Underachievement

There are a number of possible causes of underachievement in life. Most people gravitate to a self-diagnosis of Attention Deficit Disorder, however. The possible causes are:

  1. Learning Disorders
  2. Chronic Depression
  3. Attention Deficit Disorder
  4. Personality Disorder

These disorders are  fairly common each having a prevalence of between 2-5% of general population.

Their effects vary in emphasis:

  • Concentration and Memory ( Depression and ADD)
  • Frustration Tolerance and Anger Control ( ADD and Personality Disorder)
  • Ability to Finish Tasks (ADD)
  • Ability to begin Tasks    (  Depression )
  • Distractibility (ADD)
  • Ability to organise self, set goals and plan (ADD, Personality Disorder)
  • Ability to remember instructions and follow thru ( Learning Disorders and ADD)
  • Ability to correct mistakes ( ADD, Personality Disorder)
  • Ability to maintain stable relationships (Personality Disorder)

Its common for there to be more than one disorder for instance ADD + Learning Disorder  or Personality Disorder + Chronic Depression.

Learning Disorder   relates to a circumscribed problem with auditory or visual perception or memory .  The commonest example if Dyslexia where the person turns written letters around or mis-spells   because of poor visual-perceptual skills. Also common is auditory short term memory problems where a person may be given three instructions in sequence but registers and acts on only the first one.  Learning Disorder should be picked up in school years . Unfortunately   with the demise of  multi-disciplinary educational support services  this sometimes doesn’t happen. Learning Disorder is diagnosed by Neuropsychological testing  and is treated with Cognitive Remediation.

Personality Disorder is a developmental disability that relates to: (a) maladaptive ways of coping with distress and (b) unrealistic expectation of others.  The commonest maladaptive behaviours are some sort of self-destructive behaviour such as substance abuse, law breaking or self-cutting. The commonest unrealistic expectation of others relates to coming from an unloving punitive family and constantly returning for more punishment in the hope that the family will somehow turn into a loving one.   Treatment is by psychotherapy individual and group.

Attention Deficit Disorder has a strong genetic contribution with heritability ranging from 60-90% in various studies.  Hyperactivity is present in brothers 26% compared to 9% in controls. 20% of ADDs have a parent who can be diagnosed as ADD compared to 5% of controls.  Inheritance seems to be from a polygenic mix of recessive and dominant genes. Some genetic disorders such as Fragile X have a heightened risk of ADD.  Prenatal environmental factors increase the risk particularly maternal smoking and fetal alcohol exposure and low birth weight.

Neuroimaging Studies indicate problems with the Frontal Attentional System which is involved in directing attentional focus to an external object or matter.

Methylphenidate and Dexamphetamine  act by increasing extracellular dopamine  and noradrenaline.  Atomoxepine selectively increases dopamine.

Tips for Improving Attention Span

Lifestyle-   Reduce caffeine   intake including coca cola

Exercise regularly

Eat small meals regularly

Stick to a regular sleep-wake cycle

Flaxseed Oil 2 caps/day

Niacin  300-600mg/d

Organisation-  Spend 5 mins planning and prioritising your days tasks

Use lists for scheduled tasks, projects and deadlines

Deal straight away with things you are tempted to procrastinate with

Sort mail into ” act on ”  ” file it ”  and “bin it ” categories

Allot a time to each task and give yourself 15 minutes run over time time

Write down appointment times for 10 minutes earlier than they are

Break down tasks into smaller more manageable tasks

Be prepared to turn down invites or work to stay on a manageable schedule

Stretch your attention span- If someone gives you instructions repeat them aloud to be sure you have heard them correctly

Practice summarising as a paragraph (in your head)  what a person has been talking about with you

Have a favorite spot in a park of garden or city where you can spend a few minutes just observing each day. Notice any changes.

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