What is ADHD?
For a child to receive a diagnosis of ADHD, they must consistently demonstrate at least six symptoms that present problems in daily life. These are outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).
Genetics is one of the main causes of ADHD, but other factors also play a role — such as spending too much time in front of screens.
Signs and Symptoms of ADHD
Women and girls with ADHD can struggle with low self-esteem, anxiety and depression. This is especially common in adolescents. They may also have trouble in school and work settings, resulting in problems with relationships and poor job performance. They might turn to alcohol or drugs to help control their symptoms, but this can lead to addiction and other problems.
In children, symptoms of inattention might include making careless mistakes in school or work. They might forget or be late for appointments and classes. They might have a hard time sitting still for long periods of time. They might be easily distracted or have a hard time paying attention to lectures, conversations or reading. In teens and adults, inattention might look like trouble finishing tasks on time or getting organized.
Hyperactive/impulsive ADHD symptoms might look like fidgeting, always being on the go, interrupting or intruding in others’ activities or games, blurting out answers before they have a chance to think, and taking things without permission. These symptoms can interfere with daily functioning, and may become worse during periods of hormonal change (like puberty or menstruation).
Symptoms of hyperactive/impulsive ADHD can also include trouble playing quietly by themselves or finding it hard to wait their turn.
Types of ADHD
ADHD is not a one-size-fits-all diagnosis. It can manifest in a variety of ways depending on the situation, setting and person. That’s why doctors divide it into three types: inattentive type, hyperactive/impulsive type and combined type.
Inattentive type is the most common and commonly referred to as ADD. People with this type are easily distracted, have trouble concentrating on tasks and tend to make careless mistakes. They can also find it difficult to keep track of their belongings or stay organized.
The hyperactive/impulsive type is less common in children and adults, but it can still occur at any age. This is what most people think of when they hear the term “ADHD,” a child who can’t sit still or avoid jumping into dangerous or thrill-seeking activities. It’s more common in boys than girls to be diagnosed with this type of ADHD.
Lastly, the combined type of ADHD is when a person has symptoms from both categories. Typically, it is diagnosed in childhood and can be difficult to diagnose at any other age. To receive this diagnosis, a person must have six out of the nine major symptoms from both categories and these must interfere with their daily life for at least 6 months.
Causes of ADHD
Several factors have been linked to ADHD. It tends to run in families and is believed to have a strong genetic component. Studies also show that certain environmental risks increase the likelihood of developing ADHD, including exposure to toxins during pregnancy, low birth weight, and extreme stress in early life.
There is evidence that some types of brain activity are differently organized in people with ADHD. The way the brain’s major networks work is different in people with ADHD. The neurotransmitters (chemicals that help nerve cells send signals) may play a role as well.
Children with the predominately inattentive presentation type of ADHD often have trouble paying attention, making careless mistakes and forgetting things. They also frequently fidget, have a hard time sitting still or are extremely talkative. This presentation type of ADHD is the least common.
Children who have both inattentive and hyperactive/impulsive symptoms of ADHD are considered to have the combined presentation type. In this group, children exhibit at least six symptoms of each subtype of ADHD. Previously, this disorder was referred to as ADD (attention-deficit/hyperactivity disorder). ADD has since been replaced with the DSM-5, which includes three presentations of the disorder: predominately inattentive, predominately hyperactive/impulsive and combined presentation.
How is ADHD Diagnosed?
If you think you or a child may have ADHD, take one of our free online tests to see if the symptoms are present. Keep in mind that ADHD is a condition, not a disease. Symptoms are not permanent and can be treated with counseling, psychotherapy, exercise, diet and certain medications.
In order for a person to be diagnosed with ADHD, they must exhibit six or more symptoms that significantly impair their daily functioning. Symptoms must have started before they turned 12 years old and have continued for more than six months. Symptoms must also be exhibited in more than one setting.
Health professionals usually conduct an in-person psychiatric evaluation to diagnose ADHD. The evaluator will interview the patient, family members and teachers to describe the symptoms, complete scales and questionnaires and review the patient’s medical and psychiatric history.
It can be helpful for the evaluator to review report cards or other school records that can provide information about your child’s behavior. It can be difficult for adults to remember their childhood behavior, but it’s important to try and gather as much information as possible so the evaluator can accurately make a diagnosis. The evaluator will then designate the severity of the symptoms: mild, moderate or severe.
Treatsments for ADHD
Most people with ADHD benefit from treatment that includes a combination of medicine, behavior strategies and life skills training. Some adults also need counseling for coexisting problems like depression or anxiety.
Medication helps reduce impulsivity and inattention, making it easier to learn. It is usually prescribed in small doses that are adjusted over time to get the right balance for each person. The most common medications for ADHD are stimulants. They work quickly, but they can cause side effects such as trouble sleeping or appetite suppression.
In addition to medication, children with ADHD may need help at school or in their family. They may benefit from teacher coaching and classroom accommodations to improve their ability to follow instructions and complete tasks. They may need parent-delivered behavior therapy to teach them how to better manage their behaviors and emotions. They may also need family and marriage counseling to help them deal with challenges in their relationships.
Activities that provide outlets for high energy levels, such as sports or exercise, can boost self-esteem. Adults with ADHD can benefit from a daily schedule that includes regular reminders, planners and other organizational tools, and from keeping keys and other items in a specific place.
ADHD in Adults
People with ADHD may have trouble managing their emotions and their life at home, school or work. Their health and wellbeing may be affected by their struggles with daily responsibilities, such as missing appointments or forgetting to take their medication. They may struggle to find a job or maintain a career, and have difficulty with relationships. They may have difficulty staying on top of finances or may run into debt due to impulsive spending. They may also have problems with eating disorders or substance misuse.
In order to be diagnosed with adult ADHD, a person must meet several criteria. They must have exhibited inattentive or hyperactive-impulsive symptoms for at least 12 years, and the symptoms must be present in two or more settings, including work, with family members or friends, and in other activities. They must also cause significant impairment in functioning.
A GP can refer you to a mental health specialist who can complete an assessment for ADHD. The therapist will ask about your symptoms and how they affect your everyday life. They will also look at your medical history and any other difficulties you have, such as anxiety or mood problems. They will use a range of diagnostic tools, including behaviour rating scales and questionnaires, and may refer you for a medical evaluation to rule out other conditions.
People with ADHD often need to try several medications before they find the one that works best for them. Some may experience side effects, such as an upset stomach or a change in heart rate, that make them not want to take the medication. However, these side effects usually go away with time or can be controlled by adjusting the dose or dosage schedule.
Stimulants are the most commonly used medications for treating ADHD. They work by increasing activity in parts of the brain that control attention and behaviour. The most commonly prescribed stimulants are methylphenidate (methyldopa, Ritalin), amphetamines, and lisdexamfetamine. These are available as short-acting tablets taken 2 to 3 times a day and can start working in less than an hour, or as long-acting tablets that need to be taken once or twice a day for 10-14 hours of effect. Long-acting stimulants are recommended for adults, as they tend to have a lower risk of addiction.
Non-stimulant ADHD medications — including atomoxetine (Strattera), guanfacine (Clonidine, Kineret), and clonidine (Dexamethasone) — are also options. These drugs are less effective at treating symptoms, and they take longer to begin working, but they can be helpful for people who have medical reasons not to take stimulants or prefer not to do so.
How does ADHD medication work? What are some common ADHD medication side effects? What are the side effects of stimulant medication? Watch as our expert explains what you need to know about common ADHD medication side effects.
In this video, Karen J. Miller, M.D., discusses everything you need to know about ADHD stimulant medication. Dr. Miller discusses the best time of day to take ADHD medication and ways to minimize side effects. She also discusses the ADHD medication rebound effect that can occur after a dose wears off. (Dr. Miller is an associate professor of pediatrics at Tufts University School of Medicine). Keep in mind that deciding whether to have your child take ADHD medicine is a personal decision.
Understood is not affiliated with any pharmaceutical company.
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