What is ADHD?
If you suspect your child or yourself may have ADHD, talk to your primary care provider. He or she will likely refer you to a mental health professional for an evaluation.
There are four different ways ADHD presents itself. Providers diagnose the condition using guidelines from the American Psychiatric Association. Stimulants reduce ADHD symptoms quickly and come with few side effects. Non-stimulants take longer to work but also improve attention and impulsivity.
Signs and Symptoms of ADHD
Many people with ADHD have trouble paying attention, staying organized or controlling their behavior. Their symptoms may be noticeable in school, work or their relationships with family and friends. Symptoms of ADHD usually start in childhood. For a person to be diagnosed with ADHD, these symptoms must be noticeably more severe than expected for their age or developmental level and cause problems in more than one setting.
Typical symptoms include difficulty sitting still, fidgeting or moving around often. They have a hard time waiting their turn or listening to others speak. They make careless mistakes or forget important details, such as a deadline or social plans. They also have trouble following directions or making decisions. Symptoms of hyperactivity and impulsivity are more obvious in kids, such as interrupting others or running into the street without looking both ways.
Boys are more likely to be diagnosed with ADHD than girls. It’s also more common for a girl to have the inattentive presentation type of ADHD, which doesn’t show symptoms of hyperactivity and impulsivity. Some children with ADHD don’t meet the official criterion for either inattentive or hyperactive/impulsive presentations and receive a diagnosis of unspecified ADHD. This is because they have a mixture of symptoms from both types.
Types of ADHD
People with the predominantly inattentive type of ADHD show problems paying attention and may forget things, lose things or get easily distracted. This type of ADHD used to be called attention-deficit disorder (ADD). Children and adults with this presentation often have trouble at school or work.
Those with the hyperactive-impulsive type of ADHD have more symptoms of fidgeting, can’t sit still or are very talkative. They may also be prone to impulsive actions such as interrupting others or making decisions without thinking about the consequences. This type of ADHD is most common in preschool-age children and may affect boys more than girls.
Some people meet criteria for both inattentive and hyperactive-impulsive symptoms and are diagnosed with combination ADHD. This is what many people think of when they hear the term ADHD. Children and adults who have this type of ADHD may have trouble concentrating in class or at work and can often be misunderstood by their teachers or colleagues.
Researchers have found differences in brain structure and activity in people with ADHD. They think this is due to genes and chemicals that are out of balance. Studies suggest that certain brain areas, especially the frontal lobe, are less active in those with ADHD.
Causes of ADHD
ADHD is a neurobehavioral disorder that can cause problems at home, school or work. It is the most common psychiatric disorder in children and teens. It can also affect adults. The exact cause of ADHD isn’t known, but genetics and environmental factors may play a role. People with ADHD have different brain structures and activity than people who don’t have the disorder. They have a greater risk of mood disorders such as depression and bipolar disorder. They are also at higher risk of having other psychiatric disorders such as anxiety, personality or intermittent explosive disorder.
Researchers believe that a combination of genes and environment contributes to the development of ADHD. Some research suggests that problems with the frontal lobe of the brain during pregnancy, exposure to chemicals and drugs, and extreme stress during childhood might also play a role in the disorder.
To be diagnosed with ADHD, a person must show more than six symptoms over the course of at least six months. The symptoms must occur in multiple settings and significantly impair their ability to function at home, at school or in social situations. Doctors can designate the severity of a person’s symptoms as mild, moderate or severe based on the DSM-5 criteria.
How is ADHD Diagnosed?
Psychiatrists diagnose ADHD based on your symptoms, which must have interfered with functioning in two areas of life (for example school and home) for six months or more. They will consider whether you meet the criteria for either the inattentive or hyperactive/impulsive presentation type of the disorder.
People with the inattentive presentation often have trouble paying attention and forget things easily. For children, this may look like difficulty learning or listening in class or making careless mistakes on homework. For adults, this may mean problems keeping up with work tasks or remembering details of conversations or meetings.
Adults with the hyperactive/impulsive presentation often fidget and have a hard time sitting or remaining seated in places where it’s expected, like classrooms or offices. They also have trouble playing or engaging in leisure activities quietly and frequently interrupt others or blurt out answers without thinking.
It’s common for adults with ADHD to have comorbidities, such as mood disorders or anxiety. If untreated, they can lead to problems with relationships and employment, as well as substance abuse issues. It is also common for adults with untreated ADHD to feel a sense of shame and underachievement, which can cause low self-esteem and depression.
Treatsments for ADHD
Treatments for ADHD include medications, behavioral therapy and support from family and friends. Most adults with ADHD improve their quality of life and get better at school and work when treated. Many people with ADHD also have comorbid conditions such as mood disorders or anxiety disorders. Your doctor will discuss your treatment options and work with you to choose the right medicines and therapies for you.
Stimulants are the most common medicine used to treat ADHD. Your doctor will prescribe small doses at first and gradually increase them. Your doctor will also monitor your progress and watch for side effects.
Other medications that can be used to treat ADHD include the nonstimulant atomoxetine and certain antidepressants such as bupropion. They usually act more slowly than stimulants and may be better choices if you have other health problems or don’t respond to stimulants.
Behavioral therapy for ADHD can help children, teenagers and adults make sense of their diagnosis and learn to cope with and live with the disorder. Psychotherapy (counseling) for adults with ADHD can teach strategies to manage their symptoms, change negative thinking patterns and improve relationships. Marital and family counseling can help couples communicate more effectively and develop conflict resolution skills.
ADHD in Adults
For adults, untreated ADHD symptoms can cause problems at work, home and in all types of relationships. Symptoms of ADHD can range from trouble staying organized and keeping track of bills to forgetting important dates, losing things easily and impulsive behavior. Many people with ADHD struggle to find a satisfying career and to manage finances and relationships. Others have difficulty in school and may not get good grades. Symptoms of ADHD can lead to substance abuse, depression, anxiety and low self-esteem.
ADHD in adults usually presents differently than in children, with more frequent occurrences of inattentive symptoms and less common ones of hyperactivity-impulsivity. In addition, the disorder usually persists into adulthood. To be diagnosed with ADHD, several inattentive symptoms must have been present before age 12 and there must be clear evidence that the symptoms interfere with school or work functioning.
People with ADHD are more likely to have co-existing conditions, such as oppositional defiant or conduct disorders, anxiety, depression, tic disorders and Tourette syndrome, learning disabilities, mood swings and eating disorders. Some people with ADHD also have bipolar disorder or a history of childhood trauma. Treatment of these conditions is a part of the overall treatment plan for ADHD.
ADHD Medication
Most kids and teens with ADHD get better by taking stimulant medication. Stimulants are the most widely used medications and help improve focus, reduce impulsive behavior and decrease troublesome outbursts. They work mainly by boosting and balancing levels of brain chemicals called neurotransmitters. A few nonstimulant drugs, such as the antidepressants atomoxetine (Prozac) and bupropion (Wellbutrin), are also sometimes prescribed to treat ADHD in children.
In our survey, most of the children who took methylphenidate or amphetamines had been taking them for more than two years. The majority of those who stopped taking the medication did so because of side effects or other reasons, such as a desire to try another treatment.
It’s not possible to predict the exact type of medication that will work best for a child or adult. Doctors usually prescribe a drug trial, starting with a low dose and gradually increasing it in 3-7 day intervals until the right balance is found. It’s important for people with ADHD to tell their doctors about any over-the-counter or prescription medicines they take, including vitamins and supplements. This helps avoid harmful drug interactions. It’s also important to note that even though medications can help improve attention, they won’t eliminate symptoms altogether.
