What to know about ADHD.
ADHD (Attention-Deficit/Hyperactivity Disorder) is a common neurobehavioral condition that causes changing levels in hyperactivity and impulsive behaviors. While many people experience changes in energy and attention, these tend to happen to a greater degree to those with the condition. For example, it can interfere with the daily functioning of that individual’s life or their life’s achievements.
It is important to note that ADHD is commonly diagnosed in children; however, it also persists in adulthood. For example, it is estimated to affect 11% of school-aged children and an estimated 4.4% of adults.
This blog discusses ADHD and how it differs from ADD, how ADHD is diagnosed, and explains treatment options available to adults with ADHD. ADHD is a lifelong condition. While symptoms do change with time, they can still interfere with an adult's functioning. Relationships, health, work, and finances are just a few areas that may be impacted. There are treatment options, including medications and therapies, as well as coping strategies that can help you to live well with ADHD.
What causes ADHD?
The exact causes of ADHD are not known but experts believe there are several factors at play. Genetics are thought to play a significant role in causing ADHD, but environmental factors also contribute and often interact with genetic predispositions. Factors that can increase the risk of ADHD include certain illnesses such as meningitis, exposure to toxins such as lead, and poor nutrition or substance use during pregnancy.
How is ADHD diagnosed?
There is no simple lab test or questionnaire that can determine if a person has ADHD. Mental health professionals conduct an evaluation and can use a variety of tools including IQ tests, interviews, measures of attention, rating scales, and other assessments to evaluate symptoms and determine if they meet the criteria for diagnosis.
Is ADHD a mental illness?
ADHD is classified as a mental illness but can also be described as a neurodevelopmental disorder. It is important to recognize that mental illness is a broad term that refers to any type of condition that impacts a person's thoughts, moods, or behaviors. Because the three primary symptoms of ADHD—inattention, impulsivity, and hyperactivity—all impact these areas, ADHD is considered a form of mental illness.
Is ADHD genetic?
There is a strong genetic component to ADHD. Estimates suggest that the genetic heritability of the condition is over 70%. However, having a genetic predisposition does not necessarily mean that you will develop ADHD. Research has found that there are several genes that play a role, and it is the interaction of these genes along with environmental influences that may cause the disorder.
Is ADHD considered a disability?
ADHD may be considered a disability according to the guidelines established by the Americans with Disabilities Act (ADA) if you have impairments that limit one or more major life activities (such as work or school). There must be a record of this impairment or others must be able to perceive these challenges. This means some people who have ADHD may request accommodation at work or school.
What is the difference between ADD and ADHD?
ADHD has gone through several name changes over the years and one of these former names was attention deficit disorder (ADD). While the term no longer represents an official diagnosis, it is still sometimes used to describe the inattentive presentation of the condition without hyperactivity. People with this presentation of the condition have trouble staying on task.
ADHD stands for attention-deficit/hyperactivity disorder, and it is a neurodevelopmental issue with an estimated global prevalence of about 4%, meaning that about 4% of the world's population has ADHD. It is marked by symptoms that are grouped as "inattentive" and "hyperactive/impulsive."
ADHD Types
The DSM-5 breaks ADHD down into three different types:
Predominantly Inattentive Presentation
Predominantly Hyperactive/Impulsive Presentation
Combined Presentation
Predominantly Inattentive-type ADHD
Predominantly Inattentive-type ADHD requires that an individual have six or more of the following symptoms:
Making careless mistakes or overlooking details in homework, work, or other activities
Difficulty holding attention to tasks
Difficulty listening when spoken to directly
Difficulty following through on instructions or failing to finish tasks
Disorganization
Avoiding or disliking tasks that require "sustained mental effort."
Losing things
High distractibility by external stimuli or thoughts
Forgetfulness in activities
Hyperactive/Impulsive-type ADHD
Hyperactive/Impulsive-type ADHD requires that an individual have six or more of the following symptoms:
Fidgeting or squirming
Leaving their seat at inappropriate times
Running or climbing at inappropriate times
Making noise when working or playing
Moving as if they are "on the go" or "driven by a motor"
Talking excessively
Blurting out answers before someone finishes their question
Difficulty waiting their turn
Interrupting in conversations
Combined-type ADHD requires that an individual meet criterion for both inattentive-type and hyperactive/impulsive-type ADHD.
When Is ADHD Diagnosed?
Neurodevelopmental disorders, by definition, develop in infancy or early childhood. The DSM-5 requires that symptoms begin before age 12 for a diagnosis of ADHD. However, many individuals with ADHD are not diagnosed until adulthood.
Teachers often recommend a referral for ADHD testing when a child is having difficulty at school. Because of this, children who have strong academic skills might go under the radar if they are not struggling in an obvious way.
White children are more likely than Black, Asian, and Latinx children to be diagnosed with ADHD. In addition, girls with ADHD are often missed and do not get referred for testing.
If someone was not diagnosed in childhood but notices that they have many of these symptoms, they can seek ADHD testing as an adult.
ADHD Assessment for Adults
Since ADHD is a lifelong diagnosis, you are never too old for an ADHD evaluation. Psychologists, psychiatrists, and other medical and mental health professionals with appropriate training can diagnose ADHD. Most physicians have referral information for where their patients can get an ADHD evaluation.
There are many psychological assessment measures that can be used to diagnose ADHD in adults, including:
The Test of Variables of Attention (TOVA): The TOVA is a computerized, standardized test that measures an individual's ability to pay attention through a visual and auditory task. Scores compare the client's performance to that of same-age, same-gender individuals with ADHD and without ADHD.
The Conners Adult ADHD Rating Scales (CAARS): The CAARS is a norm-referenced rating scale that determines whether someone has difficulty with attention, impulsivity, and hyperactivity, as well as whether those symptoms meet the diagnostic criteria for ADHD. Clients complete a self-report form, and someone close to the client completes an observer form.
The Behavior Rating Inventory of Executive Functioning-Adult Version (BRIEF-A): The BRIEF-A is a norm-referenced rating scale to gather information about someone's ability to regulate impulses, complete tasks, organize, focus, and other symptoms of ADHD.
The Barkley Adult ADHD Rating Scale (BAARS): The BAARS links clients' symptoms to the DSM diagnostic criteria through self-report and observer data.
ADHD Treatment for Adults
When it comes to treatment for any mental health diagnosis, the individual's unique needs are prioritized. Talk to the providers on your treatment team about your concerns, questions, and preferences to determine what approach best fits you, and ask about the different options available to you.
Typically, ADHD treatment options for adults include medication, therapy, skill building, and appropriate accommodations.
Medication
Medication options for ADHD treatment in adults include stimulant (such as Adderall and Ritalin) and non-stimulant (such as Strattera and Guanfacine) medications.
Medications help regulate impulses and sharpen focus. Some take ADHD medication daily, and some take it specifically on days when they need to complete specific tasks that require a lot of focus. Consult your primary physician about medication options for your ADHD diagnosis. They will either discuss options with you or refer you to a specialist who can help.
Therapy
Adults with ADHD often benefit from ongoing therapy services to process life stressors and develop behavioral skills for symptom management. Cognitive-behavioral therapy, mindfulness-based therapy, and brief motivational interviewing offer evidence-based approaches for ADHD treatment in adults.
Social Support
Ongoing support is essential to every person's well-being. If an adult with ADHD is in a long-term, committed relationship, their partner can benefit from support to help the couple through the unique challenges that ADHD could bring to their relationship.
Treatment for Comorbidities
More than half of adults with ADHD have at least one comorbid diagnosis. The specific treatment plan depends on the individual's needs and diagnoses. For example, those with ADHD might also have a diagnosis of a disruptive, impulse-control, or conduct disorder, bipolar disorder, anxiety disorder, obsessive-compulsive disorder, depression, trauma-related disorder, substance use disorder, or personality disorder.
In addition, a high number of individuals with ADHD also meet the diagnostic criteria for autism spectrum disorder or a learning disorder.
Adults with ADHD can access treatment resources, regardless of whether they were diagnosed in childhood. Talk to your healthcare provider about which treatment is the best for you.