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Attention Deficit Hyperactive Disorder (ADHD) is an increasingly common diagnosis. Currently, in the United States, this chronic condition impacts about 3 million people per year. It impacts so many areas of occupation, overall successful life function, and activities of daily living.
In children, this typically means focus and attention for learning at school, developing social skills to interact with peers, participating appropriately within the community, and functioning as part of a family unit. For adults, this also includes the ability to attain, arrive at and manage a job; work as part of a team; as well as create and maintain successful interpersonal relationships.
People seem to use the terms ADD (Attention Deficit Disorder) and ADHD interchangeably, referring to the same struggle with attention and focus, impacting learning, and participation in daily activities. In order for someone to be diagnosed with ADHD, they have to meet certain criteria as evaluated by their health professional.
The current version of the Diagnostic and Statistical Manual (DSM-V) used by such health professionals lists only Attention Deficit Hyperactive Disorder, not Attention Deficit Disorder. ADD is technically an “outdated” term by current DSM-V standards.
The DSM-V identifies ADHD with subtypes, one in which is used to diagnose the condition (formerly) known as ADD. It is most common to diagnose a school-age child with ADHD, as symptoms typically present themselves before the age of 12.
Both children and adults can be diagnosed with the disorder though, and some adults are not identified as having ADHD until they are grown and out of school.
There are three predominant types of attention deficit hyperactive disorder that can be diagnosed. As ADHD is a life-long chronic neurodevelopmental disorder, symptoms and their presentation can change over time.
With this presentation, it is difficult for the person to organize and finish a task, focus on details, follow instructions, or have a lengthy or detailed conversation. Easily distracted, the individual may even forget daily routines. This type of presentation is what was formerly known as Attention Deficit Disorder (ADD).
With this presentation, the person may feel restless and struggle with impulsivity. It is often identified in small children with regards to their activity level, they are always in motion: running, climbing and jumping continuously. It can be difficult for the individual to sit for long periods of time at meals or to complete homework. Impulsivity can range from constant talking and interruption in conversation, or difficulty waiting for a turn or listening to directions. Someone with such impulsivity may be more accident-prone.
This term is used when symptoms from the above subtypes are equally present in an individual.
Formerly known as ADD (attention deficit disorder), ADHD is one of the most commonly diagnosed mental disorders in children. More prevalent in boys than girls, it is often identified when a child begins to struggle at school. Symptoms are grouped into three categories
Most adults can identify with losing their keys or phone or forget what they’ve gone into a room to look for. There is a range of this type of behavior in adults, but most of us are able to backtrack and recall what we are doing and get to where we need to go.
Adults with ADHD will have difficulty remembering to do daily activities, difficulty organizing tasks, and get distracted during an activity. They may avoid tasks that are necessary to function as an adult, lose focus on their duties at work, school and at home, and regularly make mistakes. Socially, they may struggle to focus, listen when spoken to, follow conversation or carryout a direction.
With adults, symptoms change as they age. For some, hyperactivity may look like periods of extreme restlessness. Adults can wear each other out with extreme activity levels. They may appear frequently “on to go”, fidget in their seat, excessively get up from a meal/meeting, or constantly feel the need to play with items on a desk. Socially they may struggle to wait their turn in conversation, talk excessively, and interrupt others.
Adults that struggle with ADHD tend to be chronically late and forgetful. They may struggle with anxiety and depression, poor self-esteem, and battle addiction.
Symptoms, presentation, and identification alone isn't enough to diagnose ADHD. A formal diagnosis needs to come from a health professional like a pediatrician, psychiatrist, or psychologist. The medical professional should administer checklists and rating scales to gain information about the child’s typical behavior in multiple settings – this means talking to teachers, parents, and any other significant adult who sees the child regularly.
Adults are more likely to be able to self-report. Ruling out other conditions before making a diagnosis is important – sleep disorders, depression, anxiety, and learning disabilities have symptoms that present similarly to ADHD.
In order to meet the DSM-V criteria for ADHD, the onset of symptoms must begin before age 12, be present for at least 6 months, and occur in multiple settings – like both at home and at school. These symptoms have to clearly impact functional participation in occupations at home, work, and school. These symptoms may not be better explained by another/coexisting disorder (like mood, anxiety or learning disorder).
In order for a specific subtype of ADHD to be assigned to an individual, he/she must demonstrate at least 6 symptoms (that would otherwise be developmentally appropriate) for children under 16 years of age, and at least 5 symptoms for adolescents and adults age 17 or older, for 6 months.
Depending on the symptom presentation– a health care professional would group them into the category of inattentive type, or hyperactive-impulsive type, and determine which is more predominant. If the two types are equally expressed, the diagnosis of combined type can be made.
In this day and age of available technology to children, there are some theories that interacting too much with screens or watching too much television and eating too much sugar causes ADHD. Family stressors, poverty, nutrition, and parenting styles often get grouped into this popular opinion. At this time, researchers say that there is not enough evidence to support these theories, and link these to the causality in ADHD.
However, these factors may exacerbate ADHD symptoms in some individuals, so it may be important to track technology and television use, nutrition, and other exposures relative to symptom presentation.
While scientists have not been able to narrow down the specific causes of ADHD, they do know that genes are a big factor. You are more likely to be diagnosed with ADHD if there is a family history of it, or even if there is a family history of another mental health disorder.
In addition to genetics, environmental factors such as prematurity, low birth weight, prenatal exposure to drugs, and alcohol are factors. Additionally, early exposure to toxins (especially lead), as well as brain injury can increase the likelihood of an ADHD diagnosis. Chemical imbalance and overall brain changes can increase the risk of developing ADHD as well.
In general, individuals with ADHD are more prone to difficulty within their relationships, with behavior and conduct, and in daily life functions. While we often see struggles begin in school if symptom management isn’t successful, these struggles often carry over to performance deficits in the workplace. The risk of unemployment and poor physical and mental health are high. Alcohol and drug abuse are potential risks in adulthood, as is trouble with the law. As adults, individuals with ADHD can struggle with their marriage and other relationships and in general, be more prone to accidents.
There are several other mental health disorders whose symptoms mirror those of ADHD. It is important to be accurately diagnosed and treated. Some of these disorders are exacerbated by ADHD symptoms. For example, feelings of depression or anxiety may worsen due to failures or outcomes of ADHD. Other disorders where ADHD is frequently comorbid (occurs along with) include:
For school children, special education services can help with learning difficulties in the classroom. Implementing structure and routine at home is important for a child to be prepared for their day. Good habits around sleep and nutrition can support a child’s success at school as well. Social skills groups can benefit a child with ADHD who needs to work on taking turns, sharing, or conversational skills.
Stimulants are the most frequently prescribed medication to treat symptoms of ADHD. These types of medications have been shown to increase and balance neurotransmitters in the brain. Amphetamine and methylphenidate are two of the most common stimulants. Non-stimulant and antidepressant medications can be prescribed for those that don’t respond to stimulants, although they typically work a bit slower than stimulants.
The FDA has recently approved a medical device for children ages 7-12 who do not take medications for ADHD. It is a stimulator the size of a cell phone connected to a patch with electrodes. When placed on the forehead at night, it sends low-level electrical impulses to the brain, to the branches of the trigeminal nerve, thought to be involved in ADHD. NeuroSigma Monarch is the manufacturer of this external trigeminal nerve stimulator, this is their first non-drug therapy approved to treat ADHD in children.
Psychotherapy in the form of cognitive-behavioral training or family therapy can be helpful to understand ADHD and develop strategies for success. Adults with ADHD may find marital counseling beneficial to help support relationships and overall family health.
In order to effectively manage symptoms of ADHD, its important to create a network of support people to keep you on track. This network could involve a formal support group, counselor or therapist, in addition to close family and friends, coworkers and bosses, teachers or classmates.
Organizational strategies can help an individual manage day-to-day tasks. Some of the following ideas may be helpful:
With ADHD affecting over 3 million Americans each year, it is important for health professionals, parents, and teachers to recognize the signs and symptoms of this chronic neurodevelopmental disorder. Most often diagnosed in elementary school, ADHD impacts boys more often than girls, and can even impact some individuals well into adulthood.
Most people with ADHD lead full, successful, and happy lives. It is very important for those impacted with ADHD to get diagnosed appropriately and participate in long-term treatment. Medication, therapy, educational or occupational supports, and organizational skills can help both a child and an adult with their symptoms; and help them learn to develop good habits and routines around organization.
Without proper treatment, adults and adolescents can suffer from anxiety and depression, substance abuse, and addiction struggles with their significant relationships and even trouble with the law. Adults who manage their disorder well throughout their childhood may see a decrease in symptoms as they get older, and some may eventually stop treatment altogether.
References
https://www.cdc.gov/ncbddd/adhd/facts.html
https://www.cdc.gov/ncbddd/adhd/diagnosis.html
https://www.webmd.com/add-adhd/childhood-adhd/attention-deficit-hyperactivity-disorder-adhd#3
https://www.mayoclinic.org/diseases-conditions/adult-adhd/symptoms-causes/syc-20350878
https://www.medicaldevice-network.com/projects/monarch-etns-system/
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