Attention Deficit Hyperactivity Disorder (ADHD)

What is Attention Deficit Hyperactivity Disorder (ADHD)?

ADHD is a mental health condition that begins during childhood. Symptoms appear before the age of 12, and they cause disruption to daily life. Research suggests that ADHD is highly heritable, which means that genetic risk factors contribute strongly to the development of the condition. Differences in brain structure and function are also believed to contribute to ADHD symptoms ^[1].

Children and teens with ADHD experience symptoms such as rushing through tasks, having difficulty paying attention, interrupting others, and fidgeting ^[1]. While these are some general symptoms of ADHD, it is helpful to understand that the DSM-5, the manual used to diagnose mental disorders, lists three subtypes of ADHD ^[2]:

1. The Inattentive Subtype: Individuals with this subtype struggle mainly with inattentive symptoms, which include appearing distracted, being unable to pay attention to details, and having a hard time following directions.
2. Hyperactive/Impulsive Subtype: A person with this subtype has difficulty sitting still and controlling their impulses, which leads to symptoms such as blurting out, struggling to wait their turn, talking excessively, and constantly being on the move.
3. Combined Presentation: Finally, people with the combined presentation of ADHD will show symptoms of both inattention and hyperactivity/impulsivity.

ADD vs. ADHD – What’s the difference?

Sometimes, people use the term “ADD,” or attention deficit disorder, when talking about ADHD. So, what is the difference between ADD and ADHD? Usually, when people use the term “ADD,” they are just referring to ADHD. In fact, in older versions of the DSM, the condition was called attention deficit disorder, and it could occur either with or without hyperactivity ^[3].

With the introduction of newer versions of the DSM, ADHD can now occur as predominantly inattentive, predominantly hyperactive/impulsive, or a combined presentation. When people use the term ADD, they are often referring to the predominantly inattentive presentation of ADHD, but the term ADD is no longer clinically accurate.

Symptoms of ADHD

ADHD symptoms can fall under the category of inattention or hyperactivity/impulsivity. Some general symptoms that occur with ADHD are as follows ^[1]:

• Difficulty sustaining attention to tasks
• Showing dislike for tasks that require mental effort
• Forgetting details or making careless mistakes
• Struggling to stay organized
• Having a hard time following directions
• Blurting out or interrupting others’ conversations
• Struggling to wait in lines
• Appearing to be constantly on the go or in motion
• Difficulty sitting still

Diagnosing ADHD

While you may notice symptoms of ADHD in yourself or a child, you cannot self-diagnose the condition. If you suspect ADHD, it is important to see a doctor or a mental health professional, such as a psychologist or social worker, to receive a diagnosis and develop an appropriate treatment plan.

Healthcare professionals diagnose ADHD using professional judgment and the diagnostic criteria in the DSM-5. To be diagnosed with ADHD, children must show six or more symptoms, whereas teens aged 17 and above and adults must demonstrate five or more symptoms. Symptoms must be present for at least six months ^[4].

A person who meets enough symptoms of inattention will be diagnosed with the inattentive type of ADHD, whereas a person who shows enough symptoms of hyperactivity/impulsivity will be diagnosed with that subtype. Finally, meeting enough symptoms of both subtypes results in a diagnosis of a combined presentation ^[4].

The diagnostic criteria for the specific subtypes are listed below ^[4].

Inattentive Subtype

Symptoms include:

• Making careless mistakes or struggling to pay attention to detail when completing tasks at school or work
• Having difficulty remaining attentive to tasks at school or when playing
• Appearing not to listen when being spoken to directly
• Failing to follow through with instructions and complete tasks like homework, chores, or job duties, due to being distracted
• Difficulty with organizing and prioritizing
• Disliking tasks that require mental effort
• Losing important items such as homework, school supplies, keys, or wallet
• Being easily distracted
• Struggling with forgetfulness

Hyperactive/Impulsive Subtype

Symptoms include:

• Fidgeting or squirming frequently
• Difficulty staying seated when it is expected
• Running or climbing when it’s not appropriate to do so, or feeling extremely restless
• Struggling to play or engage in activities quietly
• Being constantly on the go
• Speaking excessively
• Blurting out answers or comments before a question is completed
• Difficulty waiting in line or waiting for own turn
• Interrupting others’ conversations

Diagnosing ADHD can sometimes be difficult as many individuals will 'mask', or hide, their symptoms from others. See here for more information on ADHD masking.

Causes of ADHD

There is no single cause of ADHD; rather, a variety of factors can increase a child’s risk of developing this condition. Researchers have established that there is a strong genetic component to ADHD, meaning that genetic factors can contribute to ADHD’s development ^[1].

There are multiple environmental factors that can also increase the risk of developing ADHD. For example, premature birth, low birth weight, and poor nutrition during the prenatal period can all increase a child’s risk for ADHD, as these factors can negatively affect brain development ^[5].

Other factors that may contribute to ADHD are exposure to pesticides and heavy metals. Researchers have found that being exposed to pesticides during pregnancy or while breastfeeding results in symptoms of ADHD. Furthermore, lead exposure, as well as exposure to several other heavy metals, can lead to ADHD symptoms ^[5].

What can be concluded from the available research is that genetics strongly influence whether or not a child will develop ADHD, but the environment is also important. Environmental influences are at play while a child is still developing in utero.

Treatment for ADHD

There is no cure for ADHD, but there are treatment options that can make symptoms more manageable and reduce the interference that ADHD causes in daily life. With treatment and support, individuals who live with ADHD can learn to function well in work, school, and social settings. Both medication and behavioral therapies have been found to be beneficial for treating ADHD.

Both of these treatment options are detailed below.

Medications for Treating ADHD

There are numerous medications that have been found to be effective for treating ADHD symptoms:

• Methylphenidate: Also known by the brand name Ritalin, methylphenidate is one of the most popular medications for treating ADHD symptoms. It has been found to be effective for children, teens, and adults ^[5].
• Atomoxetine: This medication is often referred to by its brand name, Strattera. It tends to work better for adults when compared to children. ^[5].
• Amphetamines: Commonly known under the brand new Adderall, amphetamines are also effective for treating ADHD symptoms in children and teens ^[6].

Medications can be an effective treatment option for ADHD, but it’s important to remember medications can come with side effects. Common side effects of ADHD medications include lack of appetite, sleep disturbances, stomach pain, anxiety, headaches, and nausea ^[6]. For many people, the benefits of taking medication outweigh the side effects.

Behavioral Therapies

Therapies can teach people with ADHD to cope with symptoms and manage their behavior. Some common therapeutic modalities are discussed below:

• Cognitive Behavioral Therapy: This therapeutic modality teaches people to replace distorted or unhelpful thinking patterns with new ways of thinking. Some research suggests that it is useful for treating ADHD symptoms ^[5].
• Mindfulness Training: Mindfulness-based approaches teach people to attend to the present moment, which can reduce ADHD symptoms. Mindfulness training has been found to be effective for adults with ADHD, but more research needs to be done with children ^[5].
• Parent Training: This approach provides parents with support and teaches them techniques that can be helpful for managing behaviors related to ADHD. Parent training may reduce problem behaviors and decrease stress levels for parents of children with ADHD^[5].
• Alternative Therapies: Some evidence suggests that certain dietary supplements, such as Zinc, may be beneficial for people with ADHD. Talk with your doctor about your dietary needs. Physical activity can also improve cognitive performance in people with ADHD, so it can be helpful to follow a regular exercise regimen ^[5].

Helping a child with ADHD

If your child shows symptoms of ADHD, it’s important to consult with your child’s pediatrician. They will perform an assessment, which will likely include sending a questionnaire to your child’s teacher, to determine what symptoms your child demonstrates in the classroom. You will also be asked to fill out a parent questionnaire to rate ADHD symptoms.

If diagnosed, the first line of treatment will depend upon your child’s age. For children under age 6, behavioral therapy is typically recommended before starting medication. Once a child turns 6, medication is typically used alongside behavioral therapy ^[7].

In addition to seeking treatment for your child, you can use the following strategies to help your child cope with ADHD symptoms ^[7]:

1. Establish a routine. Children with ADHD do better with a predictable schedule.
2. Limit distractions during homework time.Turning off the TV and providing a quiet workspace can help your child to get their homework done, as they will not be side-tracked by distractions in the environment.
3. Promote a healthy lifestyle. Just like other children, those with ADHD need a consistent sleep schedule, plenty of opportunity for exercise, and a nutritious diet. If they are not eating and sleeping adequately and getting opportunities for exercise, ADHD symptoms may worsen.
4. Praise good behavior.ADHD symptoms can lead to frustrating and off-task behavior at times, but children need to know when they are doing well. Praising and rewarding good behavior reinforces it and teaches your child how they should act.
5. Teach your child to plan ahead.Saving large tasks or assignments for the last minute is likely to lead to stress and frustration for your child. Teach them to plan by beginning tasks early, breaking them down into smaller steps, and taking breaks when needed.
6. Use effective discipline.You may be tempted to scold or yell when your child with ADHD is acting out, but these forms of discipline are not likely to be effective. Address negative behavior by giving a time-out or taking away privileges.

Frequently asked questions about ADHD

The answers to the following questions can also be helpful if you’re looking for information about ADHD.

How common is ADHD?

ADHD is a common neurodevelopmental disorder in children. According to prevalence studies, 3 to 5 percent of children live with ADHD, and an additional 5 percent have attention and impulse control problems that do not meet the threshold for an ADHD diagnosis ^[8].

Can you get ADHD as an adult?

There has been ongoing debate regarding whether a person can develop adult-onset ADHD. ADHD is considered a neurodevelopmental disorder of childhood, and symptoms have to be present before age 12 for a diagnosis. Despite this fact, some adults show ADHD symptoms, but they report they did not have these symptoms during childhood.

Research into adult-onset ADHD suggests that adults who have ADHD symptoms that were not present during childhood might not have displayed obvious symptoms earlier in life because there were not as many demands placed on them in childhood.

Once they reach adulthood and are required to maintain employment and tend to responsibilities like bills and chores, symptoms become more apparent. Furthermore, some people may not have been diagnosed as children because their symptoms were not severe enough to come to the attention of a doctor or mental health professional ^[9], or they were able to manage them well enough that they could be described as 'high-functioning'.

Are there other conditions linked to ADHD?

Studies suggest that children and teens with ADHD are likely to have other mental health disorders. For example, oppositional defiant disorder (ODD) and conduct disorder are common in children with ADHD. ODD and conduct disorder are linked to aggressive, disruptive behaviors. Anxiety and mood disorders like depression are also common in people with ADHD ^[10].

In some cases, ADHD may lead to the development of other mental health conditions. It is also possible that the same risk factors can lead to both ADHD and conditions like depression ^[10].