What Is ADHD?
Attention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that affects both children and adults. 1 ADHD develops when the brain and central nervous system suffer impairments related to growth and development. A person with ADHD will show varying degrees of these three behaviors: inattention, impulsivity and hyperactivity. 2
What causes ADHD?
It’s not clear what exactly causes ADHD, though there are factors that may increase the chances of developing the condition. While researchers haven’t identified a specific ADHD gene, lots of studies show a genetic link. It’s quite common for a person diagnosed with ADHD to have at least one close relative with the condition.9, 10 Environmental factors may also play a role. These include exposure to pesticides and lead, a brain injury, being born prematurely or with a low birth weight. 11
“The brain is essentially a huge electrical system that has multiple sub-systems that need to communicate with one another constantly to get anything done,” explains Thomas Brown, Ph.D., director of the Brown Clinic for Attention & Related Disorders in Hamden, CT. Brown is considered a leading global authority on the assessment and treatment of ADHD. In his book A New Understanding of ADHD in Children And Adults: Executive Function Impairments (Taylor and Francis Group, LLC, 2013), he explains why someone with ADHD really struggles with things like listening and completing assignments in a timely manner: The brain communicates messages through neurons in the brain. But at the end of every neuron there is a gap called a synapse. The message needs to jump between the gaps, and does this with the aid of a chemical called a neurotransmitter produced by the body. “Persons with ADHD tend not to release enough of these essential chemicals, or to release and reload them too quickly before an adequate connection has been made.” In effect, messages struggle to get where they need to go to be acted on. Medications, including stimulants and non-stimulants, help make up for these deficits by triggering the release of certain chemicals, which in turn help the neurons to communicate with each other.
When is ADHD diagnosed?
ADHD is often diagnosed in childhood, and typically continues through adolescence and into adulthood. The level of impairment can vary from person to person and from one situation to another; symptoms can lessen or increase over time. 3
According to a 2015 National Health Statistics Report issued by the U.S. Department of Health and Human Services, parents reported a total of 6.4 million school age children between ages 4 and 17 having ever been diagnosed with ADHD. This works out to be 11 percent of children, or roughly one in 10 kids. 4
The rate of boys diagnosed with ADHD is three times higher than the number of girls diagnosed. And according to the National Institute of Mental Health, the average age for diagnosis when parents reported a child with moderate symptoms of ADHD was 7 years old. In instances where parents reported their child had more severe ADHD symptoms, the age for diagnosis was 5. Mild symptoms are diagnosed more often at age 8. 5
Meanwhile, 4 percent of the adult population, or 8 million adults, are estimated to have ADHD.6 When you compare this to the number of children and adolescents, the total number of adults reporting ADHD drops by more than half. This may be due to the fact that as a total population, fewer adults overall have been screened for the condition. Additionally, symptoms of ADHD can lessen in adulthood due to maturation of the brain. Adults with ADHD may also find themselves in jobs where their particular challenges are supported or don’t factor in to overall performance. The same thing can be said of a supportive spouse who might take over paying bills from the partner with ADHD, and making sure important appointments are scheduled and kept.7 Overall, of those who are diagnosed as children and teenagers, an estimated 15% of adults still meet the criteria for ADHD, according to the National Center for Health Statistics. 8
Symptoms of ADHD
A child or adult with ADHD will show varying degrees of these three behaviors: inattention, impulsivity and hyperactivity.
However, it’s important to mention that any child or adult—meaning even people without ADHD—will demonstrate one or more of these associated behaviors at any given time. Most people with ADHD will experience a combination of symptoms from each of the subtypes—inattention and hyperactivity/impulsivity. When signs of inattention, impulsivity and hyperactivity are seen for at least 6 months and demonstrated in more than one setting, such as the home, classroom or at work, ADHD may be the cause.12
A diagnosis of ADHD in a child age 16 or younger should be considered when he or she presents with six or more symptoms of inattention and/or hyperactivity and impulsivity that are characterized as inappropriate for their developmental level. Examples of these symptoms are outlined, below.
From age 17 and up, a clinician will look for 5 or more symptoms of inattention and/or impulsivity and hyperactivity that are developmentally inappropriate.
Symptoms of Inattention:
- frequent difficulty focusing on tasks, including homework or meeting work deadlines
- often struggles to follow through on projects, assignments, and chores
- has difficulty staying organized and misses deadlines
- is often easily distracted
- often fails to respond when being spoken to
- has difficulty keeping track of important items such as keys, cell phone, homework assignment pad.
Symptoms of impulsivity and hyperactivity:
- lacks careful thought/does not consider the potential consequences before acting on something or expressing one’s feelings
- abnormally active and/or disruptive behavior
- talks excessively
- struggles to be quiet during leisure activities
- finds it difficult to wait his turn
- squirms in his seat; fidgets with his hands and feet.
Another way a doctor may evaluate and categorize symptoms is by grouping them into categories. Dr. Brown’s research has pinpointed how the symptoms of cognitive function impairment caused by ADHD tend to show up in six clusters. These include: activation, focus, effort, emotion, memory and action.
For instance, initiating and organizing tasks, fall under “activation” and difficulty completing tasks or sustaining effort fall under “effort.” Under effort is also regulating alertness—a person with ADHD may not be able to quiet their mind enough to fall asleep when they should.
Less often described in ADHD literature is the “emotion cluster.” Dr. Brown, who’s assessed and treated patients with ADHD for more than 25 years, says they often report difficulty with managing emotions that include anger, worry, frustration, and disappointment. These create additional challenges for the person with ADHD. 13
Currently, the Diagnostic and Statistical Manual (DSM-IV) of Mental Health Disorders—the handbook used by mental health professionals to assess and diagnose ADHD—does not include supporting information on the link between ADHD and emotion regulation.
Finally, it’s important to highlight that while a person with ADHD will struggle with a variety of symptoms that fall under inattention and/or impulsivity and hyperactivity, in almost every case there will be areas where the person is able to focus intently, sometimes referred to as “hyper-focus.” This is typically seen in areas that the person shows a great interest in, such as playing video games, playing a musical instrument or even reading when the subject matter has great appeal.
Diagnosing ADHD in Children and Adults
The most commonly used and recommended test for evaluating a child or adult for ADHD is a standard assessment that is designed to identify behavioral patterns and traits associated with ADHD.14
If your child is between age 4 and 18 and you suspect he or she may have ADHD, the American Academy of Pediatrics recommends that your child’s primary doctor/pediatrician do the initial behavioral screening evaluation. During an office visit, the doctor will meet with your child and you and ask a series of questions to determine if your child shows persistent signs of inattention and/or impulsivity and hyperactivity and whether they occur in more than one situation, such as at home and in school.
If your child’s pediatrician suspects ADHD, he will likely recommend a formal evaluation by a mental health professional such as neurologist or psychologist who can do neuropsychological testing. This type of testing goes more in-depth than the standard screening. This testing will include screening for auditory and visual processing and sensory development, among other things.15 The idea is that by identifying the contributing factors of ADHD, the doctor can recommend a treatment approach that addresses the underlying cause(s) as well as the ADHD.
If a doctor is having difficulty pinning down the diagnosis, she may recommend neurological imaging. A SPECT (single photon emission computed tomography) scan measures blood flow in the brain. A radioactive dye is injected in the arm, and a series of pictures are taken of the head. These are turned into 3-D images and screened to see where the brain appears more and less active.16 Children diagnosed under age 6 were much more likely to have had neurological imaging compared to those 6 and older (41.8 % versus 25 %).17
Adults, meanwhile, are initially screened using the Adult ADHD Self-Report Scale.18, 19
There is no cure for ADHD. But the condition can be treated in children and adults with medication and therapy. The National Institute of Mental Health says for the best outcome, a combination of medication and behavioral therapy should be used. 20
What types of medications are used for ADHD?
Two types of drugs are approved to treat ADHD: stimulants and non-stimulants.
Stimulants. Stimulant drugs are the most commonly used medications to treat ADHD. Stimulants work by increasing brain chemicals, including dopamine, that are critical for transmitting messages between brain neurons. In kids, 70 to 80 percent show improvement in symptoms within one to two hours of taking the medication. In adults, 70 percent report noticeable improvement from stimulants within hours of using the medication. 21
The two generic stimulants, also known as central nervous system stimulants, that are widely used to treat ADHD are methylphenidate (Concerta, Aptensio XR) and dextro-amphetamine (Adderall).
Non-stimulants. In cases where a stimulant drug is not well tolerated or preferred, there is atomoexetine (Straterra), a non-stimulant that helps increase a brain chemical called norepinephrine. This chemical can help improve focus, while tamping down impulsiveness and hyperactivity. Clonidine (Kapvay) and Guanfacine (Intuniv) are also non-stimulants and work slightly differently to achieve similar effects.
Cognitive behavioral therapy and psychoeduation are recommended for people with ADHD to provide a framework for how to better manage emotions and general behavior. Therapy can also focus on strategies to help with self- regulation and self-monitoring. This education can help a child or adult with ADHD as they face day-to-day challenge’s at home, in the classroom, at work, and in social situations. In addition, social skills groups can be beneficial for children and teens with ADHD, who often struggle with their social interactions, due to impulsivity. Therapy usually occurs one time per week, for 45 minutes at a time.
A therapist may also recommend alternative therapies and/or dietary changes that have proven helpful with managing different symptoms of ADHD. These may include:
- meditation and mindfulness exercises to address the anxiety so often associated with ADHD.
- working with an ADHD coach to learn organizational techniques and other day-to-day coping skills.
- emotional freedom technique (EFT). Also known as tapping, EFT involves using the fingers to tap on a series of meridians on the body that can activate emotional release and healing.22
- neurofeedback training (or EEG biofeedback) is utilized in an attempt to teach/train one who struggles with ADHD to produce the brain wave patterns associated with focus.23
- dietary improvements that focus on eating foods that reduce inflammation in the body, which in turn can help the brain function more optimally. This includes limiting white flour, white sugar, processed foods, and incorporating more fruits and vegetables, as well as omega-3 fatty acid rich foods24 such as walnuts and salmon.
Other Mental Health Conditions Associated with ADHD
There are several conditions that are associated with ADHD, including anxiety, learning disabilities, oppositional defiant disorder, substance abuse, biopolar disorder,25 depression, and social anxiety. This is why it’s critical that an ADHD evaluation also include an initial assessment for these related conditions, as well as ongoing screenings if an ADHD diagnosis is made. If one of these related conditions is also diagnosed, the doctor can recommend a number of treatments options that, similar to ADHD, will include medication and therapy.
Living with ADHD
A child or adult diagnosed with ADHD faces daily challenges that impact nearly every area of his or her life. But persistence in finding the right medication and dosage—while also making time for therapy that focuses on effective behavioral coping techniques—will be the key to successfully managing this condition.