Josh can't keep his hands to himself when waiting in line. Seth seems to act irresponsibly. Megan never completes an arts and crafts project. These campers' behaviors may have a common link - attention deficit hyperactivity disorder.

Attention deficit hyperactivity disorder (ADHD) is one of the most studied and controversial disorders in child development. This disorder, which is present in approximately 4 to 7 percent of the childhood population in the United States, is characterized by behavior difficulties such as inattention, impulsiveness, and hyperactivity. The child, or adult, with ADHD has problems starting, staying with, or completing tasks. The result is a life that may often be chaotic.

Characteristics of ADHD

Current research theorizes that ADHD is a developmental disorder of self-regulation. A person's ability to exhibit self-regulation or self-control flows along a continuum. At one end, a person would have all the internal arousal, motivation, and persistence needed to self-regulate toward his future best interests. In the middle of the continuum, a person would have a great deal of self-regulation and self-control but still need outside performance or compliance incentives or consequences, such as laws or rituals.

As the person moves toward the other end of the continuum, he begins to exhibit less self-control. As the person moves even further down the continuum of self-regulation, his or her life begins to appear chaotic and disorganized or without direction to one's future best interests. The person may show little hindsight, forethought, or preparatory action. This level of interruption causes serious impairments in social, academic, or vocational functioning. ADHD is a diagnosis for those at this lower end of the continuum.

A Developmental Delay

These difficulties in self-regulation represent a delay in development rather than a halt in development. This means, that with age, people diagnosed with ADHD will always be improving, but they will always be behind their same-aged, non-ADHD peers. The ADHD person does not, age appropriately, gain the progressively internalized capabilities of self-control.

As a person matures, his capacity to self-regulate his own behavior comes more from internal or self-imposed neurological processes. At birth a child has practically no internalized mechanisms to self-regulate. He relies entirely on regulation or guidance imposed by others. After a few years of normal development, the child gains more internalized processes of behavioral self-control, while still needing lots of externally applied rules, guidelines, and incentives. With adulthood maturity comes behavior that is controlled via one's own internalized self-regulatory mechanisms.

The developmental delay in the person with ADHD is in the internalization of the ability to self-regulate his behavior. It consists of a problem of "behavioral inhibition" interacting with what developmental psychologists and neuro-psychologists call "executive functions." These functions are operations within the brain that promote and allow for self-regulation or self-control. This includes non-verbal memory, verbal memory, self-talk, emotions, motivation, arousal states, problem analyzing, problem solving, and thought and behavioral sequencing.

Living in the Moment

The ADHD person, in the presence of stimuli, is less able to stop or prevent an immediate, powerful, or automatic (helpful or harmful) response. This diminished behavioral inhibition then interacts with and leads to diminished functioning of the other brain operations dealing with self-regulation.

The combination of these factors cuts or blocks the connection that leads a person's thoughts to action and his knowledge to performance. It prevents the person from using the past to work toward or maximize his future. The person is often called a repeat offender. He commits the same error over and over again. This is because the inhibitory response system has not allowed for the effective employment of the thinking and problem-solving processes of self-regulation, so the person does not plan or apply new strategies that would normally result from processing one's past mistakes. Therefore, the person's behavior often appears disorganized, irresponsible, chaotic, and ill

A person with ADHD may have difficulties waiting in line or taking turns. Their brain functioning leads them to anticipate and feel that the time period will last excessively and unbearably long. They then show high levels of impatience or frustration with the delay and sooner or later act to escape from it. The delay is seen as boring or bothersome and, therefore, escape behaviors become difficult or impossible to prevent.

Difficulty Remaining Focused

Another very important part of the executive functioning of the brain is the utilization of arousal, motivation, and persistence in goal-directed behavior. Through normal maturational development the brain shifts from being dependent on external incentives to being independent through internal self-generated arousal, motivation, and persistence. This is seen when an adolescent carries out the decision to go to college, continue with graduate school, and survive a long internship training. This represents goal-directed behavior aimed over a prolonged period of time.

On the other hand, a person with ADHD will be more focused on the present moment with its immediate interests. If a task such as homework lacks immediate, external incentives, then there will be a resultant lack of arousal, motivation, and persistence. If a task is deemed of little importance or is too distant into the future, then the performance of the ADHD person drops dramatically. The failure to perform is not an issue of irresponsibility or laziness. The child with ADHD fails to perform because the internal mechanisms to self-create the arousal, motivation, and persistence are lagging behind developmentally.

Developing Social Skills

A lag in social development is another result of ADHD. There may be poor performance in applying social skills (sharing or cooperating), minding his manners, following moral conduct codes, and acquiring adaptive behaviors (rule development and safety consciousness). The deficiency is not in having knowledge of these skills, but rather, in the deployment of the skill at a strategic moment in time when it would be most adaptive to one's own immediate or distant well being. This deficiency may lead to extreme behaviors, such as lying, stealing, selfishness, and possibly impulsive social aggression.

As a result of the brain determined functioning in self regulation, there is often an effect on psychological and emotional development. A person with ADHD may develop less competencies, make more mistakes, have fewer successes, or be labeled as irresponsible or lazy. It is not uncommon for the child with ADHD to experience more pessimism with resultant passivity. It is not infrequent that the person with ADHD have or develop a co-existing problem of an oppositional defiant disorder, a conduct disorder, a depression disorder, an anxiety disorder, an obsessive-compulsive disorder, Tourette's syndrome, or other disorders.

The Positive Side of ADHD

ADHD is not all negative. The same ADHD brain functioning that causes problems for a child may also give that child qualities for success, such as intuition and spontaneity, excitement and energy, creativity and artistic skills. A comprehensive treatment program, an educational understanding of ADHD, and a focus on the skills and positive
qualities that the child possesses are important for the child's success.

Long-term Outlook

The long-range outcome for a child with ADHD varies and is often dependent on what help or interventions he receives. For some, the prognosis is a life of chaos and disorganization combined with depression, anxiety, anti-social conduct, or other mental disorders. For many the prognosis is less severe, but they may have many interruptions or disappointments in careers and relationships. Still others have very satisfactory, happy, and or productive lives.

Camp's Place

Camp can provide a very positive experience and therefore can be an asset in the developmental life of the child with ADHD. Many ADHD children attend and fit will into resident and day camps. More severe ADHD or those who have moderate to severe co-existing opposition and defiance may need camps that provide special assistance or staff. Seek a mental health professional for guidance.

Camp staff need to be knowledgeable about ADHD. They need to avoid making negative judgment statements to or about children, for example, "You are so irresponsible," "She never finishes anything," or "You don't try hard enough." They should also keep in mind that an ADHD child will need immediate, age-appropriate, and valued "performance incentives" to behave appropriately. Secondly, camp staff can, through their knowledge of ADHD, develop programs that consider emotional or social enhancements for this population. Camp experiences can focus on and magnify the assets, islands of competencies, and other skills in ways that can be a powerful counter to the child's previous negative experiences.

By learning more about ADHD, you can begin to understand why campers may behave in certain ways. This may help you formulate strategies to help them focus their energy on positive activities and ensure that all campers have an enjoyable camp experience.

Originally published in the 1999 January/February issue of Camping Magazine.