Managing Attention and Hyperactivity Deficits with Counseling

Attention deficit and hyperactivity disorder, where a person has difficulty concentrating to the point of completing tasks, or impulsivity, a type of driven restlessness to a degree that it impacts all areas of life, is not a newly noted pattern in human behavior.

The description has shown up in literature in different ways throughout recent history, and most likely will change again over time as more is discovered about where it comes from and how it appears or presents itself in cultures over time (Lange K.W. Et al., 2010). There certainly has been a lot of progress in tracking and understanding the description of behaviors.

There are also now numerous, effective, researched ways to understand and manage the symptoms, all of which should be, when in relationship with God, wrestled with and considered before Him. Understanding can begin by meeting with your doctor or a psychologist or therapist to assess whether your symptoms meet the criteria for the diagnosis.

Then, as with all things in making decisions, including mental health diagnosis and its treatment, we are invited to pray, review Scripture for guidance, and seek wise counsel to learn to manage ourselves.

In the written encouragement from E. Welch (2024), “The most important principle is that your quest for medical treatment does not outdistance your diligence in spiritual nurture.” Counseling with a mental health professional, grounded in Christ and biblical truths, can be one way to explore and develop understanding and skills to manage ADHD.

What is ADHD?

Before describing ADHD, there needs to be a discussion of the importance of the descriptors themselves. Frustration has been expressed at the ways in which terms for the same behavior or descriptors change over time. Does what we call something really matter? The pendulum may swing, but we must let it land where the Lord directs. We are directed to be thoughtful of how our words affect others.

As Proverbs 18:21 (CSB) says, “Death and life are in the power of the tongue….” Additionally, we are directed to be mindful of what we say, as it reflects our hearts, and mindful of how our words will impact others and the situations we are in (cf. Proverbs 10:19).

Additionally, the euphemism, “I just don’t have the words,” exists for a reason. Language can fall short of describing what we see and know. Ultimately, what we say matters in our own heads to ourselves and toward others. Bearing that in mind, attention deficit hyperactivity disorder is one description of a set of patterns of behaviors. It is not a newly recognized nuance in human behavior.

Descriptions of inattention first appeared in literature in 1798 by Sir Alexander Crichton, where he explored what might be typical versus atypical patterns of attention (Lange K.W. Et al., 2010). Centuries later, ADHD is described by the Diagnostic and Statistical Manual (DSM-5-TR) as a combination of six or more specific symptoms of inattention or hyperactivity, or both.

They must be present for more than six months, having started before the age of twelve, and significantly impact more than two areas of life in ways that negatively impact the person and are not consistent with what are considered developmental averages.

What medical or mental health providers are looking for is how attention and activity show up and impact living. Consider that a person with attention-deficit can attend and concentrate highly on a singular task, usually something of great interest to them, which is usually not the task at hand or required in their setting.

Attention is rapidly pulled to multiple places, like someone changing the TV channel multiple times without consent (Copeland and Dumm, 2015). It is physiologically and often emotionally exhausting, and this is where behavior starts to affect functioning in different settings.

Nowell, David, Ph.D. (2019) calls this “The GAP.” Hyperactivity is a type of driven restlessness, like an overheated internal motor that is either set to max RPMs at all times, looking for ways to release the vibrating energy, or turned completely off. ADHD is essentially not about a person’s ability, but a person’s performance.

When diagnosing ADHD, it is important that symptoms are differentiated from what is simply healthy play or activities for children and adults. An assessment also should consider a person’s personality, their environment, stressors, and medical implications that may present like ADHD, but are not actually its cause.

ADHD needs to be assessed, and other diagnoses that impact cognition and brain functioning need to be considered; things like learning disabilities, possible traumatic brain injuries, substances, etc. (Welch, 2024).

Where ADHD Comes From

There is still much to learn about ADHD and its development. Even research appears to disagree with itself, where some studies state that there is no concrete evidence that ADHD brain development and functioning are different from other neurotypical brains (Welch, 2024). Other research points to evidence that there is indeed neurodivergence in someone who has ADHD (Nowell, David, Ph.D. (2019, February).

What is known is that some factors increase the likelihood of ADHD behaviors recurring, such as heritability (where parents had the official diagnosis or presented with similar behaviors), children with low birth weight, infants and children exposed to nicotine and alcohol, and chemical changes that occur from extreme stress occurring from different factors in parents.

Studies of people with an ADHD diagnosis show a thinner cortex, more activity in the occipital lobe, the back of the brain, which impacts visual learning, and less activity in the frontal and temporal lobes where sequencing and decision-making occur (Nowell, David, Ph.D. (2019, February).

When is it really inattention and hyperactivity disorder?

As every person has their own unique summary of genetics and experiences, ADHD may look different in how it shows up from day to day. Therefore, it is essential that when managing ADHD, diagnosing ADHD, or relating to someone with ADHD, you get to know yourself or that person to figure out where the performance GAPS exist and why, and over time. Again, ADHD is not about a person’s intelligence; it is about performance.

The criteria for assessment are important in this, assessing the way symptoms show up across different environments and from a young age. For example, a parent expresses their concern that their child will make eye contact briefly but then act as if the connection was not made and begin behaving beyond or outside of what they were requested to do. This may fall under the category of difficulty sustaining attention.

In order to assess whether this is part of ADHD, an assessment needs to evaluate multiple factors to identify why this behavior occurs in daily life. Questions should be explored, such as whether the child may have hearing or vision impairment that may be impacting connection.

Is there a cultural layer at play where direct or sustained eye contact with a parent is acceptable? When, where, and how is the child being required to provide sustained attention? Is the environment chaotic or peaceful in these contexts? Is the concern only happening with one parent, or with all people? Is the child’s personality assertive or more passive? Did the child just eat, and maybe mood fluctuation is playing a role?

There are many ways and reasons divergence appears in daily life, but what is imperative is careful and thoughtful consideration of why it is impacting progress or daily functioning.

Using Counseling to Manage ADHD

As noted previously, the first step to diagnosing and managing ADHD is to pray about it. Set a rhythm of bringing thoughts and curiosities to God and anticipating that He will respond in expected and unexpected ways. This may be through Scripture, through exploration of literature on the subject, through others with wise advice and encouragement, and through counseling.

In addition, consider scheduling multiple appointments to meet with a primary care physician, a psychologist, and a therapist to have symptoms assessed. Consider their feedback and whether there is a pattern that illuminates what might be occurring. Ongoing counseling, regardless of the outcomes from a doctor and psychologist, can be beneficial in addressing what problems may be arising that led to an assessment of symptoms in the first place.

A counselor can help be a resource or director of increasing self-awareness and education about symptoms. They could provide literature and self-help tools to begin managing symptoms. Counselors can adjust session times, styles, and treatment interventions to help develop self-management tools and skills.

For some people with ADHD, medication is part of their management tools, and counseling can be a good place to process the feelings and integration of medication after seeing their doctor or psychiatrist for the actual prescription of medication. A counselor can become the one person who works to understand their experience, identify the differences in their experience, provide direction, and walk alongside with compassion.

Lastly, a counselor rooted in Christ and biblical faith can help illuminate how to practically implement God’s encouragement to all of us to have rhythms that reflect him, or filter life through Christ, no matter how our brains operate or our bodies move.