ADHD

What is ADHD?

ADHD is a common neuro-developmental disorder in children, affecting millions globally. It can be a chronic condition that may persist into adulthood. ADHD is primarily characterized by difficulty in sustaining attention, hyperactivity, and impulsive behavior. The symptoms may surface as early as the age of 3 and can vary in severity.
Children with ADHD frequently face challenges such as low self-esteem, relationship issues, and academic underachievement that is why it is important to know the signs of ADHD and to seek help from professionals.

What is the difference between ADHD and ADD?

ADHD now encompasses what was once known as ADD, or Attention Deficit Disorder. The term ADHD officially replaced ADD in 1987 with the revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). The change reflected an increasing emphasis on hyperactivity in the disorder’s description.

Although ADD is no longer an official diagnosis, it’s still commonly used, often to describe the inattentive presentation of ADHD, which lacks hyperactivity symptoms. The term ADHD is recommended for clarity and is understood to manifest differently with three presentations: primarily inattentive, primarily hyperactive/impulsive, and combined.

What are the different types of ADHD?

ADHD includes three presentations: inattentive type (formerly ADD), hyperactive/impulsive type, and combined type. The inattentive type is characterized by trouble paying attention, disorganization, and forgetfulness, while the hyperactive/impulsive type shows symptoms such as fidgeting, restlessness, and impulsivity. The combined type presents symptoms from both inattention and hyperactivity/impulsivity. The type of ADHD a person has is determined by the specific symptoms they exhibit, and treatments are accordingly tailored.

More recently, integrative doctor and ADHD specialist, Dr. Daniel G. Amen, has proposed a categorization of ADHD into seven distinct types based on extensive research and the use of brain imaging techniques, particularly SPECT scans. Examples of his types include:

1. Classic ADD: The symptoms include short attention span, distractibility, organization problems, procrastination, forgetfulness, poor impulse control, and difficulties with follow-through.
2. Inattentive ADD: This type also has symptoms similar to classic ADD, but without hyperactivity or impulsivity.
3. Over-focused ADD: People with this type struggle to shift their attention from one task to another.
4. Temporal Lobe ADD: This type is named after the part of the brain that controls memory, understanding language, hearing, and organization.
5. Limbic ADD: Named after the limbic system, a set of brain structures that supports various functions including emotion, behavior, and long-term memory.

For each type, he suggests targeted treatments involving medications, supplements, diet modifications, exercise, and neurofeedback to address specific neurotransmitter deficiencies and brain activity patterns. 

What are the most common ADHD symptoms in children?

ADHD symptoms typically fall under two categories: inattentive and hyperactive-impulsive.

Inattentive symptoms include difficulty focusing, listening, following instructions, organizing tasks, and being easily distracted. They often appear as academic underachievement, with children having trouble completing schoolwork and often seeming to daydream or “tune out” their environments.

Hyperactive and impulsive symptoms involve restlessness, excessive talking, difficulty sitting still, impulsivity, and interrupting others. Children with these symptoms may seem fidgety, unable to stay seated or play quietly. They may act without thinking, blurt out answers, and have trouble waiting their turn.

Important for diagnosing ADHD, these behaviors must be inappropriate for the child’s developmental level, occur in multiple settings (like home, school, and social activities), and interfere with the quality of social, school, or work functioning.

It is also important to note that while it’s normal for children to occasionally display these behaviors, children with ADHD show them to a degree that is disruptive and not age-appropriate. Additionally, other health and behavioral conditions can present similar symptoms, so a comprehensive process involving healthcare providers, parents, teachers, and the child is necessary for diagnosis.

What are the signs of ADHD in girls?

ADHD in girls often presents differently from boys, making it less recognized and consequently diagnosed later. Rather than overtly disruptive behaviors, girls with ADHD may exhibit internalized symptoms such as distractibility, forgetfulness, daydreaming, excessive talking, emotional sensitivity, and disorganization. They tend to develop coping strategies that mask their symptoms. However, these methods may become less effective as life’s demands increase, and undiagnosed ADHD can lead to long-term complications. Thus, understanding how ADHD manifests in girls is critical for timely diagnosis and appropriate support.

What are the signs of ADHD in women?

ADHD in women often manifests differently from men and primarily as the inattentive type, characterized by lack of focus, disorganization, forgetfulness, and difficulty following instructions. They may also experience executive dysfunction impacting concentration, emotional regulation, and self-motivation.

When ADHD remains undiagnosed in women, it can lead to serious consequences. These include low self-esteem, anxiety, psychological distress, difficulty meeting deadlines, struggling with social rules, and feeling overwhelmed in social gatherings. Also, problems with concentration and organization can severely affect work performance and personal relationships. 

What are the symptoms of adult ADHD?

Adult ADHD is characterized by symptoms such as impulsiveness, disorganization, poor time management, trouble focusing, restlessness, mood swings, and difficulty coping with stress[1]. Other signs can include forgetfulness and a lack of motivation. There is also a greater risk of substance misuse, and men with ADHD have higher rates of suicide.

While ADHD symptoms typically start in childhood, some cases may not be recognized until adulthood, often presenting differently with decreased hyperactivity but continued struggles with attention and impulsiveness. This suggests there is not necessarily adult-onset ADHD, rather a late recognition or diagnosis of symptoms that have been present since childhood. Untreated ADHD can interfere with daily functioning and increase the risk of developing co-occurring conditions like anxiety and depression. 

What tests are used to diagnose ADHD?

Diagnosing ADHD involves a comprehensive process and does not rely on a single test. Various steps are taken to assess the symptoms and gather information from different sources. In short, the goal of the ADHD diagnostic process is to gain a thorough understanding of the individual’s symptoms and how they impact their daily life to provide the most appropriate treatment and support.

Here are some of the main steps and methods used in diagnosing ADHD:

1. Interviews: Healthcare providers conduct interviews with parents, teachers, and other adults who interact with the individual in question. For adults who can accurately self-report, this step may not be as important as with diagnosing children.

2. Physical exams: Physical exams are performed to help rule out other conditions that could be causing symptoms (see more below).

3. Review of DSM-5 Criteria: The Diagnostic and Statistical Manual, Fifth edition (DSM-5) provides the diagnostic criteria for ADHD. The criteria include symptoms of inattention and/or hyperactivity-impulsivity, which must persist for at least six months, interfere with functioning or development, and be present in multiple settings.

4. Use of Assessment Tools: Various assessments are used to test for ADHD. These may include the Behavior Assessment System for Children (BASC), Conners Rating Scale, Child Behavior Checklist (CBCL), Test of Variables of Attention (TOVA), and Adult ADHD Self-Report Scale (ASRS).

5. Brain Mapping: For example, the Neuropsychiatric EEG-Based Assessment Aid (NEBA) System is a tool that measures brain wave patterns, particularly in children, to aid in the diagnosis. Another commonly used brain mapping is the QEEG.

6. Evaluation of Symptom Severity: The severity of symptoms is also assessed, ranging from mild to severe.

What other conditions look like ADHD and should be ruled out?

In the process of diagnosing ADHD, it’s important to rule out other conditions that may present with similar symptoms. These include:

1. Sleep disorders: Sleep problems can often lead to symptoms similar to ADHD, such as inattentiveness, hyperactivity, and impulsivity. This can occur in cases of insufficient sleep, interrupted sleep, or disorders like sleep apnea.

2. Post Traumatic Stress Disorder, Anxiety and Depression: These mental health disorders can also present with symptoms similar to those of ADHD. For example, a child with anxiety may appear distracted or inattentive because they are preoccupied with their worries. Or an adult with untreated PTSD or depression might lack focus due to low energy and motivation.

3. Learning Disabilities: Children with learning disabilities may exhibit behaviors similar to ADHD. For instance, a child struggling to understand or keep up with their schoolwork due to dyslexia may appear inattentive or distracted in the classroom, as a way of coping with the difficulties with learning.

4. Other medical conditions and treatments: Some other medical conditions, including some neurological conditions, as well as certain treatments can mimic ADHD symptoms[3].

It’s important to note that diagnosing ADHD in very young children can be particularly challenging due to developmental factors and comparing a young child’s behavior and developmental abilities with children who are older in a classroom.

What are the best ADHD quizzes?

There are several online self-assessment tools or quizzes available that can help screen for ADHD symptoms. It’s crucial to understand, however, that these are intended only as a preliminary check and are not definitive diagnostic tools. A diagnosis can only be provided by a trained medical professional. Here are a few examples of these tools:

1. PsychCentral’s ADHD Test: This is a self-assessment tool intended for self-screening and tracking symptoms. Common symptoms that this tool might check for include restlessness, difficulty managing time, impulsivity, forgetfulness, and distractibility. 

2. Psycom’s ADHD Quiz: This quiz is designed for adults who suspect they may have ADHD symptoms. It asks questions related to common symptoms of adult ADHD, but it cannot replace a professional evaluation. 

3. Mental Health America’s ADHD Test: The Adult ADHD Self-Report Scale (ASRS) is a validated screening scale for adults and adolescents aged 13 and up. 

If these tools suggest the possibility of ADHD, it is crucial to follow up with a healthcare provider for a thorough evaluation.

What medications are prescribed for ADHD and what are the side effects?

The most commonly prescribed medications for ADHD fall under three main categories: stimulants, non-stimulants, and antidepressants. These medications work by affecting brain chemicals that play key roles in attention and behavior.

1. Stimulants: These are the most common type of ADHD medication. They increase the activity of the central nervous system and affect attention and thinking. Commonly prescribed stimulants include Adderall, Dexedrine, Vyvanse, Concerta, Ritalin, and Focalin. They work by increasing levels of neurotransmitters like dopamine and norepinephrine. The side effects of stimulants may include loss of appetite, anxiety, restlessness, high blood pressure, and a “crash” after the effects wear off, especially with immediate-release forms.

2. Non-stimulants: These medications are typically prescribed when stimulants are ineffective or cause severe side effects. Strattera and Clonidine are examples of non-stimulant ADHD medications. Non-stimulants have fewer side effects and lower abuse potential but may be less effective for some individuals. The side effects of non-stimulants may include dizziness, fatigue, dry mouth, and sleep difficulties.

3. Antidepressants: While not specifically designed for ADHD, antidepressants like Wellbutrin may be prescribed off-label for the disorder. They can be particularly useful when ADHD co-occurs with other conditions like depression or anxiety. The side effects of antidepressants can include drowsiness, insomnia, nausea, weight gain, headaches, and sexual dysfunction.

While these medications can significantly improve symptoms, they do not cure ADHD. Instead, they ease symptoms to allow for better functioning. The choice of medication, dosage, and regimen is individualized based on the person’s specific symptoms, overall health, the presence of co-occurring disorders, and their response to medication. All these medications should be used under the supervision of a healthcare provider to manage potential side effects and monitor effectiveness.

What are the side effects of ADHD medications for children?

ADHD medications can be effective in managing symptoms in children, but they can also cause side effects. The effects vary among individuals and can depend on the specific medication taken. The common side effects are: upset stomach, headaches, decreased appetite, sleep problems, and moodiness. Less common ones are: weight loss, increased blood pressure, tics (quick and uncontrollable movements), and mood swings.

Rare but serious side effects for some children on stimulant medications is worsening tics, but changing medications may help. Some children may experience significant mood changes, or irritability, indicating that the dosage may be too high. A slight increase in heart rate and blood pressure can occur with stimulant use, but serious heart problems are rare. However, stimulant drugs slightly elevate the risk of psychotic episodes, especially with amphetamines.

It is important for parents and caregivers to maintain open communication with their child’s doctor about any observed side effects. The doctor may need to adjust the dosage, change the medication, or consider other strategies to manage these effects.

For example, to manage eating issues caused by stimulant medications, strategies like eating before medication intake and providing healthy snacks. Nausea and headaches may diminish over time. If a child’s personality changes significantly or they become irritable, this could indicate the dosage is too high and needs adjustment. Serious heart problems are rare, but a physical exam and medical history can help ensure safety. In cases where there’s a risk of psychotic episodes, non-stimulant options may be considered.

What is CBT therapy for ADHD?

Cognitive Behavioral Therapy (CBT) for ADHD involves specific techniques aimed at transforming negative thought and behavior patterns into more positive and constructive ones. During CBT sessions, individuals with ADHD learn to reframe their thoughts, leading to more proactive behavior. Techniques such as successive approximation, exposure therapy, guided discovery, cognitive restructuring, and distractibility delay are employed.

For children with ADHD, CBT helps teach organization techniques, manage emotions and anxiety, and breaks down tasks into smaller, more manageable steps. For adults, while medication may enhance attention, CBT helps individuals direct their focus effectively and develop better executive functioning skills. For adults with ADHD, training in sleep hygiene can also be necessary as those individuals often have sleep issues. 

Common CBT techniques include setting goals, developing specific objectives, and using techniques like exposure therapy and guided discovery. Additionally, at-home CBT exercises are often recommended to aid in self-regulation. 

Are there evidence-based natural treatments for ADHD?

Various alternatives to medication can be effective in managing ADHD symptoms. Psychotherapy is a common approach, including cognitive-behavior therapy (CBT), which can help individuals develop coping strategies for ADHD symptoms and improve self-esteem. Neurofeedback, a type of biofeedback, is another technique that teaches individuals to alter brain activity through training, thereby improving concentration and reducing impulsivity.

Behavioral techniques, recommended especially for children under six years old, are often used as a first-line treatment. As children grow older, these techniques can be combined with medication or other therapies.

Exercise can be highly beneficial, helping to boost attention and improve executive functions like planning and prioritizing. Spending time outdoors can also be helpful, providing a break from voluntary attention and aiding focus.

Dietary changes and supplementation, like omega supplements, can be advantageous for those with low omega fatty acids levels. Some research suggests that these supplements can improve ADHD symptoms. Elimination diets, which involve identifying food sensitivities and removing specific foods, may also alleviate symptoms.

Mindfulness practices, such as meditation, promote being present in the moment, reducing negative feelings, and anxiety. This can help individuals with ADHD manage impulsivity and restlessness.

Because each individual’s symptoms and severity are unique, it is important to consult with a healthcare professional to understand that these approaches often work best as complements to traditional treatments.

Resources:

• Non-invasive ADHD treatment program
• Watch a parent testimonial: How neurofeedback helped my family with learning disabilities