ADHD

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder. The core characteristics are difficulty with regulating attention and controlling impulses and hyperactivity. 

Generally, ADHD develops in childhood, although it might not be diagnosed until later in life. It continues into adolescence and adulthood. ADHD affects all aspects of life, including achievement in school and work, relationships, health, and finances.

It also has an emotional cost, as many people with ADHD experience deep shame and a sense of failure as they struggle with daily activities other people seem to do effortlessly.

However, the good news is ADHD can be successfully treated and managed.

Symptoms of ADHD

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, (DSM-5) identifies three different types of ADHD. These are:

• inattentive

• hyperactive-impulsive
• combined (where both inattention and hyperactive-impulsivity are present)

In the past, these types were called "ADHD subtypes." They are now called "presentations." For example, someone might be diagnosed with attention deficit hyperactivity disorder, combined presentation. 

ADHD symptoms are not uniform. Each person experiences ADHD symptoms differently and to varying degrees of severity.  

Here is a list of symptoms of the inattentive presentation. People who have this type of ADHD presentation:

• find it hard to pay close attention to what is happening in the environment. For example, they may have trouble listening to what is being said in class, at a work meeting, or during a conversation with friends.

• appear easily distracted and have difficulty doing tasks from the beginning to end
• find it difficult to listen to instructions and follow through on them
• are often criticized for making careless mistakes, as it looks like they are not trying
• resist tasks needing sustained mental effort
• find being organized very challenging
• often lose items, regardless of how expensive (cell phones) or important (passports) they are  
• do not appear to be listening when spoken to, might even appear rude and look out of the window or check the time
• often appear to be daydreaming or in a world of their own

Here is a list of symptoms of the hyperactive/impulsive presentation. People who have this type of ADHD presentation:

• are always moving and "on the go"
• find it almost impossible to sit in a chair, even when being seated is socially expected like in a classroom or airplane
• will tap feet or fidget or squirm when sitting
• will run around and climb in order to burn energy. Adults might develop a passion for rigorous exercise or extreme sports.

• find it extremely difficult to take turns, wait in line, or be held up in traffic
• interrupt when other people are speaking, and butt into games and conversations
• answer questions before they have been asked fully, and finish other people's sentences
• make impulsive decisions without thinking of the consequences. This can sometimes be physically dangerous or hurtful to others.
• rush through tasks, often making mistakes because it feels uncomfortable doing the task slowly and systematically

The symptoms can change with age, as a person develops coping strategies and has more freedom to create environments that suit him or her. For example, a 7-year-old boy might have a hard time sitting still in class. In adulthood, he might develop strategies to look externally still because that is what is expected. However, internally he feels very restless. He might choose a job where sitting at a desk is not required for long periods, so his ADHD symptoms are not so apparent.

ADHD symptoms can also appear different between genders.

 A young boy with impulsivity might dash into the street without looking for traffic, whereas a girl might be verbally impulsive and constantly interrupt others.

What Causes ADHD?

By far the biggest cause of ADHD is genes. Research and studies on families, twins, and adopted children have been helpful in our understanding about the genetic factors of ADHD.

However, if a parent has ADHD, it does not automatically mean his or her child will inherit ADHD. 

Eating too much sugar, allergic reactions, watching television, playing video games, poor parenting, or a lack of discipline does not cause ADHD.

Diagnosis and Testing

The most accurate way to get an ADHD evaluation is to have detailed testing done by an experienced clinician. There maybe differences in who is licensed and qualified to make an ADHD diagnosis; however, it is typically psychiatrists, psychologists, neurologists, and some family doctors that carry out evaluations.  

There is not a definitive test, like a blood test, to see if you have ADHD.

 Instead, an evaluation is carried out. This includes many elements as the practitioner pieces together information about you from various sources. Information is gathered from medical and school records, interviews with parents, and questionnaires. Your working memory and other cognitive functions may be tested. It is also important to check that your symptoms are not due to another condition, as other conditions sometimes occur at the same time as ADHD. For this reason, you could also be screened for learning disabilities.

The testing can take several hours. It is often spread out over more than one appointment. During the evaluation, the healthcare practitioner will determine if you meet the criteria for ADHD outlined in the DSM-5. This is the official diagnostic guide used in the United States.  

At the end of the process, you will know if you have ADHD. You will also know if you have any other conditions or learning disabilities.

Coexisiting Conditions

ADHD often exists along with other conditions. These are called comorbid or coexisting conditions.  These conditions can have similar symptoms to ADHD and can mask its presence. It is important to identify and treat each condition so that you (or your child) get relief from the symptoms of each disorder. There are many coexisting conditions. Here are six common ones: 

• anxiety disorders
• a mood disorder, such as a depressive or bipolar disorder 
• a learning disorder, such as dyslexia
• a sleep disorder 
• oppositional defiant disorder
• autism spectrum disorder

​Management and Treatment

After an ADHD diagnosis has been made, treatment and management of ADHD can begin. People typically think of treatment as medication. However, the treatment of ADHD is much broader than prescription medication. It can include life skills, therapy, and accommodations at school or work. A combination of these treatment approaches is usually the most effective way to manage ADHD symptoms. 

Medication 

For many children and adults, medication is a necessary part of the treatment plan. Work closely with your doctor to find the right type of medication and a therapeutic dosage for you or your child. 

Life Skills

Learning skills to help with ADHD symptoms is exceptionally helpful. For example, learning how to use a day planner can help an adult to manage work assignments or a child to hand in school assignments on time. Learning life skills like this might seem simple but can have a huge effect on quality of life. 

Accommodations

Students are allowed accommodations to help them get the grades they are capable of achieving. For example, another person can take notes for the student in class, and a quiet room can be provided to write exams. In the work place, there might be accommodations available that support workers in their job performance.

Education

Education about ADHD is key. ADHD knowledge can come from formal sources like doctors and professionals, and informal sources like websites, books and podcasts. Learning about ADHD helps you to understand the condition and how it uniquely affects you or your child.

Counseling

Counseling or therapy helps to address self-esteem issues, depression, anxiety, or relationship issues that might result from ADHD.

Because new challenges can occur at each development stage and life stage, different treatment options will be most effective at different phases. Be open to tailoring the treatment to your changing needs.  Adjustments and tweaking are normal!

Is ADHD a Modern Disorder?

Some people wonder if ADHD is a new condition, perhaps caused by the fast pace of modern life.  However, ADHD is not a modern disorder. It has been written about in literature and medical books for over 100 years. What is new is the name, ADHD. Over the years, the same condition has been called different names.

In 1845, Dr. Heinrich Hoffman described ADHD in a book called, The Story of Fidgety Philip. In 1902, Sir George F. Still wrote the first clinical description about a group of children who showed impulsivity and behavior problems. He called this condition "defect of moral control." In the 1950s, ADHD was called "hyperkinetic impulse disorder."

What Is the Difference Between ADHD and ADD?

People often get confused with the terms ADD and ADHD. They are both acronyms for the same condition. The condition we now call ADHD has had many names over the last 100 years. As more research is carried out and our understanding of the condition deepens, the official name changes to reflect this new knowledge. ADD was used from 1980 to 1987, to describe what we now call ADHD inattentive presentation. However, some authors and doctors still use ADD when they refer to inattentive ADHD, or use ADD and ADHD interchangeably.

Adults

ADHD used to be considered a condition that children would "grow out of." We now know that ADHD spans a lifetime. Symptoms can change with age. For example, impulsivity might decrease. People also develop conscious and subconscious strategies to manage their symptoms. However, the ADHD continues to be present, and ongoing treatment and management is required. 

Many people are first diagnosed with ADHD as adults. Sometimes this happens when their child is diagnosed with ADHD, and they recognized themselves during the diagnosis process. Other adults have always felt different from their peers and finally reach out for help after a particularly stressful event.

Girls and Women

ADHD used to be thought of as something children had, but adults did not. In a similar way, ADHD was also thought of as a male condition rather than a condition that females had too.

Typically, girls are more likely to have inattentive ADHD, which is one of the reasons why their ADHD goes undetected in childhood. It is much easier to notice a hyperactive boy than a daydreaming girl.  Historically, females who reached out for help in adulthood were often misdiagnosed with anxiety or depression.

Because of the increased awareness about ADHD, more girls and women are being accurately diagnosed, which means they can get the right treatment for their symptoms.

Females with ADHD do face some extra challenges. The hormonal changes women experience throughout their life, from puberty, pregnancy and menopause, as well as monthly changes, can make ADHD symptoms worse.  

_Sources:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.

_{Treuer T, Gau SS, Mendez L, et al. A Systematic Review of Combination Therapy with Stimulants and Atomoxetine for Attention-Deficit/Hyperactivity Disorder, including Patient Characteristics, Treatment Strategies, Effectiveness, and Tolerability. Journal of Child and Adolescent Psychopharmacology. 2013; 23:179-193.}