What is ADHD and How Can it Be Treated?
If you have ADHD, you may forget things easily or make impulsive decisions that lead to trouble at work, school or in relationships. Treatments can help.
Stimulant medicines help people with ADHD pay attention and control their behavior. Doctors start with a low dose and then gradually increase it.
Talk therapy, called psychotherapy or counseling, can also help with ADHD. It can improve your ability to manage problems caused by your symptoms, and it can teach you and your family members better communication skills.
Signs and Symptoms of ADHD
ADHD is often diagnosed in children, but people can develop the condition throughout their lives. Health care providers use the symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (DSM-5) to identify if someone has this disorder. Providers can determine if someone has the inattentive, hyperactive/impulsive or combined type of ADHD.
Inattentive symptoms can include trouble paying attention, forgetting things and being easily distracted by thoughts or surroundings. People with this type of ADHD may also have trouble staying organized and making decisions. They may also make careless mistakes or be late for appointments.
People with the hyperactive/impulsive type of ADHD have difficulty sitting or staying still for long periods, even when expected to. They have a hard time doing quiet activities, such as reading or playing games. They may fidget a lot, such as tapping their feet or chewing on their nails. They have a hard time waiting for their turn in conversation or a game. They are easily distracted and often interrupt others or blurt out answers before the person who asked them has finished speaking.
Symptoms of hyperactivity in adults can be more subtle and harder to catch than they are in kids. They can be masked by anxiety or stress or by the effects of certain medications, such as antidepressants and some blood pressure drugs.
Types of ADHD
In previous editions of the Diagnostic and Statistical Manual of Mental Disorders, ADHD was separated into two different types. However, in the most recent edition, providers now diagnose ADHD based on symptoms and their type of presentation.
People who exhibit mostly inattentive symptoms are classified as predominantly inattentive type (ADHD-I). They may have difficulty staying focused and paying attention to tasks or conversations. They also have trouble organizing and planning activities, getting work done on time or forgetting about important events. These symptoms can cause problems at home, school or work.
Those who have more hyperactive-impulsive symptoms are diagnosed as predominantly hyperactive/impulsive (ADHD-H). They often fidget, can’t sit still and have excess energy. They also have trouble playing or engaging in leisure activities quietly. They frequently blurt out answers before questions are finished and have trouble waiting for their turn in conversations or games. These behaviors can lead to serious problems if they persist into adolescence and adulthood, including academic failure or delays, driving problems, difficulties with peers and social situations, risky sexual behavior and substance abuse. In addition to medication, therapists can help address these symptoms by teaching planning, organization and time management skills, and cognitive behavioral therapy that examines how thoughts and feelings affect behavior.
Causes of ADHD
There are many things that can cause ADHD, including genetics, problems with the central nervous system at critical moments in development and problems during pregnancy. However, too much screen time and too many sweets don’t cause ADHD. It is important to talk to your doctor if you think your child might have this condition. They will do a health check, including eye and hearing tests, to make sure another illness isn’t causing the symptoms.
They may also ask you about your child’s family history of the disorder and their behavior at home and at school. They will probably want to see your child’s schoolwork and homework to help decide if they have ADHD.
To be diagnosed, your child must show at least six symptoms of inattention or hyperactivity/impulsivity. Their symptoms must also be present for at least six months. They must also occur in two or more settings (home, school and social situations) and be a significant problem in their life. Children with hyperactive/impulsive symptoms often fidget, can’t sit still and have a lot of excess energy. They frequently interrupt others and have trouble waiting their turn or considering their actions before acting. This is the most common type of ADHD.
How is ADHD Diagnosed?
If your child has trouble sitting still or seems to be easily distracted, it’s worth making an appointment with a doctor. They will ask about your child’s history, do a physical exam and review the results of any screen tests. They will use checklists or rating scales to help determine if symptoms of ADHD are present. They will also speak to your child’s teacher and any caregivers who know them well to get a more complete picture.
They will also do a mental health assessment and rule out any other causes of these behaviors. They will look at how your child’s behavior interferes with their schoolwork, social activities and relationships with family members and friends. In addition, they will follow the guidelines set forth by the American Psychiatric Association in their Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) to diagnose ADHD.
To receive a diagnosis of ADHD, children under age 16 must demonstrate six or more inattentive symptoms to a degree that significantly interferes with their daily life and that is not better explained by another condition. In addition, they must have had these symptoms for at least six months.
Treatsments for ADHD
If ADHD symptoms interfere with daily functioning, a health care professional should evaluate them and recommend treatment. Symptoms should be present for at least six months and cause trouble in several areas of life to warrant diagnosis. A health care provider should rule out other conditions that have similar symptoms, including developmental disorders, seizure disorders, hearing and vision problems, thyroid disorders, lead poisoning and certain medications.
Medication may help improve focus and reduce impulsivity and inattention. Stimulants are most commonly prescribed, and they work by boosting and balancing levels of brain chemicals called neurotransmitters. Nonstimulant medications such as atomoxetine and antidepressants are also available, but they take longer to begin working. These medications can be used alone or with stimulants to increase effectiveness.
Psychosocial treatments, such as counseling and family therapy, can also be helpful for children or adults with ADHD. Counseling sessions can teach people with ADHD behavior-changing strategies and coping skills, as well as how to better monitor their own symptoms. Family therapy can help a person’s parents learn how to respond constructively to negative behaviors and support their child or loved one in ways that encourage positive behavior. Psychotherapy can also be useful for improving communication and relationships in families.
ADHD in Adults
If untreated, the symptoms of ADHD can lead to trouble at home, work, school and in relationships. They can cause a lot of stress, such as problems meeting deadlines at work or paying bills on time. They can also cause emotional distress, such as being labeled lazy or irresponsible by others. People with ADHD often struggle to find jobs and have poor financial management skills, which can result in debt. They may forget to take medication, skip doctor appointments or neglect medical advice. They may even have trouble with alcohol or drug misuse.
Adults with ADHD may have difficulty getting the help they need because of stigma and a lack of knowledge about the condition. Many people do not realize they have ADHD and do not seek treatment, and some families are reluctant to talk about it for fear of discrimination.
A thorough evaluation of a person with ADHD includes talking with the individual and asking family members, close friends and coworkers about their behavior and performance at work or school. A health care provider or mental health professional can also use a variety of diagnostic tools, such as behavior rating scales and checklists to measure attention, impulsivity and excitability. Psychotherapy is also an important part of treatment. Cognitive-behavioral therapy can help people identify irrational thoughts that contribute to negative behaviors and develop strategies for self-management.
ADHD Medication
There are many medicines that can help with ADHD. Doctors work with people to find the right medication, dose (amount) and schedule (when to take it). It may take some time to find a medicine that works well.
Most stimulant medications for ADHD work by improving the levels of dopamine and norepinephrine in the brain. They can help improve attention and focus, and reduce impulsive behaviour. They are normally taken as tablets, with immediate-release (short-acting) formulas taking effect within about four hours and extended-release formulations working for up to 12 hours.
Children usually start on methylphenidate (e.g. Ritalin) and then have lisdexamfetamine (Vyvanse) offered to them if it does not help. It is available in capsule form, taken once a day, and is thought to help improve concentration.
Non-stimulant medications, such as atomoxetine (Strattera) and clonidine (Kapvay), can also help with ADHD. They take longer to work, but can improve concentration and control impulsive behaviour. People should tell their GP and specialist about all the medicines they are taking, including over-the-counter ones, vitamins and supplements. This is because some can affect how the medication works or increase the risk of side effects. Talking therapies, such as cognitive behavioural therapy (CBT), can help with some people with ADHD.
