Attention deficit hyperactivity disorder (ADHD) is a neurological condition that affects up to 11% of children and 5% of adults in the United States. Unlike the misleading diagnostic label suggests, ADHD is NOT a deficit in attention, but rather a difficulty in controlling and directing attention on the tasks we need to attend to at the time we need to attend to them. It involves dysregulation of what mental health practitioners refer to as “executive functions,” which are the mental skills we use to monitor and control our thoughts, feelings, and behaviors. ADHD, therefore, is not a straight-forward behavioral problem, but rather a complicated, developmental impairment in the brain’s ability to manage the functions required for the activities of daily life. This helps to explain why individuals with ADHD are able to focus on some tasks (at some moments) and not others and why “simple” chores that many people begrudgingly take care of despite limited interest are often neglected by individuals with ADHD.
Symptoms of ADHD range on a continuum from mild to severe and fall into one of 3 sub-types (primarily inattentive, primarily hyperactive-impulsive, or a combination of both). Depending on their specific presentation, individuals with ADHD may appear careless, impulsive, restless, disorganized, and spacey to those around them. Those who have more of a hyperactive presentation are viewed by others as being constantly in motion, fidgety, and impatient; while those with more of an inattentive presentation are more likely seen as forgetful daydreamers who “just need to try harder to be successful.” The unfortunate reality of ADHD, however, is that the harder these individuals “try,” the worse the symptoms tend to be (until they are effectively treated, that is).
While it is diagnosed more often in males, it is unclear whether this gap reflects a bias in referral/diagnosis or a genuine increase in susceptibility that is actually related to gender. That is, it may be that boys tend to be more hyperactive and disruptive, which prompts parents, teachers, and other adults to seek out a diagnosis and treatment plan compared to girls who may demonstrate more inattentive qualities that are less problematic and noticeable to authority figures. In fact, adult women are one of the fastest growing demographic groups of ADHD diagnoses in the United States. Many of these women seek treatment when they notice similar issues in their children as they did in themselves growing up and realize for the first time that their lifelong challenges may be due to an underlying condition.
Although the symptoms of ADHD are generally first noticed during childhood, symptoms often continue into adolescence and adulthood. While the nature of the condition may persist, the manifestation of the symptoms tends to change over time. As children, symptoms commonly include difficulty completing homework, making friends, awaiting turns, and following directions; as adults, ADHD symptoms are more likely manifested as unsafe driving practices, short-sighted financial decisions, a tendency to procrastinate on personal and professional tasks (particularly the boring ones!), and impulsive engagement in risky activities, such as unsafe sex and drug use. At any age, individuals with ADHD are more likely to misplace material objects, become distracted by stimuli in their environment (including thoughts), make careless mistakes, react impulsively to emotional triggers, and have difficulty following through on sequential and/or “boring” tasks.
Contrary to popular opinion, ADHD is not due to a lack of willpower, a result of poor parenting, or a sign of laziness. Instead, ADHD is a condition that involves significant dysregulation of brain activity in ways that greatly challenge an individual’s ability to utilize executive functions. There are many theories about what may actually cause ADHD, but the current consensus from many researchers and practitioners is that it is likely due to a combination of genetic and environmental factors, such as low birth weight, brain injuries, and exposure to environmental toxins during pregnancy, delivery, or early childhood. At this point, it does not appear to be due to a singular cause or a specific brain region, but rather a breakdown in the connectivity between brain regions and the activity of certain chemicals in the brain that are required for attention, impulse control, and other executive functions.
Treatment for ADHD is most successful when it is comprehensive and addresses the many facets of the individual’s life that are impacted by their symptoms. This commonly involves some combination of pharmaceutical medication along with psychosocial interventions such as therapy, neurofeedback, and home/school/work-based modifications. In next week’s blog post, we will explore the various medications available for ADHD, including stimulant and non-stimulant options. The following week’s post will review the most common psychosocial interventions that have demonstrated to be effective in the treatment of ADHD.