Bringing Order to Attention-Deficit Hyperactivity Disorder (ADHD)

A Disorder or Just Disorderly?

Most of us hate waiting in line, forget appointments sometimes, or nod off during boring presentations. It’s human nature to get frustrated with stressful tasks, let our desk get messy, lose our wallet, and procrastinate tasks we don’t enjoy. We can all be a little impulsive and spontaneous, letting our daydreams grab our attention and blurting out the first thought that comes to our mind. These life situations require focused attention and deliberate control over our faculties and impulses. When we’re good at doing that, we can keep track of our appointments and where we laid the keys. We can pay attention to what people are saying, even when it’s boring. It’s easier to have patience with long lines and stressful days. With a little self-control, we can reign in our tempers, spontaneity, and procrastination to meet our obligations and commitments.

When we’re not so good at these abilities, everyday tasks can become a huge challenge. Poor focus and impulsiveness can lead to neglect, accidents, getting fired, divorced, and addictions. When these significantly and chronically impair multiple aspects of our lives, it may have more to do with our brain function than our self-control. Individuals who have extreme difficulty with maintaining attention, executive function, organizing, managing tasks, and working memory may have Attention-Deficit Hyperactivity Disorder (ADHD). Living with ADHD means constantly fighting distraction, overstimulation, anxiety, and being disorganized. All these challenges (mostly related to working memory deficits) strain our ability to retain information and make it almost impossible to follow step-by-step processes.¹

What is ADHD?

ADHD is a neurodevelopment disorder affecting both children and adults. It is usually first diagnosed in childhood and often lasts into adulthood. A persistent pattern of inattention and/or hyperactivity-impulsivity gets in the way of typical development and interferes with functioning. Severity and frequency levels differ, but those with ADHD experience an ongoing pattern of the following qualities:^2,3

• Difficulty staying on task, sustaining focus, and staying organized (not due to defiance or lack of comprehension).
• Seems to move about constantly, including in situations when it is not appropriate, or excessively fidgets, taps, or talks. In adults, hyperactivity may mean extreme restlessness or talking too much.
• May act without thinking or have difficulty with self-control. Impulsivity could also include a desire for immediate rewards or the inability to delay gratification. An impulsive person may interrupt others or make important decisions without considering long-term consequences.

ADHD used to be called Attention Deficit Disorder (ADD) in 1980 when scientific opinion cited inattention as the main problem in the disorder, rather than hyperactivity. More recently, hyperactivity and impulsivity have been regarded as equally important in ADHD. By 1987, the title of ADD was renamed ADHD, and it’s remained so ever since.⁴

Do I Have ADHD?

For a person to receive a diagnosis of ADHD, the symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting, impair the person’s functioning, and cause the person to fall behind typical development for their age. Adults with ADHD have at least five symptoms, and children have at least six symptoms that occur frequently. Several of the symptoms must have been present prior to age twelve. The symptoms can change over time from childhood to adulthood. Patients can be diagnosed with one of three types of ADHD:^5,6

Inattentive Type.

• Fails to give close attention to details or makes careless mistakes
• Has difficulty sustaining attention
• Does not appear to listen
• Struggles to follow through with instructions
• Has difficulty with organization
• Avoids or dislikes tasks requiring sustained mental effort
• Loses things
• Is easily distracted
• Is forgetful in daily activities

Hyperactive-Impulsive Type.

• Fidgets with hands or feet or squirms in chair
• Has difficulty remaining seated
• Runs about or climbs excessively in children, extreme restlessness in adults
• Difficulty engaging in activities quietly
• Acts as if driven by a motor; adults will often feel inside as if they are driven by a motor
• Talks excessively
• Blurts out answers before questions have been completed
• Difficulty waiting or taking turns
• Interrupts or intrudes upon others

Combined Type.

• Meet criteria for both inattentive and hyperactive-impulsive symptoms.

What Causes ADHD?

ADHD affects people of every age, gender, IQ, religion, and socio-economic background.⁷ In 2016, an estimated 5.4 million children (8.4%) had a current diagnosis of ADHD. This includes:

• 1% ages 2-5 (335,000)
• 9% ages 6-11 (2.2 million)
• 9% ages 12-17 (2.9 million)⁸
• 4% ages 18 and over⁹

Among adults, 38% are women and 62% are men.⁹ Boys (12.1%) continue to be more than twice as likely than girls (5.5%) to have ADHD.¹⁰

Research shows that ADHD is both highly genetic (with the majority of ADHD cases having a genetic component), and a brain-based disorder (with the symptoms of ADHD linked to many specific brain areas). Approximately half of parents with ADHD will have a child with the condition. The factors that appear to increase a child’s likelihood of having the disorder include gender, family history, prenatal risks (preterm birth, low birth rate, smoking or alcohol use during pregnancy), environmental toxins (lead, bisphenol-A), brain injury, and physical differences in the brain. ADHD is not caused by moral failure, poor parenting, family problems, poor teachers or schools, too much TV, food allergies, or excess sugar. Some of these may make symptoms worse, but they are not the main causes of ADHD.^7,11,12

Dr. Julie Schweitzer, a professor at UC Davis and an ADHA expert, shares the latest research done at the MIND Institute. Findings indicate that people with ADHD have stronger connections between the reward and emotion regions of the brain and weaker connections between the reward and attention regions, which may lead to greater impulsivity. ADHD brains are also less active when using working memory during complex tasks. Strong connections exist between the reward and threat processing brain regions and weaker connections between the attention and emotion processing regions, contributing to irritability. Higher initial baselines of irritability predicted higher hyperactive/impulsive symptoms 18 months later.¹³

How is ADHD Treated?

A qualified mental health profession carefully evaluates the patient to confirm a correct diagnosis for ADHD. First, a medical exam is conducted to confirm that symptoms are not due to other mental or physical health conditions, such as learning disorder, sleep disorders, alcohol/drug use, depression, anxiety, or bipolar disorder. Next, a clinical interview gathers information about current levels of functioning and contributing factors, such as family medical and symptom history, especially in childhood. Finally, an ADHD rating scale is completed to assess symptoms, strengths, and weaknesses for a treatment plan.^11,14

While there is no cure for ADHD, individuals with ADHD can experience mental health recovery through ongoing management of symptoms. Treatments include medication, psychotherapy, coaching and education, and/or a combination of these treatments.^3,11,14,15

Medication

The focus of medication treatments for ADHD is to reduce hyperactivity and impulsivity, improving the ability to focus, work, and learn. The dosage and frequency need to be adjusted early in the course of treatment to match patient needs. Learn more about ADHD medications.¹⁶

• These work by increasing brain chemicals dopamine and norepinephrine, which plays an essential role in thinking and attention. The most common types are amphetamine (Adderall, Vyvanse, Evekeo) and methylphenidate (Ritalin, Concerta, Metadate, Daytrana).
• Non-stimulants. These can improve focus, attention, and impulsivity with ADHD. If the patient does not respond well to stimulants, has adverse reactions, or co-existing psychiatric conditions, a nonstimulant such as Atomoxetine (Strattera) or Guanfacine (Intuniv, Tenex) may be used.
• These increase norepinephrine levels in the brain. Antidepressants may be prescribed if a patient has bothersome side effects from stimulants. Some antidepressants are used alone or in combination with a stimulant to treat ADHD monoamine oxidase inhibitors, bupuprion (Wellbutrin) and venlafaxine (Effexor). These drugs are not approved by the FDA for this indication, although they are used off-label.¹⁴

Treatment

• Cognitive-behavioral therapy (CBT). This type of therapy can be focused specifically for ADHD patients to help them overcome difficulties in executive functions (managing time, decision making, organizing), self-regulation, impulse control, and self-management. CBT can also help with any co-existing anxiety and/or depression.¹⁷ CBT is often effective in treating ADHD because it helps to improve negative and unproductive thinking patterns and perspectives. A 2016 neuroimaging study of adults with ADHD who completed a 12-session course of CBT showed improvements in ADHD symptom ratings and beneficial changes in the same brain regions that are typically monitored in studies of medication treatment.¹⁸
• Family and Marital Therapy. This type of therapy can help family members and spouses find productive and supportive ways of handling ADHD behavior in those they love. Frustration, blame, and anger may have built up within a family before the individual is diagnosed. Parents, spouses, and children may need specialized help to overcome negative feelings. Mental health professionals can educate about ADHD and how it affects a family. They can also help the individual and his/her loved ones develop new skills, attitudes, and ways of relating to each other.

Life Coaching

Coaches addresses the academic, vocational, emotional and interpersonal life difficulties that are a result of ADHD symptoms and help clients find ways to overcome these challenges. Whether it’s with individual or group support, coaches help people with ADHD learn life skills, carry out practical activities in an organized, goal-oriented and timely fashion, and initiate change in their daily life. They provide encouragement, feedback, and suggestions for dealing with ADHD. Specifically, a coach may help a patient with ADHD:^14,19

• Maintain focus and cope with distractions to achieve identified goals
• Stay organized and prevent misplacing important items
• Translate abstract goals into concrete actions
• Build motivation and learn to find ways to use concrete and abstract rewards effectively.

When to See a Professional

Consult with a mental health professional if you or your child have ADHD symptoms that:²⁰

• Started at age 12 or earlier
• Interfere with performance in two or more settings — for example, at school, home, work, or in personal relationships
• Have lasted six months or longer.

Mind Spa recommends our mental health treatment for individuals with ADHD. Our licensed therapists and medical professionals are dedicated to providing patients with safe and effective mental health treatment that teaches them how to properly cope with their symptoms. Contact Mind Spa today for personalized treatment options.

References

¹ Brodey, D. (2021, August 23). Adult ADHD: What it feels like to have it. https://www.psycom.net/adhd/adult-adhd-what-it-feels-like-to-have-it

² ADHD Awareness. (2021, October). Symptoms and Diagnosis. https://www.adhdawarenessmonth.org/symptoms-and-diagnosis/

³ National Institute of Mental Health. (2021, September). Attention-deficit/hyperactivity disorder. https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd

⁴ Maucieri, L. (2016, April 7). ADD or ADHD: Are they different? Psychology Today. https://www.psychologytoday.com/us/blog/the-distracted-couple/201604/add-or-adhd-are-they-different

⁵ Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). (n.d.). Diagnosis of ADHD in adults. https://chadd.org/for-adults/diagnosis-of-adhd-in-adults/

⁶ American Psychiatric Association. (2017, July). What is ADHD? https://www.psychiatry.org/patients-families/adhd/what-is-adhd

⁷ ADHD Awareness. (2021, October). 7 facts about ADHD. https://www.adhdawarenessmonth.org/myths-vs-facts/

⁸ Danielson, M. L., Bitsko, R. H., Ghandour, R. M., Holbrook, J. R., Kogan, M. D., Blumberg, S. J. (2018). Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016. Journal of Clinical Child and Adolescent Psychology, 47:2, 199-212.

⁹ Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., Faraone, S. V., Greenhill, L. L., Howes, M. J., Secnik, K., Spencer, T., Ustun, T. B., Walters, E. E., & Zaslavsky, A. M. (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. The American Journal of Psychiatry, 163(4), 716–723. https://doi.org/10.1176/ajp.2006.163.4.716

¹⁰ Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). (n.d.). General prevalence of ADHD. https://chadd.org/about-adhd/general-prevalence/#:~:text=5.4%20million%20children%20(8.4%20percent,percent%20in%20this%20age%20group)

¹¹ ADDitude. (2021, July 28). Adult ADHD: A guide to symptoms, signs, and treatments. https://www.additudemag.com/adhd-in-adults/

¹² Centers for Disease Control and Prevention. (n.d.) Attention-deficit / hyperactivity disorder (ADHD) – What is ADHD? https://www.cdc.gov/ncbddd/adhd/facts.html

¹³ Mind Institute (2021, October 27). ADHD: An expert shares common symptoms and the latest research). UC Davis Health. https://health.ucdavis.edu/news/headlines/adhd-an-expert-shares-common-symptoms-and-the-latest-research–/2021/10

¹⁴ Cleveland Clinic. (2019, September 25). Attention deficit hyperactivity disorder (ADHD), inattentive type in adults. https://my.clevelandclinic.org/health/diseases/15253-attention-deficit-disorder-without-hyperactivity-add-in-adults

¹⁵ National Institute of Mental Health. Attention-deficit/hyperactivity disorder. https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd

¹⁶ Silver, L. (2021, December 1). ADHD Medications for Adults and Children: ADD Stimulants, Nonstimulants & More. ADDitude. https://www.additudemag.com/adhd-medication-for-adults-and-children/

¹⁷ Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) (n.d). Cognitive-Behavioral Therapy. https://chadd.org/for-adults/cognitive-behavioral-therapy/

¹⁸ Sherman, C, Ramsay, J. R., Barrow, K. (2021, August 24). How CBT dismantles ADHD negativity: Cognitive behavioral therapy overview. ADDitude. https://www.additudemag.com/cognitive-behavioral-therapy-for-adhd/

¹⁹ Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) (n.d). Coaching. https://chadd.org/about-adhd/coaching/

²⁰ Intermountain Healthcare. (n.d.) ADHD/ADD.  https://intermountainhealthcare.org/services/behavioral-health/conditions/adhd-add/

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