Table of Contents
Table of Contents
If you have questions about attention deficit hyperactivity disorder, ADHD — what causes it, is it the same thing as ADD, how ADHD is diagnosed, and what treatments are best—you’ve come to the right place. Here, top experts answer commonly-asked questions. Find peace and solutions now.
What Is ADHD?
When you hear the term “ADHD,” what pops into your mind is probably something along the lines of a shrieking kid running circles around the table instead of sitting down to do his math homework. But this image of a child gone wild isn’t an accurate picture of ADHD because the condition is a lot more complicated than that. And let’s face it, it’s totally normal (even for adults) to lose focus from time to time or have trouble sitting still. And really, what kid wouldn’t rather do anything but his homework?
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition affecting both children and adults (yup, it’s not just a kid problem). 1 In fact, about 8 million adults in the US are living with the condition, and according to data compiled by the CDC, the estimated number of children diagnosed with ADHD is 6.1 million.2
“The term, ‘attention deficit’ can be misleading because those with ADHD can pay attention; they just struggle to regulate it,” says Laura Rossillo, AAC, founder of Perfectly ADHD in Roslyn Heights, New York, which offers parent training, individual coaching sessions, support groups, and monthly workshops on various topics related to ADHD. “And, once someone with ADHD learns how their brain functions and what works for them, they can adapt by using their strengths to solve problems,” she says.
ADHD develops when the brain and central nervous system suffer impairments related to the growth and development of the brain’s executive functions — such as attention, working memory, planning, organizing, forethought, and impulse control. In other words, the skills that help us plan, prioritize, and execute complex tasks are compromised as a result of ADHD. The majority of kids who have ADHD do not outgrow it (but some do) so the disorder continues into adulthood. In fact, symptoms persist into adulthood in 60% of cases.
Treatment of ADHD can mean the difference between a person who thrives or a person who truly struggles in life, Rossillo explains. “Without proper support and treatment, those with ADHD may receive unwanted attention, suffer in their personal relationships, and struggle to achieve their goals,” she says. This is especially true for children with ADHD who may have lower self-esteem or less confidence in their abilities.
Not to mention, what may seem like a lack of motivation could really be a fear of failure holding them back. These kids may also be at risk for poor grades, anxiety, depression, or substance abuse — or engage in risky behaviors like drugs, smoking, or drinking, Rossillo says. “Adults who are left untreated may be highly unorganized and find it hard to hold onto a job.”
What Causes ADHD?
While the exact cause of ADHD remains a mystery, most researchers blame it on a combination of biology, genetics, and environment, Rossillo says. ADHD is not caused by parenting, video games, or too much sugar (those factors sometimes exacerbate the symptoms, though). Here’s the 411 on the factors researchers believe may increase the chances of developing the condition.
While scientists haven’t identified a specific ADHD gene, lots of studies show a genetic link. For instance, it’s super common for a person diagnosed with ADHD to have at least one close relative with the condition. In fact, 30-to-35% of first-degree relatives (mom, dad, sister, or brother) of children with ADHD also have the disorder.
Environmental factors include toxins and chemicals in foods, cleaning and personal hygiene products that we use each day, as well as lead exposure, Rossillo says. Infants and young children are particularly vulnerable to toxic chemicals because they can disrupt normal brain development.
A brain injury
Researchers believe that a traumatic brain injury may change brain regions associated with ADHD.
Studies show babies born prematurely or weighing too little are about three times more likely to develop ADHD than full-term, healthy-sized infants. While researchers don’t know exactly why this is, they speculate it has something to do with the stress of premature development in the body, which can lead to inflammation.
What’s Going On In The Brain When You Have ADHD?
Think of the brain as a huge electrical system with multiple wires that transmit messages to each other to keep the body functioning on the reg, explains Thomas Brown, PhD, Director of the Brown Clinic for Attention & Related Disorders in Hamden, Connecticut and author of A New Understanding of ADHD in Children And Adults: Executive Function Impairments. In this super complex network, the brain relays messages through neurons, which, with the help of chemicals called neurotransmitters, travel over gaps called synapses.
“People with ADHD don’t release enough neurotransmitters or may release and reload them too quickly before an adequate connection has been made,” Dr. Brown says. So, messages can’t get to where they need to go. This is often why those with ADHD really struggle with things like listening and completing assignments in a timely manner. Medications, including stimulants and non-stimulants, can make up for these lapses by triggering the release of chemicals that help neurons better communicate with each other.
When Is ADHD Diagnosed?
ADHD is often diagnosed in childhood and typically continues through adolescence and into adulthood. According to the National Institute of Mental Health, the average age for diagnosis of a child with moderate symptoms of ADHD is 7 years old 5 though ADHD can be detected in toddlers.
And it’s a fickle kind of condition: symptoms can vary from person to person and increase or decrease over time.
ADHD isn’t a gender-based condition but it turns out it’s more of a guy thing: The rate of boys diagnosed with ADHD is three times higher than the number of girls. One reason for this is the way the condition presents itself in boys versus girls, Rossillo says. Boys, being, well, boys, tend to exhibit the hyperactive and impulsive behaviors (blurting out the answers in class without being called on, fidgeting in their seat) associated with ADHD, which are usually red flags for parents (or teachers who notice behaviour problems in children during the school day) to seek an evaluation for the child.
ADHD symptoms are subtler in girls. They may stare out the window, be extra chatty, or anxious, but they typically don’t demonstrate the kind of disruptive behaviour that may get them noticed, so many may go undiagnosed. ADHD symptoms in girls are also frequently attributed to a mood disorder.
How is ADHD Diagnosed?
While your pediatrician is a good place to start, psychiatrists, psychologists, or neurologists are the most qualified in diagnosing ADHD (there are slightly different criteria for diagnosis based on age — more on this below). ADHD can’t be determined with a lab or blood test; it’s more about the doc knowing what signs to look out for. (If your pediatrician isn’t experienced in diagnosing ADHD — many aren’t — ask for a referral to a practitioner who is.)
During an office visit, an initial evaluation of ADHD may include a standardized questionnaire that surveys behavior across a variety of settings (e.g., home, school, work, etc.). A more thorough neuropsychological evaluation may be necessary when it’s not clear whether ADHD is present, or if the clinician suspects it’s coexisting with another condition like anxiety, depression, learning disability, etc., or is something different altogether.
This type of evaluation uses performance based-testing to measure things like intellect, language processing, visual-spatial skills, memory, sensorimotor functions, attention/executive functioning, socio-emotional development, and — depending on age — academic achievement. Then, these impressions are used to determine if your child shows persistent signs of inattention, disorganization, impulsivity, and hyperactivity and whether they occur in more than one situation, such as at home and in school. Since so many symptoms associated with ADHD are visible, a provider may ask teachers, parents, and others to observe and answer questions about the child being evaluated.
Among the 8 million adults estimated to have ADHD, the number is rising—in part because of increased awareness of the condition and its symptoms.6 Adults with ADHD, however, may not realize they have it. Instead, co-workers, partners, friends, or family might be the first to notice the person is struggling with things like impulsive behaviour, restlessness, focusing and shifting attention, or having trouble meeting deadlines.
A supportive spouse might take over paying bills from the partner with ADHD and making sure important appointments are scheduled and kept. Adults who have concerns about ADHD may first be screened by their primary care doctor but are often referred to a specialist such as a psychologist, psychiatrist, or neurologist who can confirm and treat the condition. Some are initially screened using the Adult ADHD Self-Report Scale.
The Symptoms of ADHD
Since ADHD is not a one-size-fits-all kind of condition, children and adults will show varying degrees and types of behaviors (you can think of it as a spectrum) including inattention, distractibility, hyperactivity, and impulsivity, depending on the type of ADHD they have. There are three types: Hyperactive-Impulsive ADHD, Inattentive ADHD (formerly known as ADD and more prevalent in girls), or Combined Type ADHD, a combo of Hyperactive-Impulsive and Inattentive ADHD symptoms.
While many of the symptoms that go along with ADHD may seem like behaviors many of us exhibit on any old day, when a child (under 12) exhibits at least 6 of the symptoms from one or both categories below for at least 6 months and demonstrates them in more than one setting (home, classroom, or at work), ADHD may be diagnosed. Adolescents 17 and older and adults should have at least five of the symptoms present.
Predominantly Hyperactive-Impulsive ADHD
· Fidgety with their hands or feet or extra squirmy sitting in a chair
· Difficulty remaining seated, which can be problematic in a class, lecture, or workplace
· Runs around or climbs excessively (children); extreme restlessness (adults)
· Difficulty engaging in activities quietly
· Acts like they have an internal motor on hyperspeed and always need to be on the go
· Talks excessively
· Blurts out answers even before questions have been completed
· Difficulty waiting or taking turns
· Interrupts conversations or intrudes — i.e. inserts themselves into a group of BFFs playing together
Predominantly Inattentive ADHD (formerly known as ADD)
· Misses the details, which can result in things like handing in homework with tons of spelling mistakes or having a complete recipe fail because ingredients were inadvertently skipped
· Difficulty paying attention; reading or listening to a teacher’s lesson can quickly devolve into a daydreaming session
· Doesn’t listen when spoken to—they may seem distracted and look everywhere but right at you
· Doesn’t follow through on instructions. For example, in the middle of reading directions on a homework assignment, they get sucked into a Nintendo vortex—and the homework never gets done
· Difficulty with organization and time management
· Avoids tasks requiring intense concentration (hello, homework)
· Gets easily distracted
· Forgetful in daily activities
Predominantly Inattentive ADHD (formerly known as ADD)
Eight Things Parents of ADHD Kids Need to Know
First and foremost, a diagnosis of ADHD is not a bad thing. With the proper support, tools, treatment, and most importantly, love, your child can succeed in anything she does, Rossillo says. Keep in mind:
1. A diagnosis does not mean your child can’t improve their symptoms or change. It just means that they need a different way of learning or support.
2. The brain can change and adapt to its environment, so if a child is accepted and supported early on, the outcome is very positive, Rossillo says.
3. Understanding their strengths and weaknesses can change the trajectory of a child’s life.
4. Connecting with your child in a positive way, even for just 30 minutes a day—chatting, having dinner, playing a game—can help reduce unwanted behaviors and increase positive ones.
5. Offer choices and always catch them being good. “When we shift our focus to what a child is doing well versus what is not going well, we can increase their motivation to please,” Rossillo says.
6. Brainstorm solutions together. “Usually kids know the answers to their own problems, so if they aren’t included in figuring things out, you may miss the mark on how to help them. Not only does this create a greater connection, but it is also empowering to them,” Rossillo says.
7. Do everything you can to not criticize the symptoms of ADHD. Instead, focus on your child’s strengths and how she can use them in other ways. Experts estimate that children with ADHD receive 20,000 more negatives messages in their lifetimes than typically-developing children, and their parents get more negative feedback about their children as well. The cumulative effects of all this negativity can lead to feelings of shame, guilt, and self-hatred.7
8. Extreme emotional sensitivity can be a hallmark of ADHD. Renown ADHD expert, William Dodson, MD, coined the term rejection sensitive dysphoria (RSD) to describe the intense emotional pain experienced by many people with ADHD when they perceive rejection or feel criticized by people in their lives who matter to them. Instantaneous rage directed at a person or situation causing the emotional page can be the way RSD manifests in people with ADHD. If your child is unable to tolerate perceived criticism or rejection take note and discuss with your pediatrician. RSD is a little-known symptom of ADHD.
Though there is no magic cure for ADHD, the condition can be effectively treated in children and adults often through a combination of behavior therapy, medication, and adjustments and support in work and school settings. Part of treatment for children also includes parent training, which focuses on better parent-child communication, teaching the child socially acceptable behavior, and rewarding them for good behavior. Treatment plans are not the same for everyone, so it’s important to monitor, follow up, and make adjustments if necessary.
Best Therapy for ADHD
Behavioral therapy and psychoeducation are recommended to help those with ADHD better manage emotions and behavior. A therapist can help with things related to executive functioning, such as time management, and work with the person to develop new routines to stay on track. Therapy can also focus on strategies to improve self-regulation and self-monitoring, so the patient is better equipped to handle day-to-day challenges at home, in the classroom, at work, and in social situations.
A cognitive-behavioral approach is effective for working on a specific problematic behavior by helping the person understand why they’re doing it and how to change it. Additionally, social skills groups can be beneficial for children and teens with ADHD who often struggle with their social interactions thanks to impulsivity. Therapy usually occurs one time per week, for 45 minutes at a time.
In children ages 6 and over, and adults, medication can be an important part of treatment.
Medications used to treat ADHD are categorized as stimulants and non-stimulants. They work by increasing levels of neurotransmitters in the brain to reduce common symptoms such as inattention and hyperactivity. Keep in mind, medication may not work for everyone, or it may take some time to find the right one.
Alternative Treatment Methods
Medication and therapy aren’t the only ways to treat ADHD, however. Some alternative treatment methods have proven helpful with managing different symptoms of ADHD.8 Talk to your doctor about these approaches:
Meditation and mindfulness
This kind of training, which focuses on being present in the moment, helps those with ADHD hone their attention and become more self-aware, which can curb impulsive behavior and reduce the anxiety often associated with ADHD.9
Researchers believe exercise (even just 30 minutes a day) can lessen the severity of ADHD symptoms and improve cognitive functioning including focus, attention, and memory.10
The best diet for ADHD is a simple and nutritious eating plan. Eating foods that reduce inflammation in the body may help the brain function better. This includes limiting white flour, white sugar, processed foods, and incorporating more fruits and vegetables and omega-3 fatty acid-rich foods such as salmon or tuna. Research shows foods high in omega-3s actually help ADHD brains function better, ease hyperactivity, and improve the ability to focus and pay attention.11
Through coaching, they can learn how to strengthen their organization and memory, improve social skills, and figure out how their brain functions best to find what works for them. The ADHD Coaches Organization (ACO) can connect you with qualified ADHD coaches across the country.
Those with ADHD are also prone to a variety of other issues including anxiety, learning disabilities, oppositional defiant disorder, substance abuse, bipolar disorder,12 depression, and social anxiety.
Studies have shown that having a co-morbid condition is often a hallmark for a more severe form of ADHD. This is why it’s critical that an ADHD evaluation also includes an assessment for these related conditions, as well as ongoing screenings if an ADHD diagnosis is made. If another condition is also diagnosed, your doctor can recommend a number of treatment options that, similar to ADHD, will include medication and therapy.
The Link Between ADHD and Risky Behaviour
Because people with ADHD have lower dopamine levels, the chemical that gives them a sense of excitement and arousal, they may be more likely to engage in risky behaviours like drugs, alcohol, having sex at an earlier age, or even adrenaline-seeking activities bungee jumping or car racing. This is because the thrill of the behaviour increases dopamine in the brain. “It’s especially difficult for those with ADHD to do mundane, boring tasks because of their ‘need’ for stimulating activities.” Rossillo says.
But this doesn’t mean that all people with ADHD should become stuntmen to be fulfilled; a 9-to-5 desk job just might not be their thing. “Many individuals with ADHD may ultimately look for jobs that include constant movement, high intensity, or a fast-paced environment,” Rossillo says. Emergency room doctor, anyone?
ADHD Superpowers: The Upside No One Talks About
Hyperfocus, humor, drive, passion, and of course, the famously-ADHD out-of-the-box thinking are among the many unique traits and positive abilities associated with ADHD. People with ADHD are known to be creative upside-down thinkers who care deeply for others (thanks to all the sensitivity and interpersonal intuition) and have lots of energy. “When we think about the challenges of ADHD, within the challenge, there are many gifts associated with it,” Rossillo said. Among them:
When ADHD creativity is harnessed, it can lead to solutions to problems that have repeatedly stump others. Some employers see a competitive advantage in a workforce that supports this type of diversity. Today, a growing number of companies are increasingly recruiting more neurodivergent thinkers (which includes people with ADHD).13,14
When someone with ADHD is engaged in something interesting to them, they can focus for hours, so, there’s a reason why your child can spend half a day playing Nintendo or skateboarding and five minutes on his homework.
People with ADHD are often highly sensitive and intuitive with a keen ability to pick up on what others may be feeling. This can make them very empathetic, loving, and kind.
It’s important to recognize that many people with ADHD are very intelligent but they learn differently and may need more structure, extra time, and specific tools to realize their full potential and truly thrive.
A child or adult diagnosed with ADHD faces daily challenges that impact nearly every area of his or her life. But persistence in finding the right medication and dosage—while also making time for therapy that focuses on effective behavioral coping techniques—will be the key to successfully managing this condition.
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition affecting both children and adults. In fact, about 8 million adults in the US are living with the condition, and the estimated number of children diagnosed with ADHD is 6.1 million.
It’s not exactly clear what causes ADHD, though most researchers blame it on a combination of biology, genetics, and the environment. There’s no specific ADHD gene, but lots of studies show a genetic link, meaning it’s common for a person diagnosed with ADHD to have at least one close relative with the condition. Toxins and chemicals in foods, cleaning products, and personal hygiene products, as well as lead exposure in the environment, can all increase the risk for ADHD because they can disrupt normal brain development. Other factors such as a traumatic brain injury and low birth weight may also contribute to ADHD.
There is a slew of symptoms associated with ADHD and they can vary from person to person, but the most common ones include impulsiveness, disorganization, poor time management, problems focusing on tasks, difficulty multitasking, hyperactivity or restlessness, low frustration tolerance, mood swings, poor planning, problems following through and completing tasks, and difficulty coping with stress.
There are three types of ADHD: Primarily Hyperactive-Impulsive ADHD, Primarily Inattentive ADHD, and Primarily Combined Type ADHD. Those with Primarily Hyperactive-Impulsive ADHD are super fidgety, restless, impulsive, impatient, and tend to interrupt others or talk incessantly. People who have Primarily Inattentive ADHD (previously known as ADD) have trouble focusing, completing tasks, or following instructions. They can be daydreamers and often misplace keys and homework. Primarily Combined Type ADHD is a combination of both types of ADHD.
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Rassovsky Y, Alfassi T. Attention Improves During Physical Exercise in Individuals With ADHD. Front Psychol. 2019;9:2747. Published 2019 Jan 9. doi:10.3389/fpsyg.2018.02747
Chang JP, Su KP, Mondelli V, et al. High-dose eicosapentaenoic acid (EPA) improves attention and vigilance in children and adolescents with attention deficit hyperactivity disorder (ADHD) and low endogenous EPA levels. Transl Psychiatry. 2019;9(1):303. Published 2019 Nov 20. doi:10.1038/s41398-019-0633-0
American Psychiatric Association. Psychiatric News. “ADHD With Bipolar Disorder May Be Distinct Illness” by Joan Arehart-Treiichel. Published online February 1, 2013. Available at: https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2013.2a9.
Psycom.net. Attention Deficit Hyperactivity Disorder (ADHD): Causes, Symptoms, Treatments. (2022) [online] Available at: https://www.psycom.net/adhd
Fortune Magazine. “As Workers Become Harder to Find, Microsoft and Goldman Sachs Hope Neurodiverse Talent Can be the Missing Piece,” by Gwen Moran. Published December 7, 2019. Available at: https://fortune.com/2019/12/07/autism-aspergers-adhd-dyslexia-neurodiversity-hiring-jobs-work/
Randall Robbins | Milena Ratajczak-Mrozek (Reviewing Editor) (2017) The untapped potential of the ADHD employee in the workplace, Cogent Business & Management, 4:1, DOI: 10.1080/23311975.2016.1271384 Available at: https://www.tandfonline.com/doi/full/10.1080/23311975.2016.1271384.