Memory and ADHD (ADD)

Memory and Attention Deficit Hyperactivity Disorder Many clients come to my office who exhibit signs and symptoms of ADHD (Attention Deficit Hyperactivity Disorder or ADD) and seek two things: An ADHD or ADD diagnosis, and help with what they feel is poor memory. In actuality often these individuals don’t have any significant “memory” issue, but instead have other problems that mimic memory problems. They report problems remembering to do things, to finish tasks, or difficulty with reading (and remembering who the characters are) and so on. Some of these are memory related, some are not. For these individuals we provide help by not only providing a clear diagnosis of ADHD, but also looking at issues that might relate to what appears to be memory problems. Difficulty with remembering details, following a story line or conversation, or simply “tuning out” may be caused by other issues. This include depression, anxiety, and similar problems. These are ruled out or ruled in by taking part in a more comprehensive personality assessment than you might have received in the medical doctors office. This might include self report “tests” as well as a structured history and clinical interview. Now that you may have anxiety, or depression, doesn’t mean that you don’t ALSO have ADHD. But the anxiety or depression needs to be treated before out interventions for ADHD can be expected to work. Anxiety and depression can lead to all the symptoms you might have checked off in the doctor’s office when you completed the little “test,“ he or she administered, really nothing more than a self report. So we often start there and rule out these possibilities. Still many people with ADHD (or ADD, which is an older term for ADHD no longer used) actually do have problems with memory. But there are other possibilities as to why you might have trouble remembering things besides “memory” in and of itself. These include the following: First, some executive dysfunctions or deficits that might interfere with your ability to “remember and learn:” Response Inhibition (the ability to think before you act. You may simply be missing the opportunity to act on information stored in your brain because you are too impulsive to stop, think and then act. Working Memory. Working memory is a specific part of memory that people often have difficulty with. It’s the ability to hold information in mind while performing complex tasks. Remembering a phone number while writing it down is an example. Medication often helps with this problem. Sometimes it doesn’t. There are some specific training tools that help with working memory and there are dozens of on line computer games that claim to help with improving working memory. Most of these have very little science behind them and can be a waste of time, as well as frustrating. One computerized learning program that has been shown to help with working memory is called CogMed. Cogmed uses a specific series of changes in the level of difficulty in the computer program that makes a big difference, and it has been scientifically shown to help many with issues of working memory. But here is something to remember: Improving working memory doesn’t mean curing or fixing ADHD. If one of the main problems you have is por working memory, it most likely will be helpful, but working memory does not equal ADHD. Self Regulation of Affect: This involves your ability to manage your emotions in order to achieve goals, complete tasks and stay on task. If you can’t regulate how you feel, anxiety, depression or anger may have serious consequences on how well you can think and remember things that are important. Sustained attention: The capacity to maintain attention over a period of time is critical to following through on tasks, and remember to get everything done. Boredom means getting off task. Medication can help those with problems with sustaining attention. We also have several simple environmental cues, prompts and techniques that can help with this issue. Organization: An inability to be organized often means, for the individual with ADHD, not “remembering” what is important to do. Time Management: Poor time management skills can also lead to difficulty following through, and lead to anxiety, anger and confusion. These are just a few of the executive deficits that can add to your difficulty “remembering.” But remembering itself can have many different aspects, and we often need to look at how you are doing at these many different components of remembering. These include (but are not limited to: Working memory: We have already discussed this. The ability to temporarily hold a bit of information in your mind while you do another task (like writing it down!) Long term memory: This is what most people thing of when they talk about memory. I tell you a story and you remember the details in an hour or day Visual memory: This involves an ability to remember visual cues, that might be shapes, letters, words or pictures. And this skill relays upon a number of other skills that might be specific deficits for you such as an ability to see the difference between figure and ground. Filling in missing parts of a figure. Remembering visual items in a specific sequence. We call this “temporal sequential order.” Verbal memory. Like visual memory there can be a specific problem with verbal memory. You may have good verbal memory and poor visual memory, or the other way around. And with verbal memory the problem may be an issue of “memory,” or it may be a problem with auditory processing. Hearing and understanding what is said to you. Auditory processing deficits are often taken to be ADHD. Learning. Learning is a different process than memorizing and remembering along. Your ability to learn new material depends upon a number of factors, including working memory, long term memory, auditory processing, basic understanding and cognition, and how these and other specific neurological systems connect and work together. Often we use tests such as the Test of Memory and Learning-2 (TOMAL-2) or other specific memory scales to understand if you are learning at a rate similar to others your age and with your cognitive abilities. So as you can see, having a “memory problem” may or may not mean you have ADD (Attention Deficit Hyperactivity Disorder or ADD). It can mean a number of different problems and often a comprehensive psychological or neuropsychological assessment is necessary to determine where the problem is. Besides picking out your deficit areas it is also helpful to understand your strengths as well. This helps you determine how you can use these strong points to help in the areas you are weaker. Finally, individuals who have memory problems and ADHD often have developed ways to make up for these problems. Sometimes these are positive (like using a notebook) and sometimes not (like avoiding and procrastinating). Therapy helps you address these issues and develop skills that are more useful and positive, and avoid ...well, avoiding. For more information on understanding how all these elements can come together to cause you or your child difficulty I would suggest a couple different books: Dr. Mel Levine, The Myth of Laziness Dr. Russell Barkley’s books Taking Charge of ADHD and Taking Charge of Adult ADHD For Teachers: Peg Dawsons’ Executive Skills in Children and Adolescents My website (http:www.relatedminds.com) also contains several articles that are short and useful on the ADHD page. In both my Burnaby and Vancouver offices I provide testing and assessment of ADHD as well as therapy and coaching services. Please feel free to contact me.