Attention Deficit Hyperactivity Disorder (ADHD)

What is Attention Deficit Hyperactivity Disorder?

ADHD is one of the most common neurodevelopmental disorders, typically diagnosed during childhood and lasting into adulthood. The disorder sometimes goes by its outdated name, attention deficit disorder (ADD).

Once thought only to affect patients in adolescence, individuals with ADHD may be diagnosed at any age. ADHD has no cure and can cause significant issues throughout the individual’s life, wreaking havoc on school, work, and interpersonal relationships.

People with ADHD struggle with executive function, the part of the brain responsible for planning, focusing attention, remembering instructions, and successfully juggling multiple tasks.

The dysfunction of this area makes it difficult for individuals to start and finish tasks, stay focused, and self-regulate their emotions.

Children and adults with ADHD also experience issues with certain neurotransmitters in their brains. ADHD brains often have lower levels of the brain chemical dopamine, which is responsible for feeling pleasure, satisfaction, and motivation.

With less dopamine to stimulate their brain, people with ADHD frequently seek out and focus on interesting activities to receive the stimulation they need.

Types of ADHD

Classification for ADHD falls under three types: predominantly inattentive, predominantly hyperactive-impulsive, and combined.

While individuals may have some crossover in symptoms, these presentations are distinct and should be identified by a mental health professional.

• Predominantly Inattentive Type: Difficulty organizing or finishing a task, paying attention to details, or following instructions or conversations. They are easily distracted or forget details of daily routines.
• Predominantly Hyperactive-Impulsive Type: Constant fidgeting, restlessness, impulsivity, interrupting, and excessive talking. Smaller children may run, jump, or climb constantly.
• Combined Type: Symptoms of the above two types are equally present in the person.

Symptoms of Attention Deficit Hyperactivity Disorder

The National Institutes of Mental Health (NIMH) points out that ADHD symptoms can change throughout an individual’s life.

As adolescents grow and mature into adults, symptoms manifest in new ways. For example, young, hyperactive patients may struggle to stay seated during class. Once reaching adulthood, the symptom instead presents as struggling with extreme restlessness.

Although the symptoms may change over time, the core cause of disordered behavior remains the same.

Some children with ADHD don’t receive their diagnosis until adulthood. While many factors may contribute to this late diagnosis, it’s important to consider the concept of “masking.”

Masking describes the act of an individual hiding or over-compensating for their ADHD symptoms to appear normal. Many people with ADHD feel embarrassed by their symptoms and experience low self-esteem because of their disorder.

Masking can range from physically resisting the urge to fidget in public to using numerous sticky notes to combat forgetfulness.

Adolescent Attention-Deficit Disorder Signs

Common signs of ADHD in young children include symptoms of inattention, hyperactivity, and impulsiveness. These symptoms can manifest in a variety of ways.

Hyperactivity

• Constant running and climbing on things outside of their control
• Squirming in the classroom or when in a chair
• Difficulty sitting down or constantly fidgeting with their hands or feet

Inattention

• Losing or misplacing things
• Difficulty sustaining attention
• Daydreaming
• Making careless mistakes on schoolwork or tests
• Avoiding or disliking tasks where a lot of thinking is required
• Appearing not to listen when being spoken to

Impulsiveness

• Skipping lines
• Not waiting their turn
• Blurting out answers
• Interrupting others
• Acting without thinking about the consequences of their actions
• Intruding on the personal space of others

Adult Attention-Deficit Disorder

For adults, ADHD symptoms can look very different from the symptoms they experienced as children.

Common symptoms of ADHD in adulthood also include hyperactivity, inattention, and impulsiveness. However, adult symptoms often display differently than they do in children.

Hyperactivity

• General restlessness and feeling as if a motor is driving them
• Difficulty sitting still for long periods
• Feeling fidgety and impatient
• Talking excessively, especially about topics of interest
• Becoming easily bored once they master a task
• Responding poorly to frustrating situations

Inattention

• Making careless mistakes at work or in daily activities
• Losing things, like keys or important documents
• Difficulty paying attention to detail
• Not being able to follow through with instructions or tasks
• Struggling with organization
• Attempting to multitask without completing any tasks

Impulsiveness

• Blurting out answers in meetings
• Engaging in risky or impulsive behavior
• Interrupting other people’s conversations
• Making inappropriate comments
• Intruding upon others
• Monopolizing conversations

Development of Attention Deficit Hyperactivity Disorder

Contrary to popular myths, video games, sugar consumption, or certain parenting styles are not causes of ADHD. Although the exact cause of this neurodevelopmental disorder remains unknown, research in adolescent psychiatry points to genetics and certain environmental factors.

In cases where ADHD is not passed through families, brain injuries and birth complications have been identified as the cause.

Studies have shown actual anatomical differences in the brains of adolescents and adults with ADHD. Brain scans show patients have reduced grey and white brain matter volume and demonstrate different brain region activation during certain tasks.

Risk Factors

According to Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), if a parent has ADHD, a child has more than a 50% chance of having it. If an older sibling has it, a child has more than a 30% chance.

Low birth weight, premature birth, brain injuries, and smoking or drinking during pregnancy have all been linked to rates of children born with ADHD. In addition, exposure to lead or pesticides in early childhood can contribute to the development of ADHD.

How Common Is Attention Deficit Hyperactivity Disorder?

The Centers for Disease Control and Prevention (CDC) reports that 6 million (9.8%) children aged 3–17 years are diagnosed with ADHD. Boys (13%) are more likely to be diagnosed with ADHD than girls (6%), in part because women tend to internalize their symptoms more than men.

According to data from CHADD, approximately 10 million adults have ADHD, although many don’t get diagnosed or treated for it.

Common Comorbidities and Related Conditions

According to a national 2016 parent survey conducted by the CDC, 6 in 10 children with ADHD had at least one other mental, emotional, or behavioral disorder:

• About half of the children with ADHD had a behavior or conduct disorder.
• About 3 in 10 children with ADHD had anxiety.
• Other mental health conditions affecting children with ADHD include depression, autism spectrum disorder, and Tourette syndrome.

Data from the National Comorbidity Survey reveals adults with ADHD are three times more likely to develop major depressive disorder (MDD), six times more likely to develop dysthymia, and more than four times more likely to have any mood disorder.

Many studies found common adult ADHD comorbidities, including depression, anxiety disorders, bipolar disorder, and substance use disorder.

Attention Deficit Hyperactivity Disorder and Addiction

Unfortunately, there is a solid link between addiction and ADHD. Because individuals with ADHD tend to be more impulsive and likely to have behavior problems, they are at a higher risk of developing substance use disorder (SUD) or alcohol use disorder (AUD).

Not all people with ADHD will develop drug or alcohol issues, but it’s essential to be aware of this connection.

A study by European Addiction Research found that individuals with ADHD were about 2–3 times more likely to develop nicotine, alcohol, marijuana, cocaine, and/or other substance use disorders than those without ADHD.

In addition, around 20% of adult SUD patients had ADHD. The research found that addicted patients with comorbid ADHD have an earlier onset of substance use and a higher relapse risk than those without ADHD.

How Is ADHD Diagnosed?

Thanks to ADHD’s prevalence, diagnosis and treatment of the disorder have become fairly streamlined. Social media has also contributed to the awareness of ADHD, especially in adults.

Although this awareness can be positive, it has also led to many self-diagnosing through online quizzes or popular videos.

If you suspect you or a loved one has ADHD, make sure you speak with your primary care doctor or find a psychiatrist to conduct an evaluation. Having insight that something’s up is never bad, but self-diagnosing can lead to misdiagnosis and unnecessary angst in the long run.

Once you’ve received a diagnosis from your primary healthcare provider, you can have peace of mind that you’re receiving the correct treatment.

Diagnosis of ADHD in Childhood

If your child’s behavior makes you suspect ADHD, an adolescent psychiatrist or your child’s pediatric doctor can evaluate them based on the criteria described in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

This evaluation will include interviews with parents or caregivers and the child and questions regarding family history.

Your doctor may also use psychological tests, hearing and vision screenings, and other assessments to rule out other learning disabilities.

Diagnosis of ADHD in Adulthood

In the case of individuals receiving an ADHD diagnosis in adulthood, the adult in question often seeks a diagnosis. Because adults generally have better insight into their behavior, a psychiatrist will evaluate their symptoms based on the DSM-5 criteria.

If the adult exhibits significant impairment in at least two primary settings in their life due to ADHD symptoms, they will meet the criteria for diagnosis.

Treatment of Attention Deficit Hyperactivity Disorder

First-line treatments for ADHD in children and adults include a combination of medication, psychotherapy, and behavioral interventions.

For example, preferential seating, minimizing distractions, and including tools (e.g., fidget toys) can make a huge difference for students with ADHD.

Dosage and therapy may differ, but the tactics are essentially the same. Common ADHD medications approved by the U.S. Food and Drug Administration (FDA) feature the use of stimulants like amphetamines (Adderall) or methylphenidate (Ritalin).

Stimulant medications have been subject to endless debate due to their side effects, especially for children. There are non-stimulant options available on the market, like Strattera. However, stimulants still outperform non-stimulants by a large margin.

Anti-depressants like Welbutrin are also used to help with anxiety and depression, two symptoms commonly experienced by patients with ADHD.

Regarding therapy, the most common form used for treating ADHD is Cognitive Behavioral Therapy (CBT). CBT works by helping the person identify problematic or unhelpful thought patterns and redirecting them into more constructive ones.

Finding Treatment for Attention Deficit Hyperactivity Disorder

ADHD in childhood and adulthood can be incredibly difficult for the patient and those around them. Despite how often the term ADHD or ADD gets thrown around, its emotional effects can be devastating and isolating.

Luckily, many treatment options are available for this standard and well-researched neurodevelopment disorder.

If you or a loved one might be struggling with ADHD, speak with your primary care doctor for a proper diagnosis. With the perfect blend of medication and therapy, you can live a productive, happy life with ADHD.

You can also find mental health resources through the SAMHSA online treatment locator or by calling their free helpline at 1-800-662-4357.