About ADHD

Everybody can have difficulty sitting still, paying attention or controlling impulsive behavior once in a while. For some people, however, the problems are so pervasive and persistent that they interfere with every aspect of their life: home, academic, social, and work.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood and affects approximately 12% of children and teens. Thirty to 60% will continue to have symptoms into adulthood. Individuals with ADHD can be very successful in life.

 

However, without proper identification and treatment, research has shown that there is a higher likelihood of school failure, family stress and disruption, anxiety, depression, problems with relationships, substance abuse, delinquency, accidental injuries and job failure. Early identification and proper treatment of ADHD is essential for optimal health and wellbeing. Together, we will begin the journey of identification and get you on a path to a more focused You!

 

The Three Presentations of ADHD

1

Inattentive

2

Hyperactive-Impulsive

3

Combined Inattentive & Hyperactive-Impulsive

Symptoms

Typically, ADHD symptoms arise in early childhood.  According to the DSM-5, several symptoms are required to be present before the age of 12. Many parents report excessive motor activity during the toddler years, but ADHD symptoms can be hard to distinguish from the impulsivity, inattentiveness and active behavior that is typical for kids under the age of four. In making the diagnosis, children should have six or more symptoms of the disorder present; adolescents 17 and older and adults should have at least five of the symptoms present. The DSM-5 lists three presentations of ADHD—Predominantly Inattentive, Hyperactive-Impulsive and Combined. The symptoms for each are adapted and summarized below. 

Inattentive
  • Fails to give close attention to details or makes careless mistakes

  • Has difficulty sustaining attention

  • Does not appear to listen

  • Struggles to follow through on instructions

  • Has difficulty with organization

  • Avoids or dislikes tasks requiring a lot of thinking

  • Loses things

  • Is easily distracted

  • Is forgetful in daily activities

Hyperactive & Impulsive
  • Fidgets with hands or feet or squirms in chair

  • Has difficulty remaining seated

  • Runs about or climbs excessively in children; extreme restlessness in adults

  • Difficulty engaging in activities quietly

  • Acts as if driven by a motor; adults will often feel inside like they were driven by a motor

  • Talks excessively

  • Blurts out answers before questions have been completed

  • Difficulty waiting or taking turns

  • Interrupts or intrudes upon others

Combined
  • Has symptoms from both the inattentive and hyperactive / impulsive lists.

 

Causes

Despite multiple studies, researchers have yet to determine the exact causes of ADHD. However, scientists have discovered a strong genetic link since ADHD can run in families. More than 20 genetic studies have shown evidence that ADHD is strongly inherited. Yet ADHD is a complex disorder, which is the result of multiple interacting genes.

Other factors in the environment may increase the likelihood of having ADHD:

  • exposure to lead or pesticides in early childhood

  • premature birth or low birth weight

  • brain injury
     

Scientists continue to study the exact relationship of ADHD to environmental factors, but point out that there is no single cause that explains all cases of ADHD and that many factors may play a part.

Previously, scientists believed that maternal stress and smoking during pregnancy could increase the risk for ADHD, but emerging evidence is starting to question this belief. However, further research is needed to determine if there is a link or not.

The following factors are NOT known causes, but can worsen ADHD symptoms for some children:

  • watching too much television

  • eating sugar

  • family stress (poverty, family conflict)

  • traumatic experiences
     

ADHD symptoms, themselves, may contribute to family conflict. Even though family stress does not cause ADHD, it can change the way the ADHD presents itself and result in additional problems such as antisocial behavior. 

Problems in parenting or parenting styles may make ADHD better or worse, but these do not cause the disorder. ADHD is clearly a brain-based disorder. Currently research is underway to better define the areas and pathways that are involved.

 

Diagnosis

There is no single test to diagnose ADHD. Therefore, a comprehensive evaluation is necessary to establish a diagnosis, rule out other causes, and determine the presence or absence of co-existing conditions. Such an evaluation requires time and effort and should include a careful history and a clinical assessment of the individual’s academic, social, and emotional functioning and developmental level.

 

There are several types of professionals who can diagnose ADHD, including clinical psychologists, clinical social workers, nurse practitioners, neurologists, psychiatrists and pediatricians. Regardless of who does the evaluation, the use of the DSM-5 diagnostic criteria for ADHD is necessary.
 

Determining if a child has ADHD is a complex process. Many biological and psychological problems can contribute to symptoms similar to those exhibited by children with ADHD. For example, anxiety, depression and certain types of learning disabilities may cause similar symptoms. In some cases, these other conditions may actually be the primary diagnosis; in others, these conditions may co-exist with ADHD. A thorough history should be taken from the parents and teachers, and when appropriate, from the child. Checklists for rating ADHD symptoms and ruling out other disabilities are often used by clinicians; these instruments factor in age-appropriate behaviors and show when symptoms are extreme for the child’s developmental level.
 

For adults, diagnosis also involves gathering information from multiple sources, which can include ADHD symptom checklists, standardized behavior rating scales, a detailed history of past and current functioning, and information obtained from family members or significant others who know the person well. ADHD cannot be diagnosed accurately just from brief office observations or just by talking to the person. The person may not always exhibit the symptoms of ADHD in the office, and the diagnostician needs to take a thorough history of the individual's life. A diagnosis of ADHD must include consideration of the possible presence of co-occurring conditions.
 

As part of the evaluation, a physician should conduct a thorough examination, including assessment of hearing and vision to rule out other medical problems that may be causing symptoms similar to ADHD. In rare cases, persons with ADHD may also have a thyroid dysfunction. Diagnosing ADHD in an adult requires an evaluation of the history of childhood problems in behavior and academic domains, as well as examination of current symptoms and coping strategies.

 

Treatment

Treating ADHD often requires medical, educational, behavioral and psychological intervention. This comprehensive approach to treatment is sometimes called “multimodal” and, depending on the age of the individual with ADHD, may include:

  • parent training

  • medication

  • skills training

  • counseling

  • behavioral therapy

  • educational supports

  • education regarding ADHD

Working closely with health care providers and other professionals, treatment should be tailored to the unique needs of each individual and family to help the patient control symptoms, cope with the disorder, improve overall psychological well-being and manage social relationships.

 

Recovery and ADHD

While there is no cure for ADHD, individuals with ADHD can experience mental health recovery. For these individuals, recovery can best be understood as the ongoing management of ADHD symptoms. According to the Substance Abuse and Mental Health Administration (SAMHSA), the two main hallmarks of mental health recovery are living a “meaningful life” and growing toward one’s “full potential.” For those with ADHD, these goals can be attainable. Despite the many challenges they face, resources exist that can help individuals with ADHD attain a level of well-being marked by independence, healthy interdependence, hope and personal satisfaction.

 

Treatment Research

The bulk of treatment research on ADHD has focused on the condition in children, and the options for them have a strong evidence-base for symptom reduction. For many, the need for intervention persists over the long-term. Research from the landmark National Institute of Mental Health Multimodal Treatment Study of ADHD showed significant improvement in behavior at home and school in children with ADHD who received carefully monitored medication in combination with behavioral treatment. These children also showed better relationships with their classmates and family than did not children receiving this combination of treatment. Further research confirms that combining behavioral and stimulant treatments are more effective than either treatment alone.

Although ADHD has been less thoroughly researched in adults than in children, adults who have been correctly diagnosed with the disorder can still take advantage of whatever treatments best meet their needs. Working with one or several health and mental health care practitioners, adults with ADHD can learn to manage symptoms as they are expressed in their lives.

ADHD is a condition that affects individuals “across the lifespan.” This means that ADHD symptoms are usually experienced from one phase of life to the next, and that they extend to the various spheres of life during any particular life phase. 

 

Myths and Misunderstandings

Myth No. 1

ADHD is not a Real Disorder

ADHD cases have been described as far back as the textbook published in 1775 by Adam Weikard in German. Since that time, over 10,000 clinical and scientific publications have been published on ADHD (Barkley 2015). Research studies show numerous differences between those with and without ADHD (Roberts et al. 2015). ADHD impairs major life activities including social, emotional, academic and work functioning. It is a lifespan disorder with the majority of children with ADHD continuing to struggle with symptoms as adults. ADHD also runs in families with a heritability chance of 57% for a child if a parent has ADHD, and a 70%–80% chance for a twin if the other twin has ADHD (Barkley 2015). Brain scan studies show differences in the development of the brain of individuals with ADHD, such as cortical thinning in the frontal regions; reduced volume in the inferior frontal gyrus; and reduced gray matter in the parietal, temporal, and occipital cortices (Matthews et al. 2014).

The content on this page has been generously provided by CHADD, the National Resource on ADHD. For more information and for citations, please visit www.CHADD.org/Understanding-ADHD

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