ADHD 101

What is ADHD?

ADHD is a brain-based disorder that begins in childhood and continues through adolescence and often into adulthood. Approximately 5-7% of children in the United States have ADHD, and similar rates have been found in other countries throughout the world. ADHD makes it hard for to stay focused, keep things organized, stay seated when you need to, complete work accurately, and talk without saying too much or interrupting others. The inattentive, impulsive, and hyperactive symptoms of ADHD often interfere with school work, friendships, and family relationships.

What Causes ADHD?

ADHD is a neurodevelopmental disorder that is caused by a combination of genetic and environmental factors. Scientists are still working to uncover more details about how ADHD develops, but we do know that the genetic factors are very strong. In fact, ADHD is as heritable as height! But just as genes combined with other factors, like nutrition, determine your height, it’s a combination of genes and environmental factors that influence the development of ADHD. We don’t know all of the environmental factors yet, but we do know that cigarette smoking or drinking alcohol during pregnancy, premature birth or low birth weight, and exposure lead or other toxins, and extreme neglect or abuse all increase the likelihood that a person will develop ADHD.

What Are the Symptoms of ADHD?

ADHD symptoms are related to inattention, hyperactivity, and impulsivity. These symptoms may be something that you observe in all children and adolescents to varying degrees. For those with ADHD, these symptoms occur more often, are more severe, and interfere at school, at home, and with friendships. Not everyone with ADHD has all of the symptoms. In fact, having all of the symptoms is quite rare. Instead, a child or adolescent must have at least 6 symptoms of inattention or hyperactivity/impulsivity to the degree that they cause impairment. And these symptoms must be present by the age of 12.

Inattention Symptoms:

  • Makes careless mistakes or doesn’t pay attention to details
  • Has difficulty sustaining attention
  • Does not seem to listen when they are spoken to directly
  • Has difficulty following instructions, or starts tasks but doesn’t finish them
  • Has difficulty staying organized
  • Avoids tasks that require “sustained mental effort” (i.e., homework)
  • Loses things
  • Is easily distracted
  • Forgetful

Hyperactive/Impulsive Symptoms:

  • Often fidgets or squirms
  • Leaves their seat, when staying seated is expected of them (i.e., during dinner, during class)
  • Often runs or climbs on things excessively
  • Often unable to play quietly
  • Often “on the go” almost as if driven by a motor
  • Often talks excessively
  • Often blurts out answers before questions have been completed
  • Often has difficulty waiting their turn
  • Often interrupts or intrudes on others

Are There Different Types of ADHD?

There are three different presentations of ADHD. The presentation that is assigned to an individual depends on whether their symptoms are primarily found in the inattentive cluster, the hyperactive/impulsive cluster, or are elevated in both clusters. The three presentations of ADHD are referred to as the Predominantly Inattentive Presentation, the Predominantly Hyperactive/Impulsive Presentation, and the Combined Presentation.

ADHD symptoms typically change over time. Hyperactive/impulsive symptoms decrease as children age. By adolescence these symptoms may appear primarily as restlessness, excessive talkativeness, and sometimes, impulsive decision making. Inattentive symptoms tend to become more pronounced as children age, causing greater impairment over time. Therefore, the presentation assigned to a child with ADHD may be different from the presentation that fits them best when they become an adolescent.

How is ADHD Different in Girls than in Boys?

ADHD is diagnosed more often in boys than in girls. But that doesn’t necessarily mean that girls are less likely to have ADHD. It’s just that their ADHD is more likely to be overlooked. Girls are typically less hyperactive than boys, and their symptoms tend to be more related to inattention. They have a hard time staying focused, are disorganized, struggle to follow through on things, and they complete work more slowly and make more mistakes than girls without ADHD. Boys often struggle with this too, but these symptoms can initially be overshadowed by their hyperactivity and impulsivity. Girls with ADHD also struggle socially, especially during the tween and teen years. It can be hard for them to pick up on subtle social cues, and understand the ever-changing social rules during these challenging years. Girls with ADHD are often less assertive than girls without ADHD, and as a result, they may be ignored by their peers. Of course, when it comes to ADHD, one size doesn’t fit all. So, there are also girls who fit the combined presentation, and are hyperactive and impulsive as well as inattentive. These girls struggle socially as well, but their impulsivity leads to different types of social challenges. They’re more likely to be overtly rejected by their peers rather than be simply overlooked. Girls with ADHD also appear to be more likely to develop anxiety, depression, and eating disorders than girls without ADHD or boys with ADHD.

How is ADHD Diagnosed?

Diagnosing ADHD requires a comprehensive evaluation by a psychologist, psychiatrist, or pediatrician. It’s important that the evaluation include rating scales collected from parents and teachers, as well as a comprehensive parent interview. The doctor will also rule out other causes of the symptoms, such as anxiety, depression, learning differences, or a medical condition. The ADHD symptoms of hyperactivity and impulsivity can appear as early as age 3. Symptoms of inattention tend to emerge later. So children who struggle solely with inattention may not display impairing symptoms until around 4th grade, or even middle school. In general, in order for an ADHD diagnosis to be considered, at least some symptoms of ADHD should be evident by the age of 12.

How Do You Treat ADHD?

Effective ADHD treatments are available, including medication and evidence-based psychotherapy: behavioral parent training, child social skills training, and organizational skills training, as well as classroom interventions.

Evidence-Based Psychotherapy Interventions
Many children with mild to moderate ADHD do quite well with psychotherapy alone. Children with moderate-to-severe ADHD may require a combination of medication and behavioral treatment. Research-proven interventions (also referred to as evidence-based treatments) all require some level of parent involvement in treatment. Behavioral parent training involves the therapist teaching parents strategies to help their child manage their ADHD at home. It may also include some family sessions or child-only sessions where the therapist teaches the child new skills that can be reinforced by parents at home. Child-focused social skills and organizational skills interventions can also be helpful, provided that parents are aware of what their child is learning in sessions, and can help their child practice and use the skills at home. Treatment that involves individual sessions with only the therapist and the child, without parent involvement, are typically ineffective for treating ADHD. This type of treatment is more likely to be effective for treating symptoms of anxiety or depression that may occur along with ADHD.

Medication
Medications for ADHD can be very effective for reducing the symptoms of ADHD. It’s important to note however, that while medications may help a child be more focused and less hyperactive or impulsive, they do not teach the child the social or organizational skills that they may be lacking. Child social skills and organizational skills training are often needed to supplement medication. Stimulant medications are the most commonly prescribed ADHD medications, and they are generally the most effective. These medications include Adderall®, Concerta®, Vyvanse®, Focalin®, and others. For individuals who don’t respond well to these medications, non-stimulant medications, like Strattera®, provide an alternative option. Pediatricians and psychiatrists can prescribe these medications. When your child first starts a new medication, they should meet frequently with the prescribing doctor to track side effects and identify the most effective dose.

Next Steps

If you believe your child may have ADHD, talking to your pediatrician can be a good place to start. Together you may decide that your child should meet with a licensed psychologist or psychiatrist to properly diagnose your child’s issues.

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References

APA. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Washington, D.C: American Psychiatric Publishing.

Barkley, R. A. (2014). Attention-Deficit Hyperactivity Disorder, Fourth Edition: A Handbook for Diagnosis and Treatment (Fourth Edition edition). New York: The Guilford Press.

Hinshaw, S. P., & Ellison, K. (2015). ADHD: What Everyone Needs to Know® (1 edition). Oxford ; New York: Oxford University Press.

Hinshaw, S. P., Owens, E. B., Zalecki, C., Huggins, S. P., Montenegro-Nevado, A. J., & Schrodek, E. N. (2012). Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: Continuing impairment includes elevated risk for suicide attempts and self-injury, 6(80), 1041.

National Institute of Mental Health. Attention Deficit Hyperactivity Disorder. Retrieved from: http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml.