Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects millions of children and adults worldwide. In the United States, the prevalence is higher than the national global average, with about 11.4% of children aged 3-17 years diagnosed with ADHD, as reported by the Centers for Disease Control and Prevention (CDC). ADHD is not just limited to children; around 4.4% of U.S. adults are estimated to have ADHD, though many cases go undiagnosed according to the National Institute of Mental Health. Additionally, there is a notable gender disparity in ADHD diagnoses, with boys being more than twice as likely to be diagnosed as girls, at a rate of 12.9% compared to 5.6% . Despite its prevalence, there are still many misconceptions and a lack of understanding about ADHD.
What is ADHD?
ADHD is a chronic condition characterized by persistent patterns of inattention, hyperactivity, impulsivity and emotional dysregulation that interfere with functioning or development. Attention Deficit Hyperactivity Disorder is typically diagnosed in childhood, often continuing into adulthood, and can significantly impact a person's academic, occupational, and social life. The exact cause of ADHD is not fully understood, but research suggests that it results from a combination of genetic, neurological, and environmental factors:
1. Genetics: ADHD tends to run in families, suggesting a strong genetic component. Specific genes related to the neurotransmitter dopamine, which plays a role in attention and behavior regulation, have been implicated. One of the first questions I ask when considering whether a child client has ADHD is if their parents or older siblings have been diagnosed.
2. Brain Structure and Function: Imaging studies have shown that people with ADHD often have differences in the size and activity of certain brain regions, particularly those involved in attention and impulse control. This doesn't mean that their brain is dysfunctional!!! It just means that their brain has super powers in areas that most others do not.
3. Environmental Factors: Exposure to certain environmental toxins, prenatal exposure to alcohol or tobacco, low birth weight, and premature birth have been associated with an increased risk of developing ADHD.
Symptoms of ADHD
Attention Deficit Hyperactivity Disorder symptoms are generally divided into two categories: inattention and hyperactivity-impulsivity. The severity and combination of symptoms can vary widely from person to person.
When my daughter was 6 years old, I noticed that her imagination was so much more than other kids her age; she often made up stories, would stare out the window or become preoccupied with other aspects of her environment. This led to so many comments or initial thoughts that she "lies a lot" because she makes up these wild stories. Other things I heard from her teachers were "she needs a lot of redirection" or "sometimes she just checks out." I questioned them about her having ADHD and all of them said they didn't think she did, that she just needs to learn to pay more attention! This is where I began to read and learn more about Attention Deficit Hyperactivity Disorder.
Inattention Symptoms can include:
- Difficulty sustaining attention in tasks or play; this means moving from one toy or play without completing the initial play or task
- Frequent careless mistakes in schoolwork or other activities
- Trouble organizing tasks and activities
- Avoidance or dislike of tasks that require sustained mental effort
- Losing things necessary for tasks and activities
- Easily distracted by external stimuli
- Forgetfulness in daily activities
Hyperactivity-Impulsivity Symptoms:
- Fidgeting or squirming in seats
- Inability to stay seated in situations where it’s expected
- Running or climbing in inappropriate situations
- Difficulty playing or engaging in activities quietly
- Talking excessively
- Interrupting or intruding on others’ conversations or games
- Difficulty waiting for their turn
I want to point out that another symptom that we often see with all these different types is a higher emotional dysregulation than other children of their age. Girls might be labeled as "emotional or dramatic" while boys are more likely to be labeled as "aggressive." While there are type types of ADHD, there is a third diagnosis, which is ADHD, Combined Type; this basically means that the child exhibits several symptoms that fall within both categories.
Gender Differences in ADHD
Attention Deficit Hyperactivity Disorder manifests differently in boys and girls, which can sometimes lead to underdiagnosis or misdiagnosis in girls.
Boys are often characterized by more obvious hyperactive and impulsive behaviors, such as acting out, fidgeting, and disruptive behavior. These behaviors are more likely to draw attention, leading to a higher diagnosis rate in boys.
Girls with ADHD are more likely to exhibit inattentive symptoms, such as daydreaming, difficulty paying attention, and internalized anxiety. These symptoms are less disruptive and therefore may be overlooked, leading to a lower diagnosis rate in girls. Girls with ADHD may also struggle with social interactions, which can contribute to issues like low self-esteem and anxiety. In fact, it is important to note that there is a high likelihood of co-occurring mental health diagnosis with depression and anxiety among boys and girls with ADHD; I will go over more about that later.
Mental Health Treatments for ADHD
Treatment for ADHD typically involves a combination of medication, therapy, and lifestyle changes. The goal of treatment is to reduce symptoms and improve functioning in daily life in a world that does not support nuerodivergent individuals.
1. Medications: Stimulant medications, such as methylphenidate (Ritalin) and amphetamines (Adderall), are the most commonly prescribed drugs for ADHD. These medications help increase the levels of certain neurotransmitters in the brain, improving attention and reducing hyperactivity and impulsivity. Non-stimulant medications, like atomoxetine (Strattera) and guanfacine (Intuniv), may also be used, particularly if stimulants are not effective or cause significant side effects. Always consult with your child's doctor about medications and be aware of side effects; I also encourage parents to discuss with their kids how they feel on the medication. Above all else ADVOCATE, ADVOCATE, ADVOCATE for your child; if they are stating that they are not happy with the medication or that it "makes them feel weird" listen to them! Take that into consideration and have more conversations with your prescriber about what your child is expressing.
2. Behavioral Therapy: Behavioral therapy is often used in conjunction with medication. It helps individuals with ADHD develop strategies to manage their symptoms and improve their organizational skills, time management, and social interactions. For children, parental training and school-based interventions are also critical components of treatment.
3. Lifestyle Changes: Regular physical activity, a balanced diet, and consistent sleep patterns can all help manage ADHD symptoms. Studies have shown that children with ADHD tend to fair better with symptoms when they participate in organized sports or extra curricular activities. Create structured routines, maintain balanced meals and develop a healthy bedtime routine; sleep is often impacted by ADHD but it is one of the most important basic needs for children with ADHD. My daughter often struggles with becoming auditorily overstimulated and we invested in the Loop Earplugs; these have made a noticeable difference when she needs to participate in large group settings such as sports, school events, social gatherings, etc.
Co-occurring Mental Health Conditions
Individuals with ADHD are at an increased risk of developing other mental health conditions. Some common co-occurring conditions include:
1. Anxiety Disorders: Many individuals with ADHD also experience anxiety, which can manifest as excessive worry, restlessness, and physical symptoms like a racing heart or sweating.
2. Depression: The challenges of living with ADHD, including academic struggles and social difficulties, can lead to feelings of sadness and hopelessness, sometimes resulting in depression.
3. Oppositional Defiant Disorder (ODD): Children with ADHD may also develop ODD, characterized by a pattern of angry, irritable mood, argumentative behavior, and vindictiveness.
4. Learning Disabilities: ADHD often coexists with learning disabilities, such as dyslexia, which can further complicate academic performance and self-esteem.
Attention Deficit Hyperactivity Disorder is a complex disorder that requires a multifaceted approach to treatment and support. By understanding the causes, recognizing the symptoms, acknowledging the gender differences, and addressing the co-occurring mental health conditions, we can better support children and adults with ADHD and help them lead fulfilling, productive lives.
I want to end this by stating that while a great deal included here is basic or general information, this is not meant to be used to diagnose a child or adult with ADHD. I encourage parents to seek clinical support to officially diagnose your child with Attention Deficit Hyperactivity Disorder. Factors such as culture, family history, trauma history and undiagnosed medical conditions must be taken into consideration when considering any mental health diagnosis or neurodevelopmental diagnosis. Each child is unique and it is impossible, even unethical, to take the blanket information above and assume that you can apply it to all individuals. If you want to learn more or have questions about Attention Deficit Hyperactivity Disorder please reach out to us via phone or email.
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