k.ADHD:Attention Deficit or Hyper-Attention

We do not write because we want to; we write because we have to. Somerset Maugham

As it has been detailed in the book “ADHD:Revisited”,attention that has not been explained well in psychiatric diagnostic book, DSM-5, consists of different subtypes,e.g. sustained and dynamic (alternating or shifting, divided and selective). Unfortunately the literature on ADHD has studied mostly the sustained attention among the subjects and based on that the conclusion has been mostly that ADHD patients have attention deficit as the label of the disease indicates.  But the hyperactive/impulsive subtype of ADHD who have high intelligence (see the article ADHD and intelligence), possesses dynamic attention and are excellent in its features, i.e. alternating or or shifting, divided and selective attention and not performing well on sustained attention that most tests and school tasks are based on.  In fact these ADHD subjects are bored easily when the task is not challenging, interesting to them and require a passive, sustained attention and not a dynamic, hyper-attentive brain as theirs.

Comparison studies between the ADHD subtypes, i.e. hyperactive/impulsive and inattentive have shown that executive function impairment that many studies have ignored to differentiate between subtypes, is related to inattentive but not hyperactive-impulsive subtype.   Nigg and colleagues have reported that symptoms of inattention-disorganization were uniquely related to executive functioning when hyperactivity-impulsivity were controlled. “Inattention was associated with slower response speed, and hyperactivity-impulsivity with faster output speed.” These researchers have also reported “considerable heterogeneity with regard to any single cognitive deficit.” among subtypes of ADHD.

The topic that has not been explored at all in the ADHD literature and you may read it here for the first time, could be understood better by learning more about the different types of attention and the brain function during these different attentions.  Sustained attention that is simply vigilance is “the ability to maintain a consistent behavioral response during continuous and repetitive activity.”  Selective attention is “the ability to maintain a behavioral or cognitive set in the face of distracting or competing stimuli.” Alternating attention is “the ability of mental flexibility that allows individuals to shift their focus of attention and move between tasks having different cognitive requirements.” And divided attention is “ the highest level of attention and it refers to the ability to respond simultaneously to multiple tasks or multiple task demands.” That is as it has been detailed in the book “ADHD:Revisited”, ADHD is in fact an evolutionary condition of the brain so to adjust to the modern era, demanding dynamic, fast pacing, switching and divided attentions for multi-tasking.  

Therefore and in brief, ADHD of hyperactive/impulsive subtype is not  an attention deficit condition but a “hyper-attentive” condition and a byproduct of highly developed and evolved brain, not a defective or diseased brain.

Read more in the  the book “ADHD:Revisited” at Amazon, Kindle books.


Dr.Mostafa Showraki, MD, FRCPC Lecturer, University of Toronto,Head, Community Psychiatrists Association of Toronto (CPAT),Author: “ADHD:Revisited” Book “adhdrevisited.com”/”medicinerevisited.com”   

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