Understanding ADHD

Attention-Deficit /Hyperactivity Disorder, or ADHD, is a common condition that affects millions of children, teens, and adults in the United States.¹ People with ADHD find it difficult to concentrate, pay attention, organize, plan, and focus.² Everyone experiences these symptoms from time to time, however, people with ADHD experience a pattern of inattention and/or hyperactivity/impulsivity that begins during childhood and may persist into the teenage years and adulthood. Individuals with ADHD experience these symptoms frequently in multiple settings, causing a significant impact on their functioning and daily life. Symptoms of ADHD can persist into teenage years and into adulthood.³ Those who experience ADHD often feel excessive energy, impulsivity, and emotional ups and downs.

Jordan’s experience

ADHD is like this constant rollercoaster I'm stuck on. In class, it's a battle to keep my notes straight – they end up this messy jumble that even I can't decipher. And at home, I try to finish chores, but then I blink, and hours have vanished into the digital abyss. It's like my focus has a mind of its own, and right now, it's not on my side.

Lucia’s experience

Navigating the workplace with ADHD is a daily struggle. I find myself constantly falling behind on projects because I miss important details, despite my best efforts. And when it comes to managing my time effectively, it's like I'm constantly playing catch-up, which unfortunately takes a toll on my relationships with colleagues. It's frustrating because I know I have the skills, but sometimes my ADHD feels like an uphill battle I can't seem to conquer.

Understanding ADHD is crucial because it deeply influences daily life, from academic performance and career progression to personal relationships and emotional well-being.³ The Centers for Disease Control and Prevention estimates that about 7 million children have been diagnosed with ADHD in the U.S. alone.^{4, 5} Recognizing its symptoms, seeking a diagnosis from a qualified professional, and identifying treatment options can significantly improve one's quality of life and mental health.

This article provides an in-depth understanding of ADHD, covering its symptoms, subtypes, and treatment options. Whether you or someone you love is affected by ADHD, this guide will offer valuable insights and practical strategies to transform ADHD challenges into strengths, improving overall well-being.

ADHD Symptoms

ADHD symptoms develop early in a person’s life and are often misdiagnosed as mood, anxiety, or behavioral disorders. It is common for people to experience untreated ADHD symptoms for years, only realizing in adulthood that the age-of-onset of their disorder began in grade school. Understanding the basic symptoms of ADHD is critical to ensure proper diagnosis and treatment as early as possible.

The Diagnostic and Statistical Manual of Mental Disorders, which is the clinical guide that healthcare professionals use to diagnose ADHD, describes three core categories of symptoms:

Hyperactivity

• frequently moves or taps their hands or feet, or shifts restlessly in their seat
• gets up from their seat when they are expected to remain seated
• children may run or climb when they’re not supposed to and adults/adolescents may feel restless
• has trouble participating in recreational activities quietly
• always busy or in a constant state of motion
• excessive talking

Impulsivity

• answers questions before the person finishes asking it, has trouble taking turns when talking with others
• has trouble with taking turns or waiting
• often invades others’ space or activities, like grabbing another child’s toy, or taking control

Inattention

• has difficulty paying attention to details or makes seemingly simple mistakes in schoolwork, work, or other activities
• has trouble paying attention in task or play activities
• doesn’t appear to listen when someone is speaking to them, for example appears preoccupied or distracted and has difficulty completing instructions or following through on tasks, homework, or work responsibilities. trouble organizing work and activities.
• may be disorganized, struggle with time management, miss due dates, or completing multi-step tasks.
• tends to steer clear of or doesn’t like to do things that involve a lot of focused concentration loses things that are important for jobs or school like their ID, keys, documents
• prone to being easily diverted by outside influences is often forgetful when it comes to everyday tasks.⁶

Studies have shown that ADHD has a strong genetic influence and tends to run in families.⁷

Types of ADHD

There are three subtypes of ADHD, based on the type of symptoms exhibited. While some people might have inattentive type and others have hyperactive-impulsive type ADHD, still others might have symptoms of both, which is called combined type. The sub-types of inattentive, hyperactive-impulsive, or combined are used to more precisely describe the symptoms an individual is showing.^{6, 8}

• Predominantly Inattentive presentation: A person shows six or more inattentive symptoms.
• Predominantly Hyperactive-Impulsive presentation: A person displays six or more hyperactive or impulsive symptoms.
• Combined presentation: A person shows both six or more inattentive symptoms and six or more hyperactive/impulsive symptoms.⁶

ADD vs. ADHD

ADD is an outdated term. Currently, the acronym ADHD, which stands for attention deficit/hyperactivity disorder, is used even if an individual does not display signs of hyperactivity. Generally, what used to be called ADD is now referred to as ADHD with a predominantly inattentive presentation.

How to get diagnosed with ADHD

To be diagnosed with ADHD, an individual must show symptoms of inattention and or hyperactivity in multiple settings for at least 6 months or longer. The symptoms must have started before the age of 12 years, although the diagnosis can be made in adolescents and adults if there is evidence to suggest the symptoms began in childhood.⁶

In order to be diagnosed with ADHD, you should consult with a professional who has experience in diagnosing ADHD. This might be a mental health professional like a psychiatrist, or psychologist, or a healthcare provider such as a neurologist, pediatrician, internist, or family physician. Many medical and behavioral health professionals may have experience with ADHD and diagnosing ADHD, but it’s wise to talk with them to understand their experience and find a provider who will be a good fit for your needs.

ADHD in Children

People with ADHD are often impulsive, which can get them in trouble -- this is especially true for school-aged children. It is common for children with any type of ADHD to experience consistent correction and negative feedback due to the mistaken belief by caregivers, teachers or others that the child is choosing to misbehave. ADHD in children is not due to bad parenting, and there is no evidence that it is related to gluten, sugar, or immunizations, other kids, or the weather. There should be no fault or blame for ADHD.⁸

² Here are some of the ways ADHD can affect children.

• Academic performance: When a child struggles to focus attention, he or she might have difficulty with class performance and homework, including reading, writing, engaging in long discussions, or turning in work on time. This can result in grades that are not reflective of the child’s knowledge, interest level, or overall academic ability.
• Behavior: Attention impacts how we behave and what we do. Young people with ADHD may have difficulty waiting their turns or sitting still. In a classroom, this can result in behavior like blurting out answers before being called on, or struggling to stay in their seats. Untreated ADHD is often a reason that problem behavior can become a pattern.
• Emotions: If children want to do well, but struggle with grades and frequently find themselves in trouble, they can start to feel bad about themselves. It’s frequent to hear a child say things like “I don’t know why I can’t do this,” or “I didn’t mean to skip my turn,” when ADHD starts to become a problem. These statements can easily become “I’m no good at this,” or “Something is wrong with me.” When youth think and feel this way, they become vulnerable to developing symptoms of depression or anxiety.

Signs of ADHD in Children

When evaluating symptoms of ADHD in children, it is important to consider typical behavior for children of their age. Some symptoms of ADHD are normal during certain periods of child development, but become more problematic when they are more extreme or when children don't "grow out" of these behaviors over time.

Children with ADHD are likely to exhibit the following behaviors²:

• Inability to follow through with basic daily routines like getting dressed and safety rules like holding hands to cross the street
• Difficulty taking turns with siblings
• Playing too rough
• Calling out answers without raising hand in class
• Very active and always on the move, especially younger children
• Easily distractible, requiring a lot of redirection
• Easily bored, seeking a lot of stimulation

Signs of ADHD in Adolescents

While ADHD is most commonly diagnosed in younger children, almost all people with ADHD continue to experience some symptoms into their teen years.⁸ As children enter adolescence, the way ADHD presents can change. Adolescents with ADHD commonly struggle with organization, time management, and planning, inattention, and impulsivity, which might look like².

• A messy bedroom
• Failure to complete chores
• Easily susceptible to phone/screen and social media distractions
• Forgetting to follow parent rules like “text me when you get there safe”
• Difficulty with task and time management of school assignments
• Rebelliousness or difficulty following rules and expectations

From early childhood through adolescence, family and caregiver support is a critical part of treatment. Parents, other family members, and caregivers can help a young person understand that they are not to blame for having ADHD. Caregivers at home and at school can make minor changes to the child's environment to support their functioning, such as creating routines and schedules, using visual cues and reminders, and establishing clear and consistent expectations for behavior and consequences.⁸

ADHD is not an easy condition for young people and parents and caregivers may worry that the diagnosis will label their children as problematic.⁹ While people may have concerns about receiving any mental health diagnosis (such as ADHD), having an accurate diagnosis can support appropriate interventions as well as better self-awareness. Additionally, by understanding symptoms of ADHD and effective treatments, a family can offer ongoing support, practical solutions, and effective help.⁸

ADHD and Mental Health

It’s common for people to experience symptoms of depression or anxiety after dealing with the impact of ADHD symptoms for so many years and the impact on their quality of life. Some individuals who have been diagnosed with ADHD may also experience other mental health, developmental and behavioral disorders, including oppositional defiant disorder, learning disabilities, trouble with verbal expression and listening comprehension. As a result, it’s important to find diagnosing and treating healthcare clinicians who understand ADHD well so that the best treatment can be identified.

Tips for Living with ADHD

Living a full and happy life with ADHD is possible. Many individuals even experience benefits related to their ADHD symptoms, such as creativity, having a unique perspective, or approaching challenges with a great deal of energy and resilience. Learning about ADHD, identifying what’s important for you, and focusing on your unique strengths can help you feel your best. Consider these tips:

• Stay Connected: Make time to connect to the people and experiences that bring you joy, satisfaction, and meaning and make you feel connected to the world around you.
• Get Creative: Find a creative outlet that is both enjoyable and challenging and allows you to engage the creative part of your mind. Music, writing, art, gardening, the options are endless!
• Embrace Learning: Take time to learn about ADHD and how you uniquely experience the condition. The more you know about ADHD, the more you can own it and master it so it doesn’t master you.
• Be Active: Research shows that physical exercise is as good for your brain as it is for your body. Prioritize adding physical activity to your day. It can be as simple as walking the dog.8

Treatment for ADHD

There are several methods for effectively treating ADHD, including medications, coaching, appropriate accommodations, and psychotherapy. Each of these is focused directly on managing the condition, learning and practicing specific skills, and improving a person’s ability to focus on the task at hand.8

Medication

There are several effective ADHD medications that reduce the symptoms of ADHD and help people regain focus, attention and control. Stimulants are the most common medications used to treat ADHD, and are usually the first type of medication used by physicians because of their proven results. Stimulant medications work by activating dopamine levels in the area of the brain that helps us pay attention and focus. A common concern among parents and caregivers is that children/adolescents will become addicted or develop drug use disorders as a result of taking stimulant medications. While these medications may be avoided for individuals with preexisting addiction concerns, taking prescribed stimulants for ADHD does not cause drug abuse nor does it contribute to future risk for substance use disorders.

Stimulant medications work well, but some people experience side effects that cause difficulty, including decreased appetite and trouble sleeping. It’s important for individuals taking stimulant medications to communicate with their healthcare clinicians about any side effects so that the clinician can help identify the best way to address them. A psychiatric specialist may be helpful in the case of significant side effects, poor response to treatment, or presence of multiple or complex behavioral health and/or medical diagnoses.

ADHD can also be treated with non-stimulant medications, which work by activating norepinephrine levels. Non-stimulant ADHD medications include common prescriptions used to treat depression and anxiety, and are often used by people who don’t find stimulant medications effective for their symptoms or who have too many side effects with them. Non-stimulant medications work more slowly, but may be a better choice for children who cannot tolerate stimulants.8

Behavior Training for ADHD

For children and adolescents, behavior training teaches behavioral tools to parents, caregivers, and other adults who interact with children and adolescents. For individuals and families seeking professional help with ADHD, behavior training is a natural fit, especially when combined with medication. This helps the people who support youth struggling with ADHD to become the primary agents of change.8

Behavior training is based on behavior therapy which applies evidence-based principles of learning to address challenges in psychosocial functioning and reduce the distress associated with maladaptive behaviors. Consistent application of behavioral interventions by caregivers helps youth with ADHD to learn and practice the self-management skills they need to be successful at school, home and in relationships. When caregivers have behavioral tools and understand how to use them, the child has access to impactful learning touchpoints throughout their day-to-day, which is essential for effective and sustainable change into adulthood.

Summary

ADHD is a common neurodevelopmental condition that affects individuals’ ability to concentrate, organize, plan and focus. Most people begin experiencing symptoms of ADHD in childhood that last throughout the teenage years or even adulthood.

There are three types of ADHD diagnoses based on a person’s symptoms: inattention, hyperactivity-impulsiveness, and a combination of both. The good news is that there are effective methods for coping with ADHD symptoms, and certain types of medications combined with therapy are helping many people achieve effective symptom reduction and live happy and full lives.