What to know about ADHD
In some children, ADHD symptoms begin as early as 3 years of age, according to the National Institute of Mental Health.
However, many different life events, psychological disorders, and medical conditions can lead to certain characteristics of ADHD. Even if the individual receives a diagnosis, ADHD is manageable and treatment can be highly effective.
In this article, we explore the different treatments for ADHD, as well as its possible causes. We also look at the different specifiers and characteristics of ADHD.
What is ADHD?
ADHD can lead to difficulties sitting still or distractedness.
While the actual cause of ADHD remains elusive, a person with ADHD experiences a variety of impairments, including difficulty maintaining attention or focusing on a particular task.
Some people with ADHD might have difficulty sitting still, and others may display a combination of different symptoms.
While all people may struggle with paying attention to things they find disinteresting from time to time, those with ADHD may face consistent challenges with maintaining attention and could be quick to follow through on impulses or become easily distracted.
A person with ADHD experiences impulsivity and distraction beyond a level that would be typical for a person's age.
There are three different specifiers a doctor will add to an ADHD diagnosis to identify its characteristics, including predominantly inattentive ADHD, predominantly hyperactive/impulsive ADHD, and combined ADHD.
Characteristics and specifiers
Doctors divide the presentation of ADHD into three categories: inattentive, predominantly hyperactive/impulsive, and combined presentation. Each is described in more detail below.
These do not qualify as different diagnoses. They simply provide additional information on a particular presentation of ADHD to assist the practitioner in managing its effects.
Inattentive: A person with inattentive ADHD is more likely to demonstrate the following characteristics in a way that disrupt:
- an apparent inability to pay close attention to a task or a tendency to make careless mistakes
- difficulties with holding focus on activities or tasks
- giving the appearance of not listening while other people are talking
- experiencing difficulty with time management and task organization
- frequently losing items or accessories necessary for daily function
- becoming distracted easily
- forgetting to complete tasks and fulfill obligations
- an avoidance or intense dislike of tasks that require prolonged focus and thought
- difficulties with following instructions to complete tasks
Predominantly hyperactive-impulsive: This specifier means that an individual shows more signs of hyperactivity than inattention, including:
- seeming to be constantly "on-the-go"
- an inability to remain seated
- bouts of inappropriate running or climbing
- difficulties waiting for their turn in a conversation, often finishing other people's sentences or answering before the end of a question
- frequently intruding on others, including conversations, activities, or games
- persistent fidgeting, tapping of the hands and feet, or squirming
- excessive talking
- finding it difficult to play or engage in activities without creating excessive noise
- reluctance to wait for their turn, such as in a line or a turn-based game
Combined: A person with a combined ADHD shows characteristics from both specifiers.
These characteristics interfere with daily life, relationships with others, and success in school or work.
Even if a doctor adds a specifier to a presentation of ADHD, this can change over time. Women are more likely to experience difficulty with inattentive characteristics, according to the National Institute of Mental Health.
This could be why females do not often receive a diagnosis. Educators would not describe their symptoms in class as disruptive, as hyperactive characteristics often do not have as much of a presence in female presentations of ADHD.
However, more men receive diagnoses of ADHD overall.
According to the National Institute of Mental Health, most children with ADHD receive a diagnosis during elementary school. However, some people may not receive a diagnosis until adolescence or even adulthood.
No specific diagnostic test can identify ADHD. A doctor will conduct examinations to rule out other potential causes, such as hearing or vision problems.
A child must meet six criteria of ADHD to receive a diagnosis.
A doctor will often ask questions to establish a behavioral history and obtain the best and most likely diagnosis. These questions are usually for both the person with suspected ADHD and their family or caregivers.
Many children exhibit the high energy and inattention common to people with ADHD.
However, to qualify for a diagnosis of ADHD, a child needs to demonstrate six of the criteria to an extent greater than medical professionals deem normal for their age over a period of six months, and at a level of severity that directly impacts social and academic function.
People over 17 years of age must demonstrate five criteria to qualify for a diagnosis of ADHD.
Treatments and therapies
Doctors may recommend treating ADHD with a combination of therapies. The treatments often depend upon an individual's symptoms and the degree to which ADHD is impacting on school and home life.
Behavioral therapy: This involves working with a therapist, who can help children establish social skills, learn planning techniques that help those with ADHD, and enhance the ability to plan and complete tasks.
Medications: Doctors may prescribe medications to enhance attention and focus. While a range of medications is available, the most common types are stimulants.
Non-stimulant medications for treating ADHD include Strattera and clonidine (Catapres). A doctor will usually prescribe the lowest dosage and increase if needed.
Parent coaching: Therapists can also work with parents to help them respond to the often-difficult behaviors that can accompany ADHD. Additional education can be beneficial for giving medicines.
School support: Teachers and counselors play a major role in creating education plans and employing different teaching styles to engage more actively with children who have ADHD.
Schools and teachers need to engage with and support children with ADHD.
ADHD does not resolve over time or with age, and people do not "grow out" of these behaviors. Some people may notice that some symptoms improve as they get older, but aging does not in and of itself mean that the person will be "cured."
People with an ADHD diagnosis require dedicated care and help to process and manage these characteristics.
Children with ADHD can often improve their self-control and concentration abilities in ways that support them throughout adult life, according to the Nemours Foundation.
If an individual with ADHD does not receive treatment, they can experience negative outcomes related to their condition, including but not limited to low self-esteem, depression, problems in school, and family conflicts.
Causes and risk factors
Doctors do not know the exact causes of ADHD.
However, they have identified ADHD's tendency to run in families. If a sibling or parent has ADHD, a person is more likely to have it themselves.
Research continues to delve into factors that potentially increase the risk of ADHD, such as:
- exposure to stress, alcohol, or tobacco during pregnancy
- exposure to environmental toxins during pregnancy or from a young age
- a small but significant link with low birth weight, as this 2018 study puts forward
- premature birth, according to a 2018 study published in JAMA Pediatrics
- mild traumatic brain injury
Common misconceptions distort the understanding of ADHD as a disorder, as well as stigmatizing people with ADHD and those who care for them. Contrary to popular belief, the following factors do not lead to ADHD:
- eating excessive amounts of sugar or artificial colorings
- excessive "screen-time" in front of the television, computer, or phone
- poor parenting or home environment
Research has not proven a link between these and the development of ADHD in young people.
ADHD can impair important areas of social and academic or occupational function and can result in difficulties with school performance and personal relationships.
However, a variety of treatments are available to minimize the symptoms of ADHD.
If a person thinks they or a family member may have ADHD, they should talk to their doctor about evaluation.
ADHD is associated with a series of symptoms which can include an inability to focus on tasks for an extended period or sit still, and in some people, a need to constantly be "on the go".
There are nine characteristics for each specifier of ADHD. While these characteristics are common in many young children, they are more severe than the behaviors demonstrated by others in the same age group.
Research is ongoing as to what causes these characteristics, but recent research has illustrated the links between ADHD and premature birth, stress, and smoking during pregnancy, and low birth weight. ADHD also has a strong genetic component.
For an ADHD diagnosis, a child under 17 years of age must display six of these characteristics to a disruptive extent. Adolescents and adults over the age of 17 years will demonstrate five characteristics if they have ADHD.
Treatments include medications, behavioral therapy, and providing teachers and caregivers with the support and tools to communicate with children who have ADHD and help them flourish.
I’m an adult with suspected ADHD, and I’m a little concerned about the effect it will have on my professional life, including job applications. How do I set about receiving an ADHD diagnosis as an adult without it disrupting my routine?
Your first move should be to make an appointment with your primary care provider. He or she will need to conduct a thorough examination to rule out a physical cause of the behaviors.
They may do blood tests to assure that overall health is not impacting on behavior. If the doctor cannot identify a physical basis for your symptoms, they will most likely refer you to a psychiatrist or psychologist for additional testing and a definitive diagnosis.Timothy J. Legg, PhD, CRNP Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.