What is attention deficit hyperactivity disorder (ADHD)?
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that causes problems with attention, organization, and impulsivity control. It usually begins in childhood and can interfere with functioning at school, work, home, and in social settings.
There are three types of ADHD:
- Predominantly inattentive (formerly called ADD)
- Predominantly hyperactive and impulsive
- Combined variation where you have both inattentive and hyperactivity-impulsivity
The inattentive type is more common in females, while the hyperactivity-impulsivity type is more common in males.
Females are more likely to not be diagnosed because the inattention symptoms are less disruptive and can be mistaken for gender stereotypes like shyness, daydreaming, or being overly sensitive. Sometimes boys are not diagnosed because their behavior may be dismissed as “boys being boys.”
Dr. Rx
Often people believe that they must not have ADHD because they are smart and successful and aren’t completely dropping the ball all the time on everything. But if it feels like you have always been climbing uphill and it seems like if you just got your act together that you would be fine, it might be worth an evaluation. —Dr. Lauren Parker
ADHD symptoms
Symptoms of ADHD vary depending on the type you have. They include:
Inattention
Inattention means that you have difficulty focusing, are easily distracted, are disorganized, and have difficulty starting tasks. You may seem forgetful and have a hard time managing your time and making decisions.
More specifically, you may have these challenges:
- Difficulty paying close attention to details. You may make careless mistakes in school (like on papers, tests, projects), work, and other activities.
- Difficulty keeping your attention and staying focused during activities like listening to lectures or reading.
- Often seeming to be distracted, as if your mind is somewhere else. You may not listen when someone talks to you or even be aware that someone is speaking to you.
- Difficulty completing tasks and following through on instructions, which can lead to unfinished schoolwork or work tasks.
- Difficulty with organization and managing multiple steps. You may have poor time management skills, miss deadlines, and be disorganized or messy.
- Avoiding tasks that require mental effort, such as schoolwork, completing forms, or preparing reports.
- Losing items like your wallet or cellphone, keys, and papers or important items needed for school or work.
- Easily distracted by your own thoughts or whatever is happening around you.
- Very forgetful and difficulty sticking to a to-do list. You may forget appointments, to pay your bills, or to do routine chores.
Hyperactivity-Impulsivity
Hyperactivity refers to excessive physical movement like fidgeting, talking a lot, or extreme restlessness. Impulsivity means that you make decisions quickly without thinking about what will happen next or considering the consequences.
Hyperactivity and impulsivity often lead to behavioral problems in children. In adults, they can cause difficulties in social interactions or cause reckless behaviors and poor decision-making.
You may have these specific challenges:
- Regularly fidgeting, squirming in your seat, and tapping surfaces with your hand, foot, or an object like a pen.
- Often leaving your seat when expected to remain seated, such as during a lecture or meeting.
- Running and climbing inappropriately (children) or feeling very restless (adults).
- Difficulty participating in activities quietly. You may whistle or make vocal noises.
- You become physically uncomfortable when you need to be still for long periods.
- Talking too much. Your speech may be rapid, and you’re likely to tell long-winded stories or provide a lot of unnecessary detail.
- Often blurting out answers and responses before a question or prompt is completed.
- Difficulty waiting for your turn, like when at a store waiting to check out.
- Tending to interrupt or intrude on others’ conversations.
Pro Tip
Many people are interested in more holistic approaches, meaning that they don’t just rely on medication but will use diet, exercise, executive functioning training, mental health treatment, mindfulness and meditation practices, neurofeedback training, and social support and accountability groups. —Dr. Parker
Other symptoms you may have
ADHD can also affect your mental health. It can cause mood swings, anxiety, irritability, boredom, and apathy. You may be overly sensitive in social situations and feel as though you’re being rejected or criticized. It may seem like you are overreacting to situations or you get stuck in an emotion instead of moving on.
Do I have ADHD? How to get an ADHD diagnosis
Most people, at some point, have difficulties with focusing, feeling restless, and procrastinating, especially when they’re tired or anxious. But if it happens often and causes problems at school, work, or in other areas of your life, you should see a doctor to find out if you have ADHD.
How to get evaluated
Children are most often tested for ADHD by their school system. Testing has many parts. These include self-reports, social history, medical history, family history, education history, and a neuropsychological evaluation of executive functioning and information processing.
If you’re concerned that your child has ADHD, there are online symptom tests or checklists that can help identify their symptoms (ADDitude magazine is a reliable source). But these cannot confirm a diagnosis. A professional assessment is always necessary.
ADHD in adults
ADHD affects the hardwiring of the brain, so people don’t “grow out” of it. In some adults, the symptoms may not seem as obvious because they’ve learned how to compensate (or manage) for them.
In some cases, symptoms seem to suddenly appear in adulthood, but it’s likely the disorder began at a young age and was just well hidden. Sometimes, a new job or challenges can make it more difficult for adults to compensate for their difficulties.
The strongest sign that an adult has ADHD is if you’ve struggled with the same symptoms throughout your life. In addition, if friends, family, or coworkers suggest that you may have ADHD, consider getting an evaluation. They’re often better at recognizing the symptoms than the person who has it.
Causes of ADHD
The cause of ADHD is still unclear. It is a biological disorder because brain imaging shows physiological differences in the ADHD brain. Genetics appear to play a role: Children with ADHD usually have at least one close biological relative who also has the condition.
Neurotransmitters, like dopamine, may also play a significant role. In the past, some experts thought that factors like a poor diet, bad parenting, or too much screen time could cause ADHD. These factors could aggravate ADHD, but they have not been shown to cause the condition.
People with ADHD may also have learning disabilities, anxiety disorders, mood disorders, conduct disorder (children), and substance use issues. ADHD can worsen these problems and vice versa. It is why a thorough evaluation and proper treatment are so important.
Pro Tip
It’s very important to ask about the side effects from the medications. This is especially true for people with other medical or mental health conditions, and for those with concerns about addiction because stimulants can be abused. —Dr. Parker
ADHD treatment
The most effective way to treat ADHD is to use a combination of therapies. These typically include prescription medication, psychotherapy, coaching, and healthy lifestyle habits.
Medications stimulants vs. non-stimulants
Stimulants
Stimulants are the most common type of medication for treating ADHD. They increase the neurotransmitters dopamine and norepinephrine in the brain, which helps improve thinking and attention. A doctor or psychiatrist can prescribe them. The medications are strictly monitored because they can easily be abused and misused.
- Methylphenidates, such as Ritalin and Focalin, are the stimulants that are most often prescribed for children and adolescents first because they tend to cause fewer side effects.
- Amphetamines like Adderall and Vyvanse are usually prescribed for adults. The most common side effects include sleep disturbances, fast heart rate, dizziness, and low appetite that can lead to weight loss.
Non-stimulant medications
Non-stimulant medications are becoming more popular, but it can take a few weeks for them to begin working. Examples include the antidepressants atomoxetine (Strattera) and bupropion (Wellbutrin) and the blood pressure medications guanfacine and clonidine. Side effects may include nausea and dizziness.
Psychotherapy and coaching
Therapy may help you cope and develop strategies to manage your symptoms.
- The most popular approach is cognitive behavioral therapy (CBT), which can change negative thinking and behavioral patterns.
- Behavioral and play therapy can be helpful for children with ADHD. These focus on improving behavior and on parenting skills and family dynamics.
- Mindfulness training can improve attention and awareness, leading to better stress management, increased positive emotion, and improved self-regulation.
- ADHD coaching is also helpful. Coaches help you improve cognitive skills such as time management, organization, and goal setting.
- There are many support and accountability groups, which help you stay focused on tasks and goals. These can be found at health clinics or online. Some companies also offer programs that teach executive functioning strategies in a group format, either in person or remotely.
Neurofeedback
In neurofeedback, sensors placed on your head are used to measure your brain activity while you perform mental tasks. This helps you train your brain to improve impulse control, focus, and executive function.
Biofeedback is another helpful technique that can teach these same skills, but by measuring processes such as heart rate and breathing.
Healthy lifestyle
Eating healthfully can dramatically improve ADHD symptoms when combined with the above therapies. Important nutrients include:
- Omega-3 fatty acids are vital for brain and nerve function. You can get them from food, such as salmon and walnuts, and from supplements.
- Protein triggers the release of neurotransmitters related to alertness. It also helps control blood sugar levels, which can reduce hyperactivity.
- High-fiber foods, such as berries and lentils, help stabilize energy levels.
- Iron, zinc, and vitamins C and B6, all produce and regulate neurotransmitter levels in the brain.
Studies show that exercise is also an important part of treating ADHD. Regular exercise can improve cognitive functioning and release energy and tension. It also increases pleasurable feelings by triggering the release of neurotransmitters in the brain.
ADHD can be very manageable, especially when someone understands how it affects them and affects the people in their life. Therapy and coaching are fantastic options for learning effective strategies that can be really life-changing.
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