What is ADHD?
Attention Deficit Hyperactivity Disorder (ADHD) is derived of three main types of symptoms: inattention, hyperactivity, and impulsivity in various different environments. Many people with ADHD display varying degrees of each of the symptoms. Some symptoms are usually more prevalent than others which helps to determine the type. In children, ADHD is typically diagnosed between the ages of 5 and 7. Many adults with ADHD grew up with the disorder, though it may have not been diagnosed. It will not impair a person in only one location. It would affect them pretty much anywhere but may be more manageable in certain environments.
To date, there are no truly definitive statements proving the cause of ADHD. The evidence currently available shows that a variety of biological factors may predispose children to significant symptoms relating to attention and higher energy levels and impulsive behaviors. Recent evidence specifically suggests that brain functioning in the areas responsible for modulating and inhibiting behavior may be affected by hereditary factors in individuals that develop the disorder. In the well controlled studies on the causes, no significant links have been found between the disorder and dietary factors such as sugar, caffeine, or artificial coloring. In other words, while dietary factors may have some impact on behavior or symptoms (for any child), there is no direct relationship between dietary factors and ADHD. Likewise, the evidence does not support the theory that parenting practices or anxiety are important causal factors in the development of the disorder. However, they can impact the severity of the symptoms and behaviors, as they do with any child.
Another common myth, is that children will outgrow the disorder. It was widely believed, for a long time, that children would outgrow their symptoms and behavioral difficulties by adolescence or early adulthood. However, now that data on long term outcomes has been accumulated, it shows that 70-80% of children with ADHD continue to exhibit significant deficits in attention and impulsivity relative to their same age peers during adolescence. About 50% continue to exhibit deficits into adulthood. I am one of those.
Some people question whether ADHD is a valid thing or if people with it are just “different” from the norm. Some of this doubt stems from the fact that most people, especially children, display the symptoms of ADHD at some point in their lives. For example, there are plenty of energetic children out there. Why is one considered energetic and the other considered hyper? What’s the difference? How come when I forget something silly, we call it forgetful but when my son does it, he’s ADHD?
The key difference between a person with ADHD and any “normal” person is simply persistence. People with the disorder have a persistent pattern of inattention, hyperactivity, or impulsivity, or any combination of the three that occurs in academic, occupational, and social settings. Let’s break that down a little bit to make it more clear. The environment doesn’t matter. People with ADHD can’t control themselves in a social setting but then not in an academic setting. They don’t behave at school and only “act up” at home or work. One of the key distinguishing factors of ADHD is that the symptoms are prevalent in multiple settings.
Inattentive ADHD: This type used to be called ADD as people have a hard time focusing and paying attention. We may lose our focus mid-sentence or be easily distracted. These are often called “butterfly” moments. This may also include failing to complete tasks, making careless mistakes, inability to stay organized, and difficulty keeping track of things.
Hyperactive-impulsive ADHD: These folks can pay attention but seem to always be on the go, we can’t sit still. This is often seen as tapping of the fingers, shaking a foot or leg, bouncing up and down, climbing on things, etc. Problems with hyperactivity usually present as excessive fidgeting or squirminess, inappropriate running and/or climbing, talking excessively, or constantly being on the go. Impulsivity may include frequently interrupting others, lack of patience, blurting out answers, or constant failure to wait their turn.
Combined ADHD: As the name implies, this type of ADHD includes all of the above. There are attention issues as well as hyperactivity and impulsivity. This is the most common type.
Frequent careless mistakes
Many butterfly moments (Easily distracted)
Difficulty with focus and staying on task
Blurting out answers
Trouble finishing tasks before moving on to others
Trouble sustaining attention to conversations
Trouble taking turns
Squirming when sitting
Difficulty in quiet situations
While many people may display some of these symptoms from time to time, people with ADHD experience more of these symptoms and they usually tend to be much more persistent, severe, and intense. The difference between an energetic child and a Hyperactive child is that the hyperactivity causes persistent problems. This may be in a school setting where a teacher is trying to get the class to come to order and the child with ADHD simply can’t calm down and sit still. Or it may be in the doctor’s office when trying to get a blood pressure reading and the child can’t stop fidgeting. It could be at home when the family is trying to eat dinner and the child is climbing all over the table and chairs. While it’s normal for some children to have trouble completing homework or chores, the child with ADHD needs constant supervision, monitoring, and redirection to complete any given task. The big difference between the “norm” and ADHD is that these symptoms cause significant impairment in daily functioning while the behaviors that occur only occasionally tend to reflect normal childhood behavior. Children with ADHD don’t fit in the same box as other children.
One of the most perplexing aspects of ADHD is that the symptoms tend to vary considerably at different times and in different settings. For example, my son may have very good days at school where he stays on task and completes all of his work but maybe 60 – 80% of the time, he’s inattentive and hyper. This is misconstrued as lazy or defiant to his teachers because they know he can do it. He “just chooses not to” most of the time. He “lacks motivation” or simply “doesn’t care”. Erratic performance at home and/or at school is highly common among those with ADHD. Just because he has one good day doesn’t mean every day can be just as good. I think of it this way, just because I got a “hole in one” on the putt-putt course that one time doesn’t mean I can do it every time. Can you? Performance fluctuates for everybody, even with ADHD.
Many children with ADHD tend to display several other problems. They may display low levels of frustration tolerance, temper tantrums/fits, social problems, lack of confidence, irrational fears, academic underachievement, bossiness, and low self esteem. None of these are considered ADHD symptoms and while some children with it may experience some of these difficulties, not all do. These difficulties can occur for a variety of different reasons. There is a rather long list of medical conditions and other disorders that tend to mimic ADHD symptoms as well. It is very important to know the difference as this can help prevent a misdiagnosis which can lead to ineffective treatment that may exacerbate an underlying condition.
ADHD Diagnosis & Treatment
There is no specific test to diagnose ADHD. Making the diagnosis should include a medical evaluation first to rule out any other possible causes of the symptoms. Next, there should be information gathering for medical professionals to evaluate known medical issues, personal and family medical and academic history, and academic records. This will be followed by specific questionnaires for family members, school personnel, and anybody else who is frequently involved in the child’s life, such as babysitters, coaches, and friends of the family. ADHD rating scales will help the medical professionals collect and evaluate the information for an accurate diagnosis. For a true ADHD diagnosis, multiple symptoms will be present for more than six consecutive months and will be consistent in at least two different environments, such as home and school.
While medical treatment can help with some symptoms, there is no “cure all” pill that fixes ADHD. It is not a curable disorder. As far as treating the core symptoms of inattention, hyperactivity, or impulsivity, numerous studies have shown that stimulant medication has shown significant benefits in around 80% of children with ADHD. Evidence suggests that the stimulants correct a biochemical condition in the brain that interferes with attention and impulse control. That being said, stimulant medications also come with a wide variety of negative side effects which I will list for any products I’ve tried and reviewed. It is absolutely vital that a correct diagnosis be determined, by medical professionals, before any medical treatment is started. Hindsight doesn’t undo any damage that may be done by giving meds that make an underlying condition worse.
While medications tend to help with symptoms, and may make the child with ADHD undistinguishable from other children their age, they do not treat all symptoms of the disorder. Behavior Therapy has also proven highly effective when done correctly and is often done in addition to medications. Behavior Therapy should be designed and implemented by parents with the help of a mental health professional or behavior therapist. The basic premise of behavior therapy is that every specific behavior will increase or decrease based on the consequences of that behavior. As easy as that sounds, it is extremely difficult to implement and follow an individualized behavior treatment plan effectively due to the difficulty people naturally have in being entirely consistent. Finding appropriate rewards and punishments also proves quite challenging for so many specific behaviors.
With appropriate medical and behavioral treatment, the core symptoms of the disorder can be managed effectively. However, other interventions are often necessary to address other difficulties the child may be having. These may included specialized educational assistance, social therapy, or emotional therapy to name a few. For ADHD to be treated and managed effectively, all problems that the child has must be addressed to either help reduce or eliminate the symptoms. But with a combination of treatment, constructive discipline, coping strategies, and creative parenting… people with it can be highly successful. In fact, I read somewhere that about 7% of adults with ADHD became some of the most influential people. A few of these include:
- Actor – Christopher Knight
- Actor – Jim Carrey
- Actor – Robin Williams
- Actor – Will Smith
- Actress – Paris Hilton
- Artist – Pablo Picasso
- Athlete – Michael Jordan
- Aviation Entrepreneur – David Neeleman
- Baseball Star – Pete Rose
- Business Mogul – Richard Branson
- Comedian / TV Host – Howie Mandel
- Entrepreneur – Bill Gates
- Founder of Disneyland – Walt Disney
- Founder of Kinko’s – Paul Orfalea
- Inventor – Benjamin Franklin
- Inventor – Thomas Edison
- Music Composer – Mozart
- NFL Quarterback – Terry Bradshaw
- Olympian – Bruce Jenner
- Olympian (Most decorated of all time) – Michael Phelps
- Physicist – Albert Einstein
- Political Consultant – James Carville
- President of the United States – John F. Kennedy
- Professional Dancer (Dancing With the Stars) – Karina Smirnoff
- Singer/Actor/Producer – Justin Timberlake
- Sing – Solange Knowles
- Star Chef – Jamie Oliver
- TV Host (Extreme Makover) – Ty Pennington
In conclusion, ADHD is a neurological disorder with an undetermined cause at this point. There are multiple symptoms but the primary three are a combination of inattentiveness, hyperactivity, and impulsivity that significantly impair a child’s daily functioning for more than six months in multiple settings. The two primary forms of treatment are stimulant medications and behavior therapy, though other interventions are often necessary. Academic difficulties are almost always prevalent in children with ADHD. Dietary factors, parenting practices, and anxiety have no direct link to the disorder. There are many conditions which mimic the same symptoms, as well as many myths surrounding the disorder. There are also many people with it that grow up to be highly effective people in society.
I hope this clears things up!