What exactly is Attention Deficit/Hyperactivity Disorder (ADHD)?

Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most commonly diagnosed neurodevelopmental disorders in the United States.  Population surveys shows that ADHD occurs in most cultures in about 5% of children and 2.5% of adults. There is a prevailing sentiment amongst medical professionals that ADHD is over-diagnosed.  I don’t plan on weighing in on that debate, but I do want to talk about what ADHD is and what it is not.

First, what is ADHD?  ADHD is a neurodevelopmental disorder.  This indicates that ADHD generally manifests during the developmental period, and symptoms are often observed before the child enters grade school.  In addition, ADHD can cause deficits in the child’s ability to function in personal, social, and academic domains. ADHD is defined by impairing levels of inattention/disorganization and/or hyperactivity/impulsivity. We no longer use the terms ADD and ADHD separately to refer to inattentive and hyperactive presentations of this disorder.  Instead, there are three types of ADHD: Predominantly Inattentive Type, Predominantly Hyperactivity/Impulsive Type, and Combined Presentation.  The Inattentive Type is defined by deficits in attention and organization, the Hyperactivity/Impulsive Type is defined by hyperactive and impulsive symptoms, and the Combined Type is defined by both Inattention and Hyperactivity/Impulsivity symptoms.  In order to diagnose ADHD and the various subtypes of ADHD, an individual must display a certain number of symptoms within these categories.  Below are symptoms of Inattention and Hyperactivity/Impulsivity that a child must display (according to the diagnostic criteria of the DSM-5) in order to receive a diagnosis of ADHD.

Symptoms of ADHDInattention:

  • Makes careless mistakes/lacks attention to detail
  • Difficulty sustaining attention
  •  Does not seem to listen when spoken to directly
  • Fails to follow through on tasks and instructions
  • Exhibits poor organization
  • Avoids/dislikes tasks requiring sustained mental effort
  • Loses things necessary for tasks/activities
  • Easily distracted (including unrelated thoughts)
  •  Is forgetful in daily activities

Hyperactivity and Impulsivity:

  • Fidgets with or taps hands or feet, squirms in seat
  • Leaves seat in situations when remaining seated is expected
  • Experiences feelings of restlessness
  • Has difficulty engaging in quiet, leisurely activities
  • Is “on-the-go” or acts as if “driven by a motor”
  • Talks excessively
  • Blurts out answers
  • Has difficulty waiting their turn
  • Interrupts or intrudes on others

An individual must display six or more symptoms of inattention to be diagnosed with the Inattention Subtype; and an individual must display six or more symptoms of hyperactive/impulsive behaviors to be diagnosed with the Hyperactive/Impulsive Subtype.  If someone meets the symptom threshold for both Inattention and Hyperactive/Impulsive Subtypes, then they can be diagnosed with the Combined Subtype.  To reinforce what I mentioned earlier, these symptoms must cause impairment in daily functioning or development in order to meet criteria for this disorder. In addition, several symptoms must be present before the age of 12 years old, and symptoms must be present in two or more settings (i.e. home and school).  For example, if the symptoms only occur at home and in no other setting, a child may not meet criteria for ADHD.

ADHD AssessmentsSymptoms of ADHD are often observed when the individual is a toddler, although symptoms are difficult to distinguish given the typical developing behavior of a toddler.  Thus, ADHD is easier to identify during the school age years when symptoms of inattention and hyperactivity/impulsivity impair the child’s ability to function effectively at school. Symptoms of ADHD are relatively stable in early adolescence, although hyperactive behavior generally becomes less pronounced in late adolescence and adulthood. Many people state that children tend to “grow out of ADHD” as they become an adult.  However, studies have shown that a substantial proportion of children that were diagnosed with ADHD remain impaired by these symptoms into adulthood. 

What causes ADHD? There is no one smoking gun in this scenario, although research has identified that environmental and genetic factors play a role in the development of ADHD.  In addition, there are different disorders that share features of ADHD, but they should not necessarily be considered symptoms of ADHD.  For example, a child may not pay attention in class due to oppositional and defiant behaviors.  Or a child may display impulsive behaviors at times that manifest in the form of an intense behavioral disruption that is out of proportion to the stressor that contributed to the disruption (as opposed to a more frequent pattern of impulsive behavior).  In addition, there are several other behavioral and neurodevelopmental conditions that contribute to symptoms of inattention and hyperactive/impulsive behavior (examples can include Autism Spectrum Disorder, Specific Learning Disorder, Intellectual Disability, Reactive Attachment Disorder, Anxiety Disorders, Depressive disorders, Bipolar Disorder, Disruptive Mood Dysregulation Disorder, Substance Use Disorders, Personality Disorders, Psychotic Disorders, Medication-Induced Disorders, and Neurocognitive Disorders).  Give the multitude of disorders that might present similarly to ADHD, an accurate assessment is needed in order to clarify the diagnostic picture.  Thus, a psychological evaluation can be given to assess for the presence of various symptoms, and determine which disorder/s are responsible for the child’s behavioral presentation.

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