What is ADHD?
Attention-Deficit/Hyperactivity Disorder (ADHD) is a common mental disorder. ADHD's symptoms include the inability to focus, hyperactivity, and impulsive behavior. It is considered a chronic and debilitating disorder that affects individuals in various aspects of their life – such as academic performance, professional achievements, interpersonal relationships, and activities of daily living.
When not appropriately treated, ADHD can lead to a poor social function and low self-esteem in children when not treated. Adults with ADHD can suffer from low self-worth, increased self-critique, and a heightened sensitivity toward criticism. It is estimated that about 8.4% of children have ADHD, and about 2.5% of adults have ADHD. ADHD is typically first identified in school-age children. Commonly, a concern arises when there is an issue in the classroom or with schoolwork. More boys are diagnosed than girls, as boys tend to show hyperactivity while girls tend to be inactive.
Symptoms and Diagnosis
ADHD can be hard to diagnose because most kids are rambunctious and have their own peculiarities and personality. In short, many kids have difficulty sitting still, waiting their turn, and acting impulsively. However, children who meet the criteria for ADHD have noticeably more significant symptoms than their peers. These symptoms often lead to suffering and issues at home, school, work, and in interpersonal relationships with others. The symptoms are not the result of someone being defiant nor mis-understanding the instructions.
ADHD has three main types:
Diagnosis is based on persistent symptoms that have been present over a period of time and have been evident within the past six months. While ADHD can be diagnosed at any age, the disorder begins in childhood. At the time of test diagnosis, symptoms must have appeared before the person was 12 years old, and they must have caused trouble in more than one setting. For example, symptoms don't just happen at home but also at school, the library, church, or another location.
Those with inattentive ADHD have challenges staying on task, focusing, and staying organized. To receive a diagnosis for Inattentive type, six of the following symptoms must be present:
• Inattentive or careless mistakes in school or work assignments.
• Difficulty concentrating on tasks or activities during conversations, readings, or lectures (schoolwork).
• Doesn't seem to listen when being spoken to
• Not following directions, not doing homework, chores, or work duties (may start homework, but loses focus quickly).
• Difficulty organizing tasks and work (e.g., poor time management; messy, disorganized work; missed deadlines).
• Avoid or dislike tasks that require constant mental effort, such as preparing reports and completing forms.
• Frequent loss of everyday items like school papers, books, keys, wallets, cell phones, and glasses.
• Gets easily distracted.
• Forgets about daily tasks like doing chores and running errands. Older teens and adults can forget to return phone calls, pay bills, and make appointments.
Hyperactivity refers to excessive movements like restlessness, excess energy, and talkativeness. Impulsivity is a decision or action taken without considering the consequences. Six of the following symptoms (or five in people 17 and older) are expected to diagnose this type of ADHD:
• Twisting or tapping hands or feet or wiggling in their seat.
• Inability to remain seated (in the classroom, at work).
• Walking or climbing in inappropriate places.
• No quiet play or recreational activities.
• Always moving, as if driven by a motor.
• Talking too much.
• Blurt out answers before questions are finished (e.g., may finish the sentence of the other person and can't wait to speak in the conversation).
• Difficulty waiting for their turn when waiting in line.
• Interrupting or disrupting others (e.g., interrupting a conversation, game, or activity or using someone else's things without permission).
This type of ADHD is diagnosed when both criteria are met for the Inattentive and Hyperactive/Impulsive types.
It's worth noting that several conditions can mimic ADHD, like learning disabilities, mood disorders, anxiety, substance use, head injuries, thyroid disease, and the use of medications such as steroids. ADHD can coexist with other mental health conditions, such as behavioral disorders, anxiety disorders, and learning disabilities. Therefore, a comprehensive psychological evaluation is critical. There are no specific blood tests or routine imaging tests for ADHD diagnosis. Patients may sometimes be referred for additional psychological testing (such as neuropsychological or psychoeducational testing) or computerized testing to assess the severity of symptoms.
Causes of ADHD
Scientists have not yet determined the specific cause of ADHD. While there is growing evidence that genetics causes ADHD and multiple genes are involved in the disorder, no specific gene or combination of genes has yet been identified. However, it should be noted that relatives of people with ADHD are often affected. There is evidence of anatomical differences in the brains of children with ADHD compared to other children without ADHD. For example, children with ADHD have reduced gray and white matter volumes and show differential activation of brain regions when performing specific tasks. Further research showed that ADHD affects the frontal lobes, caudate nucleus, and cerebellar vermis of the brain. Several non-genetic factors are also associated with this disease, such as low birth weight, premature birth, exposure to toxins during pregnancy (alcohol, smoking, lead, etc.), and extreme stress during pregnancy.
ADHD treatment often involves a combination of therapy and pharmacological intervention. For preschoolers and younger children, recommended first-line approaches include parental management training and behavioral strategies in the form of school interventions. Parent-Child Interaction Therapy (PCIT) is an evidence-based treatment modality for young children with ADHD and Oppositional Defiant Disorder.
According to current guidelines, psychostimulants (amphetamine and methylphenidate) are the drugs of choice for ADHD. Amphetamines are the only FDA-approved drug for preschoolers with ADHD, although guidelines suggest that methylphenidate may help replace amphetamines when behavioral interventions prove insufficient. Alpha-agonists (clonidine and guanfacine) and the selective norepinephrine reuptake inhibitor atomoxetine are other FDA-approved options for ADHD.
There are newer FDA-approved medications for ADHD, including:
• Jornay (extended-release methylphenidate)
• Xelstrym (dextroamphetamine), an amphetamine patch
• Qelbree (velozine), a non-stimulant
• Adhansia (methylphenidate hydrochloride)
• Dyanavel (extended-release amphetamine oral suspension)
• Mydayis (mixed salts amphetamine)
• Cotempla (extended-release methylphenidate tablets to disintegrate in the mouth).
Many children and families may switch between different drug options based on how effective treatment is and how well the drug is tolerated. The goal of treatment is to improve symptoms to restore function at home and school.
ADHD and Children
Teachers and school staff can provide information to parents and doctors to help assess behavior and learning problems and assist with behavior training. However, school staff cannot diagnose ADHD, make treatment decisions, or require students to take medication for school. Only parents and legal guardians can make these decisions with the child's doctor.
Students whose learning ability is impaired by ADHD may be eligible for special education under the Disabled Persons Education Act or a Section 504 program under the Rehabilitation Act of 1973 (for children who do not require special education). Children with ADHD may benefit from a study skills curriculum, changes in classroom design, alternative teaching methods, and a modified curriculum.
ADHD and Adults
Many children diagnosed with ADHD go on to meet the criteria for the disorder later in life and may have barriers that require ongoing treatment. However, sometimes an ADHD diagnosis is missed in childhood. Many adults with ADHD do not know they have the disorder. Comprehensive assessment usually includes reviewing past and present symptoms, physical examination and medical history, and use of adult rating scales or checklists. Adults with ADHD receive medication, psychotherapy, or combination therapy. Immediate family support and behavioral management strategies, such as methods to minimize disruption and improve structure and organization, can also be helpful.
ADHD is a protected disability under the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA). That means agencies receiving federal funding must not discriminate against people with disabilities. Individuals whose ADHD symptoms interfere with the work environment may be eligible for reasonable work accommodation under the ADA.