ADHD

What Is ADHD?

Attention-deficit/hyperactivity disorder (previously known as attention deficit disorder, or ADD) is a neurobehavioral disorder characterized by core symptoms of inattentiveness, distractibility, hyperactivity, and impulsivity.

ADHD is thought to be the most common childhood mental health disorder, with estimates of its prevalence in children ranging from 5 to 11 percent. Some of these children find it difficult to concentrate on schoolwork or other tasks, and may frequently succumb to daydreaming. Others become disruptive, defiant and have trouble getting along with parents, peers, or teachers. Children who struggle with hyperactivity and impulsivity, in particular, frequently have behavioral challenges that can be difficult for adults to manage. It’s also possible for both sets of symptoms to exist together, in what is typically called combined type ADHD. Executive functioning (planning, emotional regulation, and decision-making) is invariably affected as well. 

Though it’s been listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) for decades, ADHD remains controversial. Is it a true disorder, or simply a collection of naturally occurring behaviors that aren't tolerated in today’s high-demand, results-driven world? Even among those who agree the disorder exists, there are competing theories about what, if anything, triggers its symptoms.

Until recently, ADHD was considered a childhood disorder that individuals eventually grew out of. And while evidence still suggests that up to 50 percent of children with ADHD do appear to outgrow the condition, many others don’t—about 4 percent of adults in the U.S. have been diagnosed with ADHD, and more are thought to be undiagnosed. Even among children who “outgrow” the condition, early developmental delays and academic setbacks may create enduring learning problems.

Experts disagree over whether treatment for ADHD should be behavioral (therapy, training of attention, increased play, greater structure) or pharmacological—typically, the prescription of stimulants such as Ritalin and Adderall, though non-stimulant options have become more common in recent years. Several large studies have concluded that a combination of both may work best.

Managing work, school, and household tasks can be a challenge for people with ADHD. Fortunately, they can learn coping skills to work around shortcomings and harness their talents—as many successful individuals with ADHD have already done.

Symptoms of ADHD

Given the fuzzy character of the disorder, the symptoms of ADHD are not always clear-cut. Since everyone experiences inattention or impulsivity from time to time, an individual’s symptoms must be persistent to be considered diagnostically relevant. For children, they must also be unusual for the corresponding developmental stage, as some symptoms may simply represent typical behavior for his or her age group.

To qualify as indicative of ADHD, symptoms must also create significant impairment of functioning in school, at work, or at home. For an adult to be diagnosed with ADHD, he or she must have had some of these symptoms before age 12.

The symptoms of ADHD fall into two distinct categories—inattention and hyperactivity/impulsivity. Those whose symptoms are restricted to inattention don't tend to find them as disruptive, and are thus more likely to go undiagnosed.

Symptoms of Inattention

  • difficulty sustaining attention, organizing tasks, or setting up tools needed for a task.
  • easily distracted by irrelevant sights and sounds.
  • does not pay attention to detail or follow instructions carefully.
  • makes careless mistakes in work, schoolwork, or other activities.
  • fails to finish schoolwork, projects, or household chores.
  • loses things and is forgetful.
  • does not seem to listen when spoken to directly; lethargic, appears to be daydreaming.

Symptoms of hyperactivity/impulsivity

  • fidgeting with hands or feet or squirming while seated.
  • unable to stay seated or play quietly.
  • may run, jump, or climb about constantly [for small children].
  • may often complain of feeling “restless" [for adults].
  • talks excessively at inappropriate times.
  • blurts out answers before questions are completed.
  • has trouble taking turns or waiting on line.
  • interrupts or intrudes on others; grabs things from people.

Causes of ADHD

The causes of ADHD are not clear. As with other mental health and behavioral disorders, genes likely play a role, but more recent research also implicates exposure to environmental toxins such as pesticides or lead, as well as prenatal cigarette smoking or alcohol intake. The popular belief that eating too much sugar causes the condition has not held up in research.

“Poor parenting” is not to blame for ADHD, but parenting styles and strategies can have an effect on children's self-regulating abilities. Children who are exposed to inconsistent discipline, or who suffer from neglect, may find it more challenging to rein in their impulses or direct their attention later on.

Treatment of ADHD

Medication and behavioral treatments are both widely used for treating ADHD. Patients who receive behavioral treatments—typically therapy, parent training, or neurofeedback—often ultimately need less medication, but several influential studies have concluded that the two treatment approaches may work best in tandem.

The most commonly used ADHD medications are stimulants such as Ritalin and Adderall. Non-stimulants, like Strattera or certain classes of antidepressants, can be used for those who don’t respond to stimulants, or cannot tolerate them. Whatever medication is used, it's important to receive the correct dosage, since ADHD medications, and stimulants in particular, can worsen other conditions that may co-occur with ADHD, including bipolar disorder, obsessive-compulsive disorder, and anxiety.

Children, Teens and ADHD

Boys, who tend to show more hyperactive or impulsive symptoms, have historically been more likely to be diagnosed with ADHD than girls. But increased awareness of inattentive symptoms has led to an increase in diagnoses among girls in recent years. Overall, five to eleven percent of children and adolescents have been diagnosed with ADHD. Children and teens with ADHD may benefit from accommodations at school to help adapt curricula, classroom environments, and testing procedures to their learning styles and to compensate for developmental delays.

Technology and Everyday Distractions

There is an ongoing debate over whether multitasking, an increasing societal dependence on technology, or the competing demands of the modern world create ADD symptoms in otherwise attentive people. Most psychologists believe that attentional challenges long predate even the most rudimentary technology, and yet it’s also true that increasing diagnosis rates have coincided with a growing influence of technology on many people’s daily lives. Aside from the merits of the clinical debate, however, a plugged-in world of noisy, visually cluttered phones, screens, and other devices can be frustrating to many, and is likely to be especially challenging for individuals with ADHD.

ADD and Relationships

Maintaining fulfilling relationships can be a challenge for people with attentional problems. Because they are easily distracted, they may not appear to be listening closely to loved ones, and time-management challenges may lead them to be frequently late—or to forget social plans and important errands altogether. Because close relationships are so crucial to happiness and well-being, it's critical for those with ADHD to be aware of the effects of their condition on others, and to develop skills for building stronger social ties. On the other hand, it’s equally important for loved ones to be cognizant of ADHD-related challenges, and to understand that in many cases, the person with ADHD is aware of—and struggling to manage—their frustrating behaviors.

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