What is ADHD?
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The majority of people with ADHD do not outgrow it. They will often struggle with disorganization, forgetfulness, and impulsivity into adulthood.
Signs and Symptoms of ADHD
A child who has difficulty paying attention in school, at home or at play can have ADHD. A health care provider will ask about the behavior, and review family history and education, and take a medical exam. They may also give tests to look for other problems that can cause similar symptoms, like learning disorders and mental health conditions.
Children with the hyperactive-impulsive type of ADHD are restless and have trouble sitting still, playing quietly or relaxing. They often run around or climb where it is inappropriate, and they have trouble waiting for their turn in games or conversations. They blurt out answers without thinking and might interrupt others or cut into conversations. They have trouble keeping powerful emotions in check, which can lead to angry outbursts and temper tantrums.
Adults with the inattentive type of ADHD have trouble paying close attention to details, making careless mistakes at work or school, or maintaining focus on tasks, lectures or reading. They are often late for work or missing appointments. They may have trouble following instructions and managing finances. They might have trouble with relationships and family problems. They are more likely to misuse alcohol or drugs.
Types of ADHD
Until recently, ADHD was divided into different subtypes that focused on specific behavioral symptoms. But in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) these subtypes were replaced by presentations, which better reflect that individuals often move from one to another throughout their life.
Inattentive ADHD manifests as forgetfulness, trouble with following instructions and frequent daydreaming. People with this presentation might get in hot water at school or work for being absent from class without explanation, or they might have trouble keeping track of their cell phone, homework and appointments. They might also tend to be more socially aloof than their peers.
Hyperactive/impulsive ADHD is the stereotypical image of a young boy bouncing off the walls and interrupting the teacher mid-sentence, but this type can affect adults as well. They might fidget, squirm in their chair or fall out of their office seat during meetings and they might struggle to sit still when working on tasks that require concentration.
Combined type ADHD, or ADHD-C, is diagnosed when an individual meets the criteria for both the inattentive and hyperactive/impulsive presentations. This is the most common presentation of ADHD. It usually co-occurs with externalizing disorders such as oppositional defiant disorder (ODD) and conduct disorder at high rates.
Causes of ADHD
People with ADHD have trouble with the way their brains work. Scientists aren’t sure what causes it, but genetics, the environment and problems during development may play a role. Certain substances, such as sugar and lead exposure during pregnancy, also may increase the risk of ADHD. Many people with the condition have other health, learning and behavioral issues. Tourette syndrome and autism spectrum disorder, for example, can present similar symptoms to ADHD.
Children who only have inattentive ADHD may struggle to do well at school because they can’t sit still and listen. They might have difficulty with homework, make careless mistakes at school or work and get in fights with their parents or friends because they aren’t listening.
On the other hand, kids with hyperactive/impulsive ADHD can’t seem to stop moving and talk nonstop. They can’t wait their turn at a game or in class and have trouble following directions. They might get into trouble at school for disrupting classrooms and arguing with teachers and classmates. They often have trouble with relationships and jobs because of their impulsive behaviors.
How is ADHD Diagnosed?
Getting diagnosed with ADHD can be challenging, especially in adulthood. While there are many online tests that act as a screening tool, it is best to see a professional for a full evaluation. The diagnosis process starts with a health professional like a psychiatrist or psychologist. It can also be done by a primary care provider, depending on the situation. They will interview you and your family about your symptoms, social history and behavior as well as perform a physical examination. They may use checklists or rating scales to help assess your symptoms. They may ask for feedback from other people you interact with, such as teachers or coworkers.
There are certain medical and psychological conditions that can mimic symptoms of ADHD, so it is important to rule them out. They include learning disorders, mood disorders like anxiety and bipolar disorder, sleep disorders, head injuries, thyroid conditions, certain medications and major life events. People with ADHD may also have difficulty with other mental health disorders, including oppositional defiant disorder and conduct disorder. Some children and adults with ADHD are very creative and imaginative. They might have ten thoughts at once or be able to solve complex problems.
Treatsments for ADHD
Children and adults with ADHD often get better treatment when they work with doctors, therapists, family members, teachers, and school staff to develop a plan to manage symptoms. The goal is to improve daily functioning, achieve goals, and improve the quality of life. Medication is often part of the treatment plan, but it should not be used alone.
Medications, including stimulants and nonstimulants, can help reduce symptoms of ADHD, according to the National Institute of Mental Health (NIMH). Doctors can recommend different medications and dosages to find the right one for each person. Stimulants may cause side effects, but many people with ADHD find that they improve their symptoms and ability to function with medication.
Behavior therapy, which teaches kids or adults new skills to manage their emotions and behaviors, can be helpful. This can include teaching them how to use organization strategies, improve their self-monitoring abilities, and improve social skills. It can also involve learning to set clear boundaries and expectations, and how to respond when they are disobeyed.
For older children or adults, counseling can help them understand their ADHD and improve communication with family members. This can reduce frustration and conflict and teach parents or spouses how to support their loved ones.
ADHD in Adults
When untreated, ADHD symptoms can interfere with work, school, family life and other important activities. The resulting problems can cause stress and frustration, which may increase the severity of symptoms. Symptoms of ADHD in adults can vary by individual, but may include difficulty with organization or trouble keeping track of time, forgetfulness, failing to complete tasks, and being easily distracted by irrelevant thoughts or activities.
Women often experience more difficulty with untreated ADHD than men. They are expected to be responsible for a great deal of self-care and caretaking of others, which can add up to significant stress when the symptoms of ADHD become noticeable. Many women with untreated ADHD feel that they are a failure, especially when they miss deadlines or fail to meet their responsibilities.
NIMH’s online screening tool can help you identify whether your behavior might be a sign of ADHD. This tool should be used as a screening tool only; it is not a diagnostic test. A qualified health care professional can diagnose ADHD based on your reported symptoms, family history, physical examination and other medical tests. Be sure to tell your doctor about any other medications you are taking. Some common medications, such as diet pills and some antidepressants, can interact with stimulants.
There are several types of medications used to treat ADHD. They can be taken by mouth, through a patch on the skin or nose, or as an injectable. The medicines work differently for different people, and it may take a while to find the right one and the best dose. The most common medications are stimulants. They improve attention by increasing the amount of dopamine and norepinephrine in the brain. They can also reduce fatigue, which makes it easier to concentrate. The most common stimulant drugs are methylphenidate (Daytrana), amphetamines such as Adderall or Ritalin, and atomoxetine. Some doctors use a combination of these medications.
Stimulants can have side effects, including decreased appetite, weight loss, trouble sleeping, tics and an increase in anxiety and depression. They can also raise blood pressure and heart rate, so they need to be carefully monitored by a doctor.
A psychiatric evaluation may be done before starting medication, and your child should see a doctor regularly while taking these drugs. Some places have laws or regulations requiring that kids with ADHD get regular medical checkups. This can help your doctor know how the medication is working and if it needs to be changed.
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