Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is a mental disorder that affects someone’s ability to regulate attention, emotion, and/or impulsive behaviors. Unlike some other mental disorders, ADHD is considered to be neurodevelopmental, meaning it is related to how a person’s brain develops.

While people often have a preconceived notion of what ADHD looks like (often picturing a hyperactive little boy who can’t sit still in class), it is a deeply complex and frequently misunderstood or mischaracterized disorder. For starters, the phrase “attention-deficit” can be misleading, as those with ADHD don’t actually lack attention﹣they lack the ability to regulate it.

Understanding the true nature of this disorder can help ensure people receive the proper diagnosis so they can get the treatment and care they need to live amazing lives.

ADHD Types

Despite the stereotypes associated with the disorder, ADHD is incredibly complicated and varies greatly from person to person. While two people may have the same diagnosis, they may experience distinct symptoms at differing severities. One may have a much harder time sitting still and controlling their impulses, while the other might struggle more with focusing or recalling information.

In the past, those in the latter category who only showed signs of inattention may have been diagnosed with attention-deficit disorder or “ADD”. While ADD was often mentioned alongside ADHD, they used to be considered separate. However, further research on attention-related disorders led the American Psychological Association (APA) to adapt the categorization of these issues.

Now, ADD is an out-of-date term and is no longer used in diagnosis. Instead, ADHD is the overarching term used to describe the disorder, which is categorized into three distinct types﹣inattentive, hyperactive/impulsive, and combination. These types describe the nature of the specific symptoms present in an individual.

ADHD Symptoms

Unlike many other mental health conditions, ADHD impacts an individual’s executive functioning, which are typical mental skills relating to working memory, flexible thinking, and self-control. ADHD symptoms revolve around an individual’s executive functioning and fall within 2 distinctive categories: inattention and hyperactivity/impulsivity.

ADHD symptoms related to inattention may include:

• Making careless mistakes and overlooking simple details
• Struggling to sustain focus in school, work, conversations, etc.
• Daydreaming or “zoning-out” regularly
• Forgetting to do basic daily tasks, like attending appointments, doing homework, cleaning, brushing teeth, etc.
• Losing important or frequently-used items or documents regularly
• Failing to complete projects or follow-through on set plans
• Getting distracted or off-task easily
• Avoiding mentally challenging, boring, or detailed tasks
• Lacking sufficient organization in their time, schedule, workspace, and more
• Difficulty listening even when spoken to directly

ADHD symptoms related to hyperactivity or impulsivity may include:

• Fidgeting and squirming constantly
• Feeling like they’re driven by a motor
• Struggling to remain seated or still, even when expected to, like in a meeting
• Talking excessively, even when told or required to be quiet
• Blurting out responses before thinking or interrupting someone who is talking
• Excessively spending money
• Driving recklessly, often speeding excessively
• Struggling to wait their turn and demonstrating impatience

While everyone experiences some of these symptoms at different points in their life, people with ADHD experience many of these symptoms consistently across all areas of life.

As an example, everyone likely experiences difficulty focusing in long, detailed business meetings. However, those without ADHD can push themselves to listen and remember what’s discussed, with a little bit of effort. People with the disorder, though, have different experiences on a neurological level in which their brains do not communicate the same way internally. They cannot push themselves into focusing and retaining information, which can have significant impacts on their home, work, and social lives.

Accurately recognizing and identifying attention-deficit/hyperactivity disorder takes a well-trained professional. While your primary care physician may be able to make recommendations or refer you to a mental health professional, they are often not trained or qualified to make a diagnosis.

The DSM-V (or DSM-5) is the current diagnostic manual of mental disorders used by qualified professionals. It is followed strictly when making an ADHD diagnosis since the disorder can look drastically different across people. However, the DSM is updated very infrequently, often only every decade or two. So while there is a lot of research indicating some other potentially major ADHD symptoms, like emotional dysregulation, their lack of acknowledgment in the DSM-V means that the experience of certain symptoms associated with the disorder may not necessarily “count” in a diagnostic setting.

To be diagnosed with ADHD, a person must have experienced several qualifying symptoms frequently and in multiple areas of life (work, relationships, school, etc.) over the last six months. They must also have shown many symptoms in childhood if they’re now an adult. Professionals may also gather information about family history with the disorder since there seems to be a strong genetic component in its development.

If you’ve experienced many ADHD symptoms that have significantly impacted your life, talk to your doctor about your concerns and options. They can help you understand the disorder and refer you to a specialist who can further help.

Statistics

• ADHD is the most common mental disorder in childhood. It is estimated that between 5-10% of children ages 2-17 have had a diagnosis of ADHD.

• Recent studies indicate that more than 60% of those who are diagnosed as children continue experiencing symptoms as adults.
• The estimated prevalence in adults is about 4-5%. There is great potential for this number to be higher, though, since the study of ADHD in adults is fairly new given the previous expectation for it to naturally dwindle and disappear over time.

• Rates of diagnosis are also increasing in the U.S.

Risk factors and causes

Many misconceptions surround the causes and risk factors associated with developing ADHD. While research has yet to find a clear cause of the disorder, the link between ADHD and commonly-blamed sources like sugar, TV, and video games is not supported by research. However, there are certain factors that evidence shows may affect a person’s likelihood of having the disorder, including:

• Genetics (Family History)
• Maternal substance use during pregnancy
• Exposure to toxins before birth or at a young age
• Low birth weight

Because ADHD is a neurological and developmental disorder that impacts how someone’s brain works and it begins displaying in childhood, there aren’t as many risk factors associated with its development. However, the presence of attention-deficit/hyperactivity disorder can be a risk factor for other problems, including:

• Mood disorders, like depression
• Anxiety
• Substance use disorders
• Learning disorders, like dyslexia
• General injury
• Autism
• Tourette’s Syndrome
• Sleep disorders
• Eating Disorders

Between 60 and 80% of people with attention-deficit/hyperactivity disorder have one or more co-occurring disorders or conditions. While there’s not a clear reason why this is, many find relief for both issues when they’re able to effectively treat and manage their ADHD.

ADHD Treatment

Despite previous thought that it was a disorder to be “outgrown” after childhood, recent research indicates that ADHD is often chronic. While there’s currently no cure for attention-deficit/hyperactivity disorder, there are many ways to manage symptoms. For example, doing higher-intensity exercise for at least 30 minutes 3-5 days a week can have a huge impact on hyperactivity symptoms, while building a structured routine in which chores, meals, work, sleep, and other activities are done at the same time every day can help someone navigate some of the inattentive symptoms.

Many helpful skills and strategies, like the ones mentioned above, are often taught and discussed in therapy. Therapy sessions with a trained ADHD specialist can help someone understand exactly how the disorder impacts their thoughts and behaviors, sort through the emotion often tied up in these issues, and come up with practical solutions for managing symptoms and addressing the disorder head-on.

Sometimes, therapy sessions alone can help people see significant improvements in their lives. However, in many cases, medication is necessary to help someone find relief, particularly in adults who may have a harder time incorporating new habits, might have more emotional damage as a result of their lifelong experience with symptoms, and work in sedentary, repetitive jobs that require a lot of focus. ADHD medication is typically divided into two categories: stimulants and non-stimulants.

Stimulants, including amphetamines and methylphenidates, work by targeting the central nervous system and slowing dopamine reabsorption in the brain to help improve communication within the brain itself. Stimulants, like Adderall, can be incredibly effective for people with ADHD, with most people reporting a significant reduction in symptoms. However, they can also come with a risk of side effects like increased anxiety, heart palpitations, and lack of appetite, as well as other potential symptom trade-offs, like increased energy that may cause distraction or hyperfocus that may exacerbate other symptoms. While these trade-offs can certainly be managed by working with your doctor to find the right stimulant and dosage, some people and their doctors may opt to explore non-stimulants if the potential side effects seem too risky based on a person’s unique history and experience.

Non-stimulants include a variety of options, like long-acting guanfacine, a medication typically prescribed for high blood pressure that has shown to also reduce ADHD symptoms in about half of people, bupropion, an antidepressant typically used to treat depression, and more. However, many non-stimulants are severely under-researched in the treatment of attention-deficit/hyperactivity disorder and aren’t FDA-approved for ADHD treatment in adults, which means it can be hard for doctors to prescribe the right dosage and most insurance companies won’t cover them.

As more research is done to understand the complexity of ADHD and how it works, treatment drastically improves. Talk to your doctor about what’s right for you and your concerns. Because ADHD symptoms and severity differ from person to person, treatment needs to be custom fit for your exact needs.

ADHD and Substance Use Disorder

Unfortunately, people with ADHD are at a much higher risk of developing a drug addiction or substance use disorder, particularly those with more hyperactive and impulsive symptoms. The National Comorbidity Survey Replication estimated that 15.2% of adults with ADHD also met the criteria for a SUD, compared to only 5.6% of those without the disorder. They also found that among those with a diagnosed SUD, 10.8% met the criteria for ADHD, compared to only 3.8% without SUDs.

Many may make an association with the risk of dependence that accompanies stimulants, which are often prescribed to treat ADHD. While it is true that stimulants, like Adderall and Ritalin, can be addictive, studies have shown that the risk of stimulant misuse and addiction is actually much lower for people with ADHD. This is likely because their brains work differently than people without the disorder and thus the effects of the medication are very different for them. Most stimulant misuse impacts those without a diagnosis of the disorder, though it also isn’t impossible for someone with ADHD to misuse stimulants.

However, people with ADHD are more likely to instead cope with other drugs or alcohol. This is particularly the case for those who haven’t received proper treatment or a clear diagnosis of the disorder. With effective treatment for their ADHD, people can learn skills to help them manage the disorder without depending on other substances. For those with a dual diagnosis of attention-deficit hyperactivity disorder and a substance use disorder, proper treatment means caring for both mental health issues at the same time. By doing so, those with coexisting disorders can learn to thrive and find long-term recovery.

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