The Who, What and Why of Attention Deficit Hyperactivity Disorder (ADHD)

Nowadays, it seems everyone has ADHD. In fact, this has been termed the “ADD generation”. What’s the difference between someone who actually has ADHD and someone who is accustomed to multitasking and constant entertainment?

What is ADHD?

Attention Deficit/Hyperactivity Disorder, commonly known as ADHD, is a neurodevelopmental disorder in which a person’s ability to attend to and control impulses are significantly impaired. While everyone can get restless and have trouble paying attention, ADHD causes significant impairment, whether at school, the work place, at home, or in social settings. Even though it is sometimes thought of as a “modern” disorder, the first clinical description dates back to the early 1900s. In the past, ADD and ADHD were classified as two distinct disorders. Currently, they are recognized as having similar etiologies and treatments and so are lumped together.

 

There are Three Different Types of ADHD:

1) Inattentive Type 

  • Displays a pattern of inattentive behaviors
  • Doesn’t pay close attention to details
  • Has difficulty sustaining attention in tasks or play activities (such as lengthy reading or conversations)
  • Doesn’t listen when spoken to because the mind is elsewhere, even in the absence of any obvious distraction
  • Fails to finish important schoolwork or duties at work due to getting easily sidetracked
  • Has difficulty staying organized
  • Often loses things necessary for tasks (pencils, wallets, keys, cell phones)
  • Frequently forgets daily activities (keeping appointments, doing chores, etc.)

 

2) Hyperactive and Impulsive Type

  • Displays a pattern of hyperactive-impulsive behaviors
  • Fidgets, taps the hands or feet, and squirms in a seat
  • Gets out of seat when remaining seated is expected (such as in a classroom, meeting, or restaurant)
  • Runs or climbs in inappropriate situations (for adults, this may mean feeling restless)
  • Isn’t able to play in leisure activities quietly
  • Often talks excessively
  • Has difficulty waiting their turn
  • Interrupts or intrudes upon others’ conversations

 

3) Combined type 

  • Displays a pattern of both inattentive and hyperactive-impulsive behaviors

 

How common is ADHD?

According to the CDC, 11% of children between the ages 4-17 have been diagnosed with ADHD. Typically, during the teen years, signs of hyperactivity (running and climbing) are less common, but inattentive behaviors often persist. About half of children diagnosed with ADHD outgrow it by adulthood. People with ADHD have higher rates of antisocial behavior, academic underachievement, substance abuse, and poor employment evaluations.

 

 

How Do I Know if I or my Child has ADHD?

Typically, those with ADHD have at least some symptoms before they turn 12. There is a wide range of severity and number of symptoms, and many other disorders such as depression can mimic the symptoms of ADHD. If your child has difficulty at school but not at home or visa versa, they are unlikely to have ADHD but may benefit from behavioral or environmental interventions.

 

Screening for ADHD consists of questionnaires filled out by parents, teachers and often the symptomatic individual. These questions assess whether the person meets criteria in multiple domains. To fully establish the diagnosis, a series of tests lasting several hours, and examining multiple areas of functioning is typically performed.  However, a diagnosis of ADHD can be made without performing such tests.

 

 

Why Do People Get ADHD?

Like many other psychiatric disorders, there are strong genetic, biological and environmental risk factors. 60% of people with ADHD have a parent with the disorder as well. Those with ADHD have been found to have impaired brain circuits and reduced volumes of multiple brain regions. Smoking during pregnancy, delivery complications, history of head injury, and poverty are all associated with the diagnosis, but none individually cause it. There is no known direct relationship between parenting styles and ADHD.

 

 

How is it treated?

Patients under the age of 6 or those with mild symptoms are treated with behavior therapy. The treatment of choice when symptoms significantly impair day to day functioning is a combination of medication and behavior therapy.

 

The most commonly used medications are stimulants such as Ritalin, Adderall and Concerta. About 70 to 80 percent of people treated with stimulants experience significant improvement. When hyperactive symptoms are predominant, alpha2 agonists such as Intuniv have shown benefit. Children with ADHD treated with medication, do better in school, get better jobs, have lower rates of substance use and have better marriages compared to those who are not treated with medications.

 

Have you experienced ADHD in yourself or children? What do you wish you knew from the outset? What advice do you have for others? Please share your comments, questions, and advice below.

 

Sources:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC

Dulcan, M. (2016). Dulcan’s Textbook of Child and Adolescent Psychiatry (2nd ed.). Arlington, VA: American Psychiatric Association Publishing

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder. (2008). Focus, 6(3), 401-426.

Hannah Goldberg

Hannah Goldberg

Child Mental Health Advisor at Refuat Hanefesh
Hannah Goldberg grew up in Denver, Colorado. She completed her Bachelor’s in Nursing at University of Wisconsin-Madison. She received a Master’s of Science in Advanced Practice Nursing from the University of Illinois-Chicago, where she trained as a Pediatric Nurse Practitioner. Subsequently, Hannah received her second master's degree from the University of St. Francis, where she trained as a Psychiatric Mental Health Nurse Practitioner. Currently, she works at Children's Hospital of Los Angeles in outpatient psychiatry, where she treats children and adolescents with a broad range of mental illness. In her practice, she frequently sees mental health stigma as a barrier to the care that so many desperately need, and she is excited about this opportunity to alleviate stigma and cultivate awareness within the Jewish community!
Hannah Goldberg

Share your thoughts