What is ADHD? Symptoms, Diagnosis, and Management

Attention Deficit Disorder (ADHD) is a neurodevelopmental disorder that affects both the thought processes and behavior of individuals. It is one of the most common neurological disorders and is often diagnosed in childhood.

Historically, it has been more prevalent in boys but it is now understood that many girls flew under the radar as the symptoms can vary significantly between males and females.

When was ADHD founded?

ADHD was first Identified in 1798 by a Scottish doctor, Sir Alexander Crichton, who realized that some people were easily distracted and unable to focus on their activities the way others could.

It was again mentioned in 1902 by a British pediatrician named Sir George Frederic Still; he described it as an “abnormal defect of moral control in children.”

After 1902, it was not brought up again until the American Psychological Association recognized it in the late sixties. It was added to the second edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) of Mental Disorders in 1968. Here it was known as the Hyperkinetic Reaction of Childhood.

In 1980, the third edition of the DSM was released. The diagnosis became officially known as Attention-Deficit Disorder with or without hyperactivity.

Attention-Deficit Disorder without hyperactivity was removed from the DSM IV published in 1994. It was replaced with Attention-Deficit/Hyperactivity Disorder with 3 subtypes including predominantly inattentive, predominantly hyperactive-impulsive, and combined type.

Types of ADHD and Symptoms

The three types are broken down as follows:

ADHD: Predominantly Hyperactive-Impulsive Type

The symptoms that fall under this type are the most commonly associated. Generally, these symptoms are most prominent in males, which contributes to the higher male-to-female diagnosis ratio.

-Restlessness: Unable to sit still, shifting positions, getting up constantly to move around

-Fidgeting: Tapping fingers, bouncing leg, playing with objects

-Impulsiveness: Talking excessively, interrupting, pacing

ADHD: Predominantly Inattentive type

The symptoms that fall under this category were not commonly recognized for a long time. Most females fall under this category.

– Lack of organization: Messy spaces, difficulty prioritizing and organizing, losing items

– Procrastination: Difficulty initiating tasks, getting overwhelmed and not completing tasks

– Time perception issues: Late to appointments, misjudging time to complete tasks,

– Trouble following conversations

ADHD: Combined Type

People with combined type often have some or both of the symptoms listed above. They could have trouble organizing and also be restless and fidgety. There are no right or wrong symptoms and most people tend to lean towards combined type.

Causes of ADHD

Genetics

ADHD has a strong genetic component. Most people who have been diagnosed with ADHD have at least 1 family member who also has this disorder. Statistics suggest that you are 60% to 90% more likely to be diagnosed if a parent has been diagnosed.

Neurological signs

Some studies show that ADHD brains may have smaller and/or larger areas than a typical brain while other studies show that there may be a different number of neurotransmitters. It is also linked to lower-than-normal dopamine and norepinephrine levels.

Common Traits of ADHD

Hyperfixation

Hyperfixation is when a person becomes completely absorbed in the task they are doing. They will neglect other tasks, responsibilities, and interests. This task can become an obsession for hours, days, or even weeks. They display increased enthusiasm and may indulge in deep conversations or research.

Overstimulation

Overstimulation can occur from many different things. In ADHD the most common is sensory overload which includes: sights, sounds, and textures. Bright lights, loud rooms, and crowded environments are all common triggers of overstimulation. It is also common to also be triggered by multiple tasks, complex directions, or even too much emotional input.

Object Permanence

Object permanence is the understanding that an object exists even when it is not seen, heard, or sensed. Usually this develops in young childhood such as when you are playing peekaboo with your parents. People with ADHD don’t develop this skill like a neurotypical person would, however. Due to a lack of focus, impulsivity, and poor working memory, if an object is out of sight it is out of mind; this is why people with ADHD tend to lose things constantly.

ADHD Paralysis

While ADHD paralysis is not a recognized “medical term” it is commonly associated with ADHD. It is the feeling of being paralyzed when needing to initiate a task. This is usually due to struggles with decision-making, transitioning from one task to the next, or being overwhelmed by too many steps and/or possibilities.

Time Blindness

Time blindness refers to the issues of perceiving, estimating, and managing time. Oftentimes, people with ADHD have an “off” sense of time. They struggle with telling how much time has passed, this is derived from under or overestimating the amount of time it takes to complete tasks. They also have difficulty judging time intervals. Five minutes can feel like an hour, or a day can feel like a week.

Zoning Out

Zoning out is a period of reduced awareness, attention, or engagement. There is no real cause for this as it is mainly just a characteristic of ADHD.

Diagnosing ADHD

Where to go?

It is becoming more common now for your pediatrician or family doctor to diagnose and treat ADHD. Some regular doctors are not comfortable diagnosing or treating ADHD and will refer you to a psychiatrist for further testing to be done.

Types of tests

If you go to a pediatrician or family doctor for a diagnosis they will generally give you two forms to fill out. A depression screening and an ADHD rating scale. Both forms have questions that will total up to a certain number of points. Depending on your final score, you will either be diagnosed or you won’t.

If you go to a psychiatrist they will most likely use a combination of these scaled forms and a computerized test. The computerized test can vary depending on the doctor but will gauge attention and focus.

Management Options for ADHD

Stimulants

Stimulants are the most common management option for people with ADHD. These medications are controlled substances and usually require regular drug screenings. Medications include:

– Adderall

– Ritalin

– Vyvanse

– Concerta

– Focalin

Non-stimulants

Non-stimulants are generally used if stimulant medications do not work or if the patient prefers to not be on a controlled substance. There are antidepressants, blood pressure medications, and more that are used in the management of ADHD. Some of these are:

– Strattera

– Quelbree

– Clonidine

– Intuniv

Behavioral Therapy

Behavioral therapy can be very beneficial for a multitude of ADHD symptoms. You can choose to use medication, therapy, or even both! Therapy for people with ADHD can include:

Cognitive Behavioral Therapy: Teaching people to recognize and change negative thought patterns and behaviors and how to correct them
Social Skills Training: Teaching skills that people need for everyday interactions such as active listening, empathy, and social cues
Executive Functioning Training: Teaching time management, organization, and planning
Mindfulness Training: Teaching how to become more self-aware and the steps to calm and ground yourself to come back to the present

Natural Remedies

There are many natural things you can do to help manage ADHD as well. Lifestyle changes and supplements can all be beneficial. When using supplements or herbs, make sure to check with your doctor and/or check for contraindications associated with them!

Common Lifestyle changes include:

Establishing routines
Setting realistic goals
Exercising 60 minutes per day
Eating a healthy diet: Rich in fat, low in sugar, cut out dyes, especially red dye
Getting adequate sleep
Limiting screen time
Practicing mindfulness (more on this here)

Supplements/herbs:

Fish Oil
Magnesium
Vitamin B6
Ginseng
Ashwagandha
Ginkgo biloba

Mental Health Conditions Related to ADHD

Anxiety

Anxiety is one of the most common comorbid conditions with ADHD. While anxiety and ADHD share similar neurological factors, it’s often exacerbated by the academic and social struggles that come along with ADHD as well as the stress and emotional dysregulation that occurs.

Depression

The feelings of hopelessness, low self-worth, and failure that go along with ADHD make people more inclined to develop depression. Emotional dysregulation also can cause intense mood swings that can land people in a depressive state.

Sensory Processing Disorder

SPD and ADHD are two separate conditions but are very commonly comorbid. It is characterized as an increased sensitivity to sound, touch, taste, and smell. SPD can present as an over or under-reaction to the stimuli. It is common for people with SPD to have issues with focus, emotional regulation, overwhelm, and motor coordination. Increased anxiety, emotional outbursts, and issues responding to stimuli are all normal.

Rejection Sensitivity Disorder

RSD is often associated with ADHD and other mood disorders. It is the intense emotional reaction to anything that is perceived as rejection, criticism, or failure. This has a strong impact on social interactions and can cause feelings of sadness, anger, and low self-worth.

Autism Spectrum Disorder

While it is not as common for ASD and ADHD to be comorbid, it does happen and sometimes one can be misdiagnosed for the other. ASD poses its own unique set of challenges but also has a lot of overlap which is the reason for the misdiagnosing. It causes social and communication issues, sensory sensitivities, attention/focus issues, and poor executive function.

Obsessive Compulsive Disorder

OCD also shares neurological factors with ADHD though it is quite different. OCD is generally characterized by difficulty with attention, mental or physical rituals to satisfy the anxiety that comes with obsessive thoughts (such as counting steps or checking locked doors repeatedly,) and emotional dysregulation due to distress caused by obsessive thoughts.

Oppositional Defiant Disorder

ODD is a disorder that is characterized by defiance, hostility, and disobedient behaviors toward people who are authority figures. It can sometimes be difficult to differentiate from ADHD as it generally presents as arguing, temper outbursts, and emotional dysregulation. It leads to increased social challenges.