What is ADHD?
ADHD is a mental health condition that affects a person’s ability to function in school and work. It typically appears during childhood and does not go away.
A pediatrician or a child psychiatrist can diagnose ADHD using guidelines provided by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). Psychotherapy, medication, and behavior management strategies are usually effective treatment options.
Signs and Symptoms of ADHD
Many people with ADHD have a hard time sitting still, waiting their turn, paying attention or keeping track of details. But they go further than others with these problems — their symptoms cause substantial difficulties in multiple areas of their life, such as schoolwork, jobs, relationships and living situations.
Adults with hyperactive-impulsive ADHD are often fidgety or restless, easily distracted, talkative and disrupt or interrupt others. They have trouble staying focused, miss deadlines and lose things needed for work or activities, including keys, wallets and cell phones. They may also have mood swings and find it difficult to make and keep friends.
For a diagnosis, symptoms must have been present before age 12, persist for at least six months and significantly interfere with functioning at home, school or work. Symptoms cannot be explained by other factors, such as learning disabilities, depression or anxiety, or medical illnesses.
Symptoms can range from mild to severe, and how they affect a person can change over the years. Getting a diagnosis is the first step toward understanding what causes your difficulties and finding solutions. Without treatment, undiagnosed ADHD can lead to missed opportunities, chronic stress and feelings of inadequacy or low self-esteem.
Types of ADHD
Attention deficit hyperactivity disorder (ADHD) is a behavior disorder marked by inattention, impulsiveness, and sometimes hyperactivity. It can occur in children and adults. It is typically diagnosed in childhood, but can go undiagnosed or under-diagnosed during adolescence and into adulthood. If you think you may have ADHD, it’s important to get a professional evaluation and diagnosis. Your healthcare provider will ask questions and use a behavioral rating scale to help determine if you have ADHD and which type of ADHD.
The most common type of ADHD is inattentive-type ADHD, which causes people to forget details or lose their place when reading or doing schoolwork. These individuals also find it hard to stay focused during conversations or work tasks. They tend to procrastinate or miss deadlines. People with this type of ADHD are more likely to seek treatment, as their symptoms interfere with everyday life and relationships.
The other two types of ADHD are hyperactive-impulsive and combined type. Individuals with hyperactive-impulsive type ADHD show a combination of impulsive behaviors, like interrupting or butting into conversations, and inattention, making it difficult to complete tasks. They have trouble keeping track of things, often losing their cellphone, keys, or project notes.
Causes of ADHD
There is no one answer for why people have ADHD. But research shows that certain genes and environmental factors make someone more likely to develop it. For example, children who have a parent or sibling with ADHD are more likely to have it themselves. And exposure to toxins like alcohol, smoking and lead during pregnancy can also increase the risk of developing the disorder.
Scientists have also found differences in the brain structure and activity of people with ADHD. In particular, the frontal lobe, which is responsible for planning and paying attention, functions differently in people with ADHD. They have trouble modulating their behavior and may act impulsively.
As a result, kids with ADHD often act one to three years younger than their peers. Their symptoms may change over time as they get older and enter different stages in life. For instance, some children with primarily hyperactive-impulsive symptoms fit this presentation style in preschool, but lose most of their hyperactivity during adolescence and transition to combined presentation. It is important to know which presentation style you have because it affects how your symptoms are treated. Behavioral symptoms are only part of the diagnosis, and providers also use questionnaires and interviews with patients, caregivers and teachers, a physical examination and lab tests to rule out other health conditions.
How is ADHD Diagnosed?
Doctors use guidelines set by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (DSM-5)1 to diagnose ADHD. The first step is to interview the patient and review their medical and psychiatric history. Doctors will also examine the person to rule out other conditions that could be causing their symptoms, such as mood disorders or learning disabilities.
To get a diagnosis of ADHD, the person must have six or more inattentive symptoms that cause significant trouble at school or work. Their problems must start before they turn 12 and have been persistent for at least six months. They must also have more than one of the nine hyperactive/impulsive symptoms. Examples include fidgeting with hands or feet, leaving their seat when they’re supposed to remain seated, and trouble waiting for their turn.
Some doctors will interview the patient and others who know them well — a spouse or sibling for adults, a teacher, coach, or nanny for children. They will use checklists to help identify symptoms. The doctor will then make a diagnosis and determine which type of ADHD they have: inattentive, hyperactive/impulsive, or combined. They will also identify the severity of the condition.
Treatsments for ADHD
People with ADHD can be helped by medication, school support services, psychotherapy and lifestyle changes. A person with ADHD should always take medications as directed by a doctor, and be monitored regularly for side effects and compliance. Stimulants are the most commonly used medications to treat ADHD, and have a good safety record when taken under a doctor’s supervision. They may reduce the symptoms of ADHD but cannot cure the disorder.
Non-stimulant medications are available for people with ADHD who can’t use stimulants due to medical reasons or a history of substance abuse. These include atomoxetine, clonidine and bupropion for children and adults. These drugs may be less effective than stimulants but can reduce the symptoms of ADHD, and have different side effects.
Behavior therapy can help a child or adult develop new skills, attitudes and ways of interacting with others. Family counseling can also help parents learn about ADHD and how it affects their family, and improve communication between family members.
ADHD in Adults
In adults, ADHD symptoms can lead to serious consequences, such as trouble in school or work, financial difficulties, marital problems, strained relationships, and poor health. Adults with untreated ADHD can experience depression, substance abuse, and anxiety disorders. They also have an increased risk of skipping doctor appointments, not following medical instructions, and forgetting medications.
Symptoms of inattentiveness are more prevalent in women than hyperactivity or impulsiveness, and they often go undiagnosed or misdiagnosed. This is because women tend to hide their symptoms better, which means that they may not be able to get the help they need.
Stimulant medication is usually prescribed for people with ADHD, as it increases the levels of dopamine and norepinephrine in the brain. This helps to improve concentration and focus. There are other non-stimulant medications that can be used as well, such as guanfacine and atomoxetine. They take longer to work, but they can still help to reduce impulsivity and inattentiveness. They can also be used in combination with stimulants to increase effectiveness. In addition, dietary changes and home remedies can be helpful in managing symptoms of ADHD in adults.
ADHD Medication
There are medicines that help people with ADHD focus, pay attention and control their behavior. Medications for this condition work by changing the chemicals in the brain that control behavior. These medications are called stimulants. They include methylphenidate (e.g., Ritalin) and amphetamines, such as dextro-amphetamine (e.g., Adderall).
Stimulant medicine works well for most people with ADHD. It is a safe and effective treatment, especially in children. It is not likely to be addictive, even when taken regularly for long periods of time. At therapeutic doses, these medicines do not sedate or tranquilize children and do not increase their risk of tics or Tourette syndrome.
Side effects of these medications can be bothersome for some people, but they usually go away within a few days or weeks. They may include decreased appetite, trouble sleeping and jitteriness. The drugs may also cause a slightly higher heart rate and blood pressure, and some people might experience weight loss.
There are other medicines that reduce impulsivity and improve focus and concentration without stimulating the brain, but they do not work as quickly or as well as stimulants. Doctors sometimes prescribe them when a person has intolerable side effects from stimulants or as an addition to their medication. These medications are called non-stimulants and include norepinephrine reuptake inhibitors, such as atomoxetine (brand name Strattera).
