Shirah Vollmer MD

The Musings of Dr. Vollmer

ADHD: Is It A Thinking Problem or a Personality Problem?

Posted by Dr. Vollmer on January 24, 2010

This blog is part of my series on psychopathology.

When I was a child psychiatry fellow from 1989-91, I was taught by Dennis Cantwell MD, a world leader in ADHD, who stated that kids who have problems concentrating have different brains than other kids. As such, they have struggles that other children do not have. Typically, this means that an ADHD child cannot focus on things that he has no interest in, whereas another child of the same age, could force himself to focus on something, even if it bores him.

Karen Gilmore MD, as have child psychoanalysts before her, add that children with  ADHD,  also have problems regulating their ego. Personality is often defined by how one monitors themselves. The word ego, in this sense, is interchangeable with the word personality. Dr. Gilmore argues that the inconsistency and variability of the integrative, organizational and synthetic functions of personality are really the problem in ADHD. In other words, the child with ADHD suffers because he has a harder time forming relationships, in addition to suffering because he has a harder time learning.

Historically, at the turn of the last century in England, George Still (great name) observed a group of children in his practice who showed a pattern of aggressiveness, defiance, resistance to discipline, excessive emotionality, little “inhibitory volition,” “lawlessness,”  spitefulness and cruelty; these children were also notable for their impaired attention, over activity, and a “defect” in moral control” (Still 1902).This syndrome was attributed to an underlying neurological deficiency.

More recent research has taught us that ADHD has pointed us to areas of the brain which may be affected such as the frontal lobes, the inhibitory mechanism of the cortex, the limbic system and the reticular activating system. It has been said that 70% of the brain is there to inhibit the other 30% of the brain. It is possible that those with ADHD have a lower percentage of inhibition.

To meld these psychoanalytic ideas with the neurological notions, I have come to understand that ADHD children have a hard time with inhibition. As such, learning is difficult, particularly for tasks with low enjoyment, and relationships are difficult, particularly if they involve a reliance on verbal interchange. In general, school is hard for kids who do not feel rewarded by pleasing others. The same could be said for relationships. As such, it is easy to understand the child with ADHD in that he struggles in school and he may also suffer with friendships. Having said this, each child with ADHD is  unique, such that some will have more difficulties with school, others will have more difficulties with relationships, and the most severe cases will have difficulties with both.

As we look to Russell Barkley’s work, we derive the answer. Although attention may be a prominent part of ADHD, the most disabling symptom is the inability to control impulses. Without the ability to control impulses, no one will cut you slack: not your friends and not your teachers. If no one wants to help, then the child will have problems learning things which do not interest him, and he will have problems being patient with friends. Impulse control is an ego function. Impulse control is  a cognitive skill. Both are true. Dr. Cantwell, may he rest in peace, would agree.

15 Responses to “ADHD: Is It A Thinking Problem or a Personality Problem?”

  1. Nice blog, keep up the good work and thank you for sharing. 🙂

  2. very interesting.

  3. Indeed

  4. Paul Baker said

    Another great post!

  5. umm… I am not

  6. Thanks…

  7. umm… I am not

  8. Jeremy Maez said

    Thanks in advance for your kind and generous input.

  9. Thank you for your article. It makes a change to read an article that actually means something connected to ADHD. I’ve made a note of your site details and will visit again.

  10. lisa said

    my son has been diagnoised with adhd for many years, he is now 11. he has taken almost every medication drug out there for this disorder. I have wondered for years if it is actually adha that he has because even when taking his meds he still has a very disruptive behavior, very poor grades, held back once and possibly again this year. I cannot travel with him cause he cannot sit still long enough, even for a hour train ride, even if dinning out. he does not have or has not ever made any friends in his young life and is not welcolmed in other peoples homes. I receive bad behavior reports from his school saying that he causes disruption on other students when they try to focus, teachers ask me “well what do you do at home for this? he goes to the doctor on a regular basis for his adhd follow ups, now he has some counceling from public resources that also say he has ODD. they diagnoised this with one visit. besides my child I am the one who suffers the most because I have to watch him being put through this and not being able to enjoy life just as a child. I have been fighting for disability for my child for 4 years, one neglection after another, I need to get him more serious help than I can provide because the sources that are given to him are not helping. I will soon end up seeing my child in a special school because of neglectful help from social services, dotors, and the state I have seen other children receive benefits within 30 days when their children are not even 1/4 as needy as my child. here we are over a year still awaiting a appeal date, I have four years of proof that my is not getting any better, but just extremely worse. nobody will me, I even have a lawyer who has a stack of paper work, I never hear from him, sometimes I have to call and ask if we still have a case. 4 years, just seems long for such an ongoing case with for a suffering child as mine, as for myself I can’t don’t know to do anymore, nobody seems to care.

  11. Owen said

    Thank you, thank you for sharing this info! So very insightful for this parent!

    There is a HUGE range of misconceptions & diagnosis in regards to ADHD & AS from early educators & sadly OT’s right now. So many Pre K teachers seem to not be very well informed, but super ready to check a flag list. And in my family’s recent experience OT’s were more focused on quick drive-thru like diagnosing to promote or scare parents into multiple weekly therapy sessions, rather than trying to help parents better understand the child’s behavior, mindset, social anxieties and possibly explore educational options.

    Do you believe there might be a future initiative to provide more up-to-date education for early educators and therapists in regards to the huge trend in misdiagnosis?

    • Hi Owen,
      Thank you for chiming in. Unfortunately, I think the “huge trend in misdiagnosis” is going to persist, because, as you say, there is a profit motive involved, and since all of our diagnoses are clinical, in that there are no objective tests, there is a huge opportunity to “diagnose” and then “treat.” As you say, fear is a powerful motivator and diagnoses can provoke fear and fear can yield spending a lot of money. This is a sad, but true, commentary on so many products out there, including mental health. Thanks again for chiming in.

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