Frank has a hard time focusing on “boring” stuff. If it requires sustained, effortful attention, it’s not going to happen without a whole lot of environmental, behavioral, and motivational strategies in place. Instead of  writing the topic sentence of his essay, Frank’s brain indulges in YouTube. He doesn’t even realize he’s forgone the schoolwork and clicked on the app. It’s automatic.

Wanna know something else Frank’s brain effortlessly and compulsively indulges-in? Details that don’t matter.

When his mother restricts the wifi access so he can’t be pulled-into YouTube and social media, Frank spends forty minutes sharpening his pencil just-right.  He takes 30 minutes, erasing-writing-erasing-rewriting, arranging seven words in one answer. Sometimes, he’d rather doodle in the margins than take a leap into potential failure by reading the directions. He’s not just distracted because of his ADHD; He’s paralyzed from progress because of an anxious drive for perfection.

I don’t know what is exactly going on in the brain of Frank and all the others who are wired like him. I often wonder if it is the same mechanism that accounts for both the distractability AND the rigid difficulty tolerating ambiguity (imperfection, uncertainty). I wonder if the basis of this rigidity and perfectionism is a similar mechanism to the tunnel-vision obsession that characterizes mania. All I know for sure is that the trifecta of obsessession, perfectionism, and distractability is incredibly common. And, in the absence of blaring social deficits, the OCD is often overlooked for the sake of solely treating the attentional defects. (Those who are rigid, anxious, inattentive, with social deficits are typically considered Aspergers with a side of ADHD.)

No, disorganized OCD is not an oxymoron. So if you have a kid who never does his school work, is incredibly distractible, and has a hard time sustaining attention, please don’t overlook the possible need to encourage overcoming paralyzing perfectionism, obsession, fear of failure, and other symptoms of anxiety (at home and in therapy).

A victory for a person who is normally paralyzed by perfectionism. Hey, the cake actually got made!

Just something to think about, from the therapist who also says don’t forget about possible expressive/receptive language processing disorder, which is often misdiagnosed for ADHD when the kid has difficulty sustaining attention and tolerating ambiguity with verbal information.