ADD and Temperament Extremes

Temperament Extremes | The Being Well Center

image via Flickr, Austin Kirk

Individuals with ADD seem to have a greater frequency of extreme temperamental characteristics, those inborn behavioral response patterns that shape how an individual approaches and responds to life’s events and circumstances.

The most common temperamental extremes identified in individuals with ADD appear to be high activity level, low threshold of response, high intensity of reaction, negative mood, slow adaptability, short persistence, and unpredictability of basic bodily functions such as eating, sleeping, and bowel habits.

This means that people with ADD tend demonstrate a short fuse, a low frustration tolerance, a tendency to demonstrate temper outbursts, and difficulty adjusting to change. In addition, they often seem more excitable, sensitive, cranky, and unpredictable.

Why is it that so many individuals with ADD seem to have extreme temperaments?

It may be that individuals with ADD come into the world with a greater number of these temperamental extremes. However, it is also possible that these behaviors seem to be more common in individuals with ADD because their attentional differences interfere with their awareness of and ability to control these built-in personality characteristics.

That is, it may be that extremes in temperament such as high activity level, high intensity, low threshold, negative mood, slow adaptability, and short persistence occur just as frequently in the non-ADD populations as in the ADD population.

In order to exert control over these temperamental characteristics, an individual must be aware of his extremes, monitor his behavior, and develop effective ways to keep his extremes in check. As this requires efficient monitoring, problem-solving, vigilance, and impulse control, it is likely that individuals with ADD will struggle with their temperament more frequently and as a consequence, demonstrate these characteristics more often.

What’s your experience with ADD and Extreme Temperaments?  Do you or a loved one fall strongly on one end or another of the temperament spectrum?  The Being Well Center follows The Being Well System, which looks beyond the symptoms of ADD/ADHD to take into account a person’s in-born temperament traits.  Treating the whole person is crucial to a successful ADD/ADHD treatment.  Talk to your doctor or care provider about your temperament traits.


9 Traits You Should Know About Your Temperament

Temperament refers to our in-born (not learned) behavioral style. We all come into the world with a unique set of temperamental characteristics that remain stable throughout our lifetime. These characteristics modulate how we respond to every situation in our lives. Understanding our own temperament as individuals and the temperament of our children is incredibly helpful in being the best we can be and in bringing out the best in our children.

In our experience, understanding the concept of temperament and applying that knowledge to ourselves as parents and spouses and to those around us helps us to better understand behavior…struggles, failures, and successes. In fact, failure to understand a child’s temperament and the role it plays in his behavior and performance can be a major source of frustration for parents.

add treatment, family, the being well centerIn our model, there are nine dimensions of temperament and we all fall somewhere along a continuum for each one. The ranges for these continuums are presented in the next section for each temperamental trait. It is important to know that where an individual falls along this continuum for any given temperamental trait is neither good nor bad…it just is! In fact, the same temperamental trait (e.g., being very intense) that is helpful to us in one situation may interfere with our behavior or performance in another.

A key goal should be to understand our temperament and the temperament of the children we live and work with. We need to critically consider how any extreme temperamental traits might be contributing to problems in performance, behavior, or social interaction. When temperamental extremes do interfere with performance, behavior or social interaction, we need to learn how best to work around or control these extremes.

Therefore, when we suspect that an ADD/ADHD child’s or adult’s temperamental characteristics play a role in his failure to meet an expectation at school or work, we know we must develop some type of accommodation to address this contribution.

1. Activity Level refers to the amount of activity from high to low that we engage in throughout our day. Some of us are always moving and physically active; others of us are more sedentary and spend most of our time engaged in quiet activities. The child with a high activity level is likely to be in his element in gym class and playing tag during recess and to have more difficulty staying settled during quiet seated activities; on the other hand, the child with a low activity level might prefer sitting and drawing or reading during free time rather than going outside to play an active game.

2. Rhythmicity refers to the predictability of our daily bodily routines for sleeping, eating and going to the bathroom. It ranges from highly regular to highly irregular. Those of us who are highly rhythmic are hungry, have a bowel movement, and feel sleepy at about the same times every day. Others of us, who are highly irregular do not have a schedule or rhythm at all…our wake-up time varies from day to day; we feel ready for bed at different times and need to go to the bathroom at various, unpredictable times throughout our day. This unpredictability can present a challenge for the child who is asked to adhere to a rigid school schedule where everyone eats and takes bathroom breaks at the same time every day.

3. Threshold of Response refers to the amount of stimulation, ranging from high to low, we require before responding. Those of us with a low threshold require very little to make us happy, sad, angry, etc. Others of us with a high threshold require a lot before we react. The child with a very high threshold may be injured and not seem to notice his pain. At the other extreme, the child with a very low threshold may be bothered by the slightest noise, the frown from the teacher, the tags in clothing, the buzz of the fluorescent lights, the seams in socks, and the taste, texture or smell of food.

4. Frustration Tolerance refers to the level of difficulty we are able to experience before we become frustrated. Frustration tolerance ranges from high to low. Those of us who have a high frustration tolerance are able experience an awful lot of difficulty before we feel frustration. Others of us who have a low frustration tolerance become frustrated very easily. The child with a high frustration tolerance may be able to deal with repeated struggles and failures in the classroom without experiencing significant frustration. The child with a very low frustration tolerance, however, can be quick to experience frustration when asked to perform tasks of only moderate difficulty. This, in turn, sets him up for repeated struggles and can turn into negativity towards school and other learning situations.

5. Intensity of Response refers to the strength of our responses ranging from high tolow. These responses can be demonstrated outwardly or experienced inwardly. So it is not always easy to judge someone’s intensity of response by what we see. Our intensity is independent of the quality (negative or positive) of our response and the immediacy of our response (threshold).

add in school children | the being well centerThose of us with a high intensity of response experience or show strong responses. When we are happy we are very, very happy; when we are sad, we are very, very sad; when we are angry, we are very, very angry. Others of us who have a low intensity of response barely show a blip on the screen when our emotions are set off. A child with high intensity may become overly silly at birthday celebrations, rageful during a conflict on the playground, and immobilized with nervousness on math time-tests. On the other hand, the child with low intensity of response may not seem to react at all; she does not experience extreme excitement over a special event or intense disappointment over a failure. In fact, we may find it difficult to read the reactions of a child with low intensity, often misjudging low intensity for not caring.

It is important to remember that when observing for intensity of response, we can’t always judge the book by looking at the cover; some very intense people experience all their intensity internally; nail-biting, skin-picking, complaints of a tightness in one’s chest, stomachaches, jaw aches, or headaches, etc., may be our only clues to what is going on inside.

High intensity of response (externally or internally) is a very powerful temperamental trait. When present, it can rule over everything: good thinking, paying attention, proper self-control, and appropriate social skills to name a few. Failure to identify a high intensity response pattern and appropriately accommodate for it can, inadvertently, set a child up for turning to a variety of other dysfunctional behaviors in an attempt to cope with her strong reactions including such things as over-eating, drug use, and developing an “I don’t care” attitude.

6. Mood refers to the overall quality of emotion throughout the day ranging from very positive to very negative. Those of us with positive mood spend the greater portion of our day in a pleasant mood; we are likely to put a positive spin on everything; problems are challenges. Others of us with a negative mood may seem more critical throughout our day; we are likely to see the glass as half empty. A child with positive mood is generally pleasant in the classroom and may even struggle to recognize when difficulties are present or percolating. The child with negative mood is likely to respond with frown, a headshake, or critical comment to most anyone or anything.

7. Approach-Withdrawal refers to our initial response to new persons, places, events, and ideas ranging from highly approach to highly withdrawal. Those of us who are highly approach readily jump into attempting new tasks, meeting new people, and trying new foods. Others of us who are highly withdrawal resist trying a new activity, avoid attending a party with strangers, and step back from a different kind of food. The child who is highly approach will not hesitate to start a conversation with a new student or teacher, jump into new activities and embrace new concepts and academic challenges. The child who is highly withdrawal may struggle with new students, avoid new playground activities, and step back from an unfamiliar concept in the classroom.

8. Adaptability refers to the amount of time and effort it takes to adapt or accommodate to a new person, situation, or concept after our initial approach or withdrawal response. This can range from easy (highly adaptable) to very slow (non-adaptable). Those of us who are highly adaptable easily integrate new routines, expectations, and concepts into our life. Those of us who are slow to adapt struggle tremendously with these same changes. In the classroom, the child who is highly adaptable readily goes with the flow regardless of the changes in his day, such as routines, class structures, and rules. The child who is slow to adapt may require an extended time to get into the flow at the beginning of each school year, struggle with changing expectations, buck new rules, and resist changes in routines. This same child may seem slow to understand and integrate new concepts that are presented even when they are in sync with his ability level.

9. Persistence refers to how long we stick with tasks regardless of their difficulty ranging from very long to very short. Some of us are highly persistent even in the face of tremendous difficulty; we keep going and going and going. Others of us spend only a short time on a challenging task before giving up and moving on to something else. The child with long persistence resists giving up and will practice a task repeatedly until he has mastered it. This same child may struggle to stop an activity when it is time to move on if he has not yet mastered or completed it. The child with short persistence may stop practice before mastery, struggle to stick with longer, more complex tasks, and be ready to put down a challenging book long before the last page.

A Final Word about Temperament

9 Temperament Traits | The Being Well CenterEach of our temperamental traits is important and plays a significant role in shaping who we are, how we behave, and how we experience and respond to the world around us. While we have defined and discussed these traits individually, it is important to remember that in the real world these traits do not exist in isolation; they interact with each other to influence our behavior in a complex way. Subtle differences in temperamental profiles can result in dramatic differences in how they present themselves in our homes and classrooms.

For example, a child with a negative mood, long persistence, slow adaptability, low frustration tolerance, and high intensity of reaction may be very difficult to work with when this set of characteristics interact with each other to result in frequent, very big negative reactions that last a long time in response to the inevitable changes and challenges that occur every day in the classroom.

On the other hand, a different child with a very similar profile including a negative mood, long persistence, slow adaptability, low frustration tolerance, but a low intensity of reaction may be much less difficult to work with. This is because his low intensity of reaction means his frequent, negative reactions to the changes and challenges in the classroom will be milder and, even if they do persist, their small magnitude may not register on anyone’s radar.

Therefore, as we examine a child’s temperamental profile, it is important to look closely at each trait separately and then consider how each of these individual traits may interact with the others to shape the behavior and personality we are observing.

We’d like to share a quick worksheet to help you apply the 9 Temperament Traits to yourself or a loved one.  Download: 9 TEMPERAMENT TRAITS WORKSHEET.  Where do you fall on the spectrum?  Your spouse?  Your children?

Sharing ADD/ADHD in the Workplace

What should the ADD adult share with his coworkers and employer?

When adults are first diagnosed and beginning treatment for ADD, often, they are excited to finally have an answer to a lifetime of frustration and struggle. In their excitement, they frequently want to share their experience with everyone who will listen. Unfortunately, this invariably leads to problems, particularly at work.

add_workplace_being_well_centerCoworkers and employers, who do not have a good understanding of ADD or the effects of medication, commonly put the ADD adult under the microscope looking for immediate positive changes and assuming any new unproductive behaviors are negative effects of medication use.

Because the newly diagnosed adult needs time to learn strategies for improved work skills, organization, interpersonal skills, and problem solving, this microscopic observation sets everyone up for disappointment.

Except when employment is already at serious risk, in my experience, it is wisest for the newly diagnosed adult to keep his personal medical affairs to himself, immediate family members and close friends.


The Being Well Center supports the whole person through all of life’s demands. We specialize in accurate diagnosis of ADD at any age, and we have extensive experience guiding adults with ADD through expectations across the lifespan.

Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

Help for someone resistant to ADD treatment

add treatment, family, the being well center

What can be done to help someone who is resistant accept treatment?

How we can best deal with a family member’s resistance to evaluation and treatment varies dependent upon the individual’s age. In younger children, we rarely see resistance. Once they see the positive impact of medication and other strategies on their school experience, social interactions, and home life, most young children are happy and, actually, excited about treatment.

add treatment, family, the being well centerThere is much more resistance pre-pubertal children and young adolescents who frequently struggle with the notion that ADD and its treatment make them different from their peers. This is a developmentally appropriate response for children this age who can react intensely to anything that sets them apart . . . a pimple on the forehead, not enough pubic hair, or having to take a pill in order to pay attention. Parents of these children can promote acceptance by being empathetic and providing educational materials that demystify ADD and its treatment. In my experience, however, it is important that parents of the resistant young adolescent take charge by setting clear limits about taking medication and participating in follow-up counseling. Typically, resistance and struggles with acceptance at this age fade relatively quickly as the child matures and begins to appreciate that we are all different in some way.

When dealing with older adolescents and young adults, addressing resistance is often more challenging. We frequently see older adolescents or young adults who have struggled for years, been accused of being lazy or stupid, or been told that they could do it if they just tried harder. After years of failure, many of these young people develop a hard exterior shell, an “I don’t give a damn” attitude to cover up a very low and damaged self-esteem, and intense resistance to help. While educational materials and frank discussions about ADD and its long-term consequences can sometimes help to overcome the resistance, it is often necessary for parents to focus on establishing firm limits and to stop enabling in order to motivate the older adolescent or young adult to comply with treatment. This may mean taking away the car, refusing to provide spending money or, in the case of the young adult, withdrawing the comfort and support of continuing to live at home.

Addressing resistance to evaluation and treatment with an adult, particularly a spouse can be tricky. Adults may have many reasons for not wanting to become involved in treatment. Some may have developed a version of that hardened, self-protective shell and, belligerently proclaim, “I’m just fine the way I am!” Many adults with ADD, as a consequence of their poor self-monitoring, truly do not see the problems that a spouse, close friend or even co-worker sees. When this is the case, it is important for significant others to provide direct feedback when problem behaviors occur and be careful to avoid enabling, co-dependent behaviors that can mask the impact of untreated ADD. Learning to detach, let go, and take care of himself are important steps for the spouse of the adult with ADD.

Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

ADD and Chronic Health Problems

ADD ADHD health problemsWhat types of health problems are associated with ADD?

There is a wide range of health problems associated with ADD. In some circumstances, the underlying neurological differences that accompany ADD may predispose patients to other related health problems. In other circumstances, ADD seems to be genetically linked to certain other medical problems.

In addition, longitudinal studies in the medical literature along with clinical experience support the fact that failure to properly identify, diagnose, and treat this physically based problem at the earliest possible age, places patients with ADD at a significantly greater risk for other serious health problems.

Some of these health problems are a consequence of unhealthy living patterns and behaviors that can result from ADD, some are related to the chronic stress frequently associated with ADD and unhealthy attempts to cope with it, and some are related to the consequences of the chronic failure associated with ADD.

Health problems, which seem to be associated with ADD through one or more of these mechanisms, include the following:

  • Alcoholism
  • Drug Addiction
  • Eating Disorders – Compulsive Over-Eating/Obesity
  • Anorexia/Bulemia Nervosa
  • Sleep Disorders
  • Enuresis
  • Chronic Constipation
  • Irritable Colon and Related Bowel Problems
  • Hypertension
  • Hypercholesterolemia
  • Recurrent Otitis Media
  • Recurrent Infections
  • Allergies/Immunological Disorders
  • Accidents – Ingestions/Automobile, etc.
  • Suicide
  • Child/Spousal Abuse
  • Chronic Fatigue Syndrome
  • Unplanned Pregnancy
  • Recurrent Headaches
  • Recurrent Abdominal Pain
  • Chronic Back Pain
  • Premenstrual Syndrome
  • Poor Treatment Compliance

At the time of initial presentation, ADD may not clearly seem to be a health problem. However, the relatively minor behavior or learning problems, which may be the first sign of ADD in childhood, may actually be the “red flag” that signals a problem (i.e., ADD) which could ultimately contribute to a variety of serious health problems in children or adults with ADD.

Want to stop the chronic stress, failure, and health concerns associated with undiagnosed or mistreated ADD/ADHD?  Get on a healthier track today!  If you’re ready now, contact Dr. Liden at The Being Well Center.  Or keep learning more about being a good consumer of ADD/ADHD resources.

Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

Drugs, Alcohol and ADD

Drugs, Alcohol and ADD | ADD treatment | Dr. Craig LidenHow Does ADD Impact Drug and Alcohol Recovery?

Drug and alcohol recovery often begins with involvement in some type of rehabilitation program. Success in these programs is predicated upon an ability to listen attentively and to participate in group discussions. It is also necessary to read and comprehend various educational materials. Obviously, these tasks can represent a huge challenge for the unrecognized and untreated ADD individual who is simultaneously struggling with withdrawal symptoms and possible long-term impact of the abused substance on his nervous system.

If the ADD individual makes it through detoxification and initial rehabilitation, he must take on the difficult challenge of maintaining sobriety every day. In my experience, this is most likely to happen through participation in a 12-step program. Unfortunately, this can represent another challenge for the ADD individual. One of the mantras of 12-step recovery programs is “90 meetings in 90days.” And what does it take to meet this expectation? Organization, planning, sustained commitment to name a few — all things that are hard for the untreated ADD individual to do even in the best of times.

Furthermore, establishing and maintaining a healthy balanced lifestyle is the foundation of a successful recovery. To maintain sobriety, an individual must find a way to avoid hunger and fatigue through healthy eating and sleeping patterns, to manage stress through exercise and mind-centering activities, and to balance work, family and personal responsibilities – all overwhelming tasks for the untreated ADD individual.

In my experience, if the addicted ADD individual is not receiving proper treatment for his ADD, his ability to effectively participate in recovery and sustain sobriety is doubtful at best. It is no wonder that less than 20% of addicted individuals achieve and sustain long-term sobriety. 

As we come to understand of the nature of ADD and its serious consequences, we can appreciate the serious need for its appropriate diagnosis and treatment.

We’re talking tricky topics this week on the Being Well Center blog.  Check back Friday for our next discussion about ADD and chronic health problems.

Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

The ADD Adult

lifespan_adultWhat specific behaviors indicate that an adult might have ADD?

Efficient attention is required for success in all areas of life. As an ever-present filter between the individual’s external and internal worlds, it screens all incoming and outgoing information to and from the brain. In this way, attention has a profound influence on how an individual experiences events and behaves in all life spheres: school, job, home, and neighborhood. It interacts with other skills and abilities to shape the quality of social interactions, school/job performance, and independent functioning. Therefore, behaviors that suggest attentional difficulty can appear in any area of a person’s life. The following behaviors identify some of the more common red flags that might signal ADD in adults ages 18 and over.

Adults with ADD

  • Being irresponsible; exhibiting poor follow through
  • Changing jobs frequently
  • Having trouble with money management, characterized by excessive spending and poor budgeting
  • Making repeated careless mistakes on the job
  • Exhibiting poor communication skills that result in repeated misunderstandings
  • Being late
  • Reacting before thinking
  • Lacking a healthy daily routine
  • Having difficulty managing children
  • Being overly dependent on spouse, boss, or co-worker for supervision
  • Abusing drugs and alcohol
  • Experiencing eating disorders
  • Lacking the ability to solve problems effectively
  • Lacking the ability to prioritize things
  • Taking on projects without thinking about what is involved
  • Experiencing depression and/or anxiety

ADD Basics 101 | Dr. Craig LidenIf you just recognized someone you know (maybe yourself?) in this list, go to and download Dr. Liden’s free guide, ADD Basics 101. In 10 clear steps, Dr. Liden will guide you to an accurate, trustworthy diagnosis and outline what you should look for in an effective treatment plan.

Check back next week when Dr. Liden discusses how ADD impacts sexual behaviors…

Catch up on previous posts in the Pay Attention series.

Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.