devoted my entire scientific career to studying children with ADHD. Over that period of time, I've seen several things in the field. Most importantly, the way we think about the disorder and conceptualize it has changed markedly.

Back in the 1950s and 1960s, we really thought . . . that these were children who moved around a lot and climbed on furniture and couldn't control their activity level, and we called them hyperactive children. We then learned in the 1970s and the 1980s that they had tremendous problems with inhibitions, with impulse control. They can't stop and think before they act. They say things without regard to what's going to happen to them for saying or doing those things. We also found they had tremendous problems with being distractible and inattentive. So our view of the disorder expanded greatly over that period of time.

It's now evolved to a point where we have begun to see ADHD as a deeper problem with how children develop self-regulation and self-control. These problems with activity level, and later, with attention span and with impulse control, are simply the more superficial manifestations of a deeper developmental disorder, and with how the children go on to develop self-regulation--the ability to control your own behavior for social purposes.

We've also changed our understanding of the etiology of ADHD. . . . Back in the 1950s and 1960s, we didn't know what caused it. There was a suspicion that maybe bad parenting or social learning of some kind attributed to it. Other people thought it was just an immature personality development, and that within a few years, these children would outgrow the problem by the time they were adolescents.

We know now, thanks to a number of studies over the last decade, that ADHD is a real developmental disorder; that largely biological and genetics contribute to the disorder; and that it's the most inherited of all the psychiatric disorders, rivaled only by autism in terms of its genetic contribution to it. And we're beginning to focus now on three critical brain structures that seem to be implicated in this disorder. Interestingly enough, they are the same brain structures that are involved in inhibitions and in developing self-regulation--the ability to stop and think before you engage in your behavior.

Your conception of self-control varies from others' views. Why have you chosen self-control?

Well, I've begun to study self-control in ADHD children, because we began to realize that the problems with attention that ADHD children were having were not problems with how they perceived things or see the world around them. It really was more of a problem that they couldn't persist at something as long as other people. And they couldn't resist the distractions around them as well as other people, particularly when they were involved in very boring or very tedious work.

That began to suggest that there was a problem in how they were controlling behavior, not in how they were seeing the world. It would therefore be a problem with how the output of the brain--behavior--is organized, and not a problem with input coming into the brain, with how you perceive and see your world. . . .

What we've found is that ADHD children can pay attention to things that are around them in the immediate situation, so that it's really not an attention problem. What they don't pay attention to is what lies ahead in time, what has to be done next in order to get ready for the future. They're not stopping to think about that future. So they don't have a problem with attention; they have a problem with intentions. Intentions are the things we are doing to get ready for what lies ahead in time--our goals; our plans; the assignments that we should be working on; the paths that other people have given us that we need to be paying more attention to in order to be ready when that time gets here. That's what ADHD children are not doing. . . .

Are there studies that indicate an element of the brain that might be different?

We think that the brain is very much involved in ADHD, for a number of good reasons. First of all, for many years, an extensive amount of research shows that the kinds of electrical activity that we can monitor . . . indicates that certain portions of the brain, particularly the right frontal area, are less active, less mature. They're under-aroused more than they should be, and we've known this for a long time. Other studies, also using brain electrical activity, indicate that the brain doesn't respond as quickly to certain kinds of stimulation, particularly stimulus to stop and inhibit their behavior. And so we have a large amount of research there as well.

Finally, using the most recent technology called "functional MRI," studies are now indicating that these brain regions are substantially less active than they ought to be for someone of that age group. So we have multiple lines of information that converge on a common conclusion: that we have three regions in the brain that are less developed, less active than they should be; and, it turns out, that these regions are absolutely crucial for inhibitions and for thinking before you act--for self-control.

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Written 2000. Updated 2001. Reviewed: 02/2006