What is Attention-Deficit Hyperactivity Disorder (ADHD)?

Attention-deficit hyperactivity disorder (ADHD) is a chronic neuro-behavioral condition that affects millions of children each year. For many, this condition begins in childhood and persists well into adulthood. For others, however, it appears to naturally “fade-out” or improve once the individual becomes an adult. There is no specific test used to diagnose ADHD, so some experts believe it is over-diagnosed, while others believe it is under-diagnosed.

How Common is ADHD?

It is one of the most diagnosed childhood disorders.

Are Boys or Girls Most Frequently Diagnosed with ADHD?

Yes, boys are diagnosed with ADHD more frequently than girls.

What are Common ADHD Symptoms?

ADHD symptoms vary based on the child, however, there are some symptoms that children with ADHD tend to experience. For instance, children with ADHD typically have a hard time paying attention to details – at home and at school. They also tend to be “extremely active” or hyperactive. Moreover, children with ADHD are usually more impulsive or “rash” than children who do not have the condition. Lastly, some children may have one or two of these symptoms, while others may exhibit all three.

Note: It is “normal” for children to exhibit one or two or even all three of these behaviors from time-to-time, however, when these behaviors persist past the “normal” timeframe for them or if your child exhibits these behaviors long past the time when others in his/her age group stopped doing them – it may be time to get your child evaluated by a trained health professional.

Other symptoms normally associated with ADHD include poor self-esteem, a lack of confidence, low grades or poor academic performance, and short-lived and/or volatile or dysfunctional relationships.

Remember, it’s “normal” for children to occasionally be “absent-minded,” hyperactive, and/or impulsive. They are children, after all, and their minds and bodies are still developing. A problem occurs when these behaviors continue, worsen, and/or persist way past the time when they should be lessening.

For a child to be “officially” diagnosed with ADHD, he/she must display the following symptoms for at least 6 months and to a greater degree than other children of the same age. According to the Diagnostic and Statistical Manual (DSM-IV), your child may have ADHD, if he/she falls into one or more of the following three subtypes of ADHD:

1. Hyperactive-Impulsive
   • Exhibits six or more symptoms of hyperactivity and impulsiveness
   • Exhibits less than six symptoms of inattentiveness

2. Inattentive
   • Exhibits six or more symptoms of inattentiveness
   • Exhibits less than six symptoms of hyperactivity or impulsiveness

3. Combined (Hyperactive-Impulsive and Inattentive)
   • Exhibits six or more symptoms of hyperactivity and impulsiveness
   • Exhibits six or more symptoms of inattentiveness

Symptoms of hyperactivity

• Squirming in one’s seat or fidgeting with one’s hands or feet
• An inability to remain seated when it’s expected – i.e. during meals, storytime, etc.
• Running and/or climbing when it’s inappropriate
• Problems with playing quietly and/or completing calmer activities
• Being always on-the-go
• Constantly touching and/or playing with anything within sight
• Talking non-stop – even when asked to be quiet

Symptoms of impulsiveness

• Is extremely impatient
• Blurting out answers before the question has been completely asked
• Displaying “unchecked” emotions and/or performing irrational or impulsive acts – without regard for the consequence
• Has a hard time waiting for things he/she wants or waiting for his/her turn
• Frequently interrupts conversations or activities

Symptoms of inattention

• Does not pay attention to details and makes careless mistakes on schoolwork & homework
• Has a hard time paying attention for long periods of time – i.e. during tasks or play
• Gets bored with tasks quickly and bounces from activity to activity
• Does not appear to be listening when spoken to directly
• Frequently daydreams
• Becomes easily confused
• Is slow at completing tasks
• Has problems completing tasks on time or by the deadline
• Does not follow instructions
• Has poor organization skills
• Has a hard time grasping new concepts
• Avoids or dislikes tasks that require sustained mental concentration – i.e. puzzles, reading, etc.
• Tends to misplace things – i.e. lose toys, assignments, backpacks, keys, pencils, books, coats, etc.
• Is easily distracted
• Has a hard time processing information quickly and accurately

What Causes ADHD?

The exact cause of ADHD is unknown and may depend on the child, which is why experts disagree on the possible causes of it. However, studies suggest that ADHD stems from a combination of genetics/biology, neurological (brain) trauma, poor nutrition – too much sugar, dyes, and salt, not enough sleep, and/or environment.

Researchers have begun to study the relationship between ADHD and nicotine use and alcohol abuse during pregnancy, biology, brain injury, and food additives -i.e. artificial colors and preservatives more in-depth. Moreover, neuroimaging studies suggest that the brain of a child with ADHD operates differently than his/her peers, specifically in reference to neurotransmitter (dopamine, serotonin, and adrenaline) function. But regardless of the cause of it, ADHD usually first appears during early childhood, between 3 and 6 years old.

How is ADHD Diagnosed?

All children get distracted, act impulsively, and struggle to sit still from time-to-time. However, these “normal” behaviors tend to be easily misdiagnosed as ADHD symptoms. Determining what is considered “normal” can be challenging because a child’s maturity, temperament, and energy vary based on a child’s personality and level of self-awareness.

Surprisingly, you may be the first to notice that your child is developing differently from other children his/her age. Or, it may be your child’s teacher or teachers that first notice that your child struggles to follow rules, or frequently “spaces out” in the classroom.

As mentioned above, there is currently no definitive test that can diagnose a child with ADHD. Therefore, a licensed health professional (child psychologist, child therapist, pediatrician, child psychiatrist, or child clinical social worker) must fully evaluate your child – i.e. his/her behavior before he/she can diagnose him/her with ADHD.

In addition, before an official ADHD diagnosis can be made, this health professional will need to rule out any other medical conditions that could be contributing to your child’s ADHD-like symptoms. Other medical conditions like depression, sleep deprivation, learning disabilities, tic disorders, and behavioral problems may be confused with, or appear alongside ADHD. In fact, most children with ADHD have at least one other developmental or behavioral problem.

What Should I Do If I Suspect That My Child Has ADHD?

If you suspect your child may have ADHD, the best thing you can do is document his/her symptoms – i.e. when they arise, how often they arise, and what they are in detail. Learn about the condition, possible causes, and treatment options and then have your child evaluated by a qualified health professional.

What are Common ADHD Treatments?

It is important to understand that treatment will not cure ADHD.

However, it may help curb some, if not all, of the symptoms of it. It can also help your child better manage his/her symptoms, so it doesn’t wreak havoc in his/her life. Treatment typically involves a combination of methods, such as counseling (psychotherapy), lifestyle changes (healthy diet without sugar, dyes, and preservatives, proper sleep, plenty of exercises, and/or medication. The good news is that with proper treatment and child counseling, children with ADHD can grow up to be happy, successful adults.

Remember, ADHD is a chronic condition. What does that mean? It means that approximately 50% of children diagnosed with ADHD will have trouble paying attention, and/or behave impulsively – even as adults. But, with the help of medication, psychotherapy, and/or behavioral training, these individuals can learn how to better manage their symptoms, so they can go on to lead productive lives. Still, it’s important to understand that your child will require extra guidance, structure, and understanding from both you and their teacher(s). Because, by the time your child is diagnosed, blame, frustration, and even anger may have accumulated within the family or within the classroom environment. Therefore, you may need to participate in parenting therapy or anger management therapy in order to develop new skills, attitudes, and ways of relating to your child.

Keep in mind that if ADHD is not properly treated, it can negatively affect your child’s academic performance and friendships. Also, prepare yourself to be exhausted. Parents of children with ADHD are often tired and frustrated. Why? Because this condition can cause each family member to experience a high level of stress at times.

Help My Child Be Better Organized & Follow Instructions

There are many ways that you can help your child be better organized and follow instructions. In fact, the best way to combat the effects of your child’s ADHD is to be vigilant and proactive, if you suspect that something is “amiss” with your child. If your child’s problem is inattention and disorganization, there are things you can do to help your child get back on track until you can get an appointment with a health professional.

These tips include:

• Post a schedule of tasks (i.e. homework, sports, TV, family time, etc) at a central location in the home and try to follow the same routine every day.
• Make sure the house is always tidy and neat. Have a specific place for everyday items like clothing, backpacks, toys, food, etc.
• Help your child organize his/her school materials and supplies, and stress the importance of writing down instructions for homework assignments.
• Be clear and consistent. In other words, use words that your child can understand.
• Reward good behavior. Children with ADHD often receive a boatload of criticism, but not so much praise. Praise will get your child’s attention – so do it when warranted.

Can Adults Also Have ADHD?

Yes! But, unfortunately, many adults with this condition aren’t even aware they have it. Why not? Well, because adult ADHD symptoms tend to be more varied, and not as clear cut, like those in children.

What Are Some Adult ADHD Symptoms?

It’s important to highlight that although most studies and articles focus on child ADHD, adults can also be diagnosed with late-onset ADHD or childhood ADHD may persist into adulthood. Adult ADHD symptoms can lead to a host of problems, such as dysfunctional or unhealthy relationships, poor attendance or productivity at work, low grades at school, and/or dismal of self-esteem or self-confidence.

Other examples of adult ADHD symptoms include:

• Difficulty at school – i.e. low grades, making and keeping friends, etc.
• Problems at work – i.e. productivity problems, quality issues, low attendance, etc.
• Failed relationships – i.e. cheating/adultery, impulsiveness, poor communication, lack of detail, hyperactivity, etc.
• Problems with organization – messy work, forgetting where one places things/problems finding things, etc.
• Inability to maintain a job or keeping appointments
• Difficulty with daily tasks like getting out of bed, leaving for work, and/or arriving at appointments on time
• Chronic procrastination
• Restlessness and an inability to multitask
• A desire to fix things “quickly,” rather than taking one’s time and doing it right
• Frequent speeding tickets and/or a history of traffic violations
• Frequent mood swings or anger
• Trouble coping with stress

For some adults, ADHD diagnosis brings a sense of relief. More specifically, an ADHD diagnosis helps them better understand why they have been experiencing so many issues. It also offers them hope through therapy and medication.

Still, the best treatment for ADHD is still under debate. Adult ADHD treatments are similar childhood ADHD treatments – i.e. ADHD medications like stimulants, counseling (psychotherapy), and treatment for any mental health conditions. A combination of therapy and medication is often the most effective treatment.

And, while not the cause, a number of mental health conditions can occur with ADHD. The conditions include the following:

• Mood Disorders: Adults with ADHD may also struggle with mood disorders like clinical depression, bipolar disorder, etc. ADHD does not directly cause mood disorders, however, it may worsen or trigger them – in some people.
• Anxiety: It is common for adults with ADHD to experience anxiety. ADHD can lead to excessive worrying and “nervousness.” Fretting over one’s ADHD symptoms can trigger or increase anxiety – in some people. Therefore, anxiety must be managed, in conjunction, with ADHD symptoms for treatment to be effective.
• Personality Disorders: Adults with ADHD have a higher risk of personality disorders like narcissistic, histrionic, or borderline personality disorders.

How Can I Find a Good Therapist For Me or My Child?

If you or your child suffers from ADHD, it is imperative to seek treatment. Remember that with medication, psychotherapy, and/or behavioral training, individuals (children and adults) can learn how to better manage the symptoms, so they can live happy and successful lives.

In fact, the prognosis of ADHD with treatment is good. If you are wondering where you can find a good therapist for you or your child – look no further, our TherapyTribe Directory can help you find a good ADHD Therapist, while teaching you more about available ADHD treatment options.

New ADHD Treatment Trials and Studies 

ADHD treatment trials and studies are constantly being conducted, which means that new treatments are constantly being created and put on the market for ADHD. Almost every year or few years there is a new possible treatment for ADHD. Listed below are some of the newest treatments for ADHD. 

1. Qelbree: In 2021 Qelbree, a non-stimulant medication, was FDA-approved for children with ADHD, and in 2022, it was FDA-approved for adults with the disorder. Researchers suggest that Qelbree (viloxazine) is an effective ADHD treatment due to its ability to reduce ADHD symptoms like inattention, fidgeting, hyperactivity, and impulsivity.  

2. Jornay PM: In 2019, the FDA approved Jornay PM for the treatment of ADHD in both children and adults. Jornay PM is designed to improve concentration, focus, memory, emotional control, and behavior. Keep in mind, however, that Jornay PM contains the same active ingredients as Ritalin and Daytrana. The FDA has deemed Jornay PM a federally-controlled substance (CII) because it can be abused or lead to addiction. Jornay PM is taken at night, so that by the time the person awakens the medication is already working.

3. Adhansia XR: In 2019, Adhansia XR, another stimulant, was approved by the FDA for the treatment of both children and adults with ADHD. Adhansia XR is available in extended-release capsules, and offers the highest dosage strengths on the market.

4. Catecholaminergic Reuptake Inhibitors & Releasing Agents or Selective Noradrenaline Reuptake Inhibitors: Researchers have recently found that catecholaminergic reuptake Inhibitors & releasing agents or selective-noradrenaline reuptake inhibitors may be an effective ADHD treatment. However, more research is needed to determine the overall effects of these inhibitors in the treatment of ADHD. 

5. eTNS: In April 2022, eTNS, the first device to treat ADHD in children, received clearance from the ADHD. eTNS stands for external trigeminal nerve stimulation. Researchers suggest that eTNs may be an alternative treatment for more than 6+ million American children with ADHD.

Post-Pandemic Update

The coronavirus pandemic brought many changes to almost everyone. These changes affected people in different ways. For some people, COVID-19 caused a loss of employment and isolation, and triggered or worsened depression, anxiety, fear, doubt, and uncertainty, yet, for others, like those struggling with ADHD, the pandemic was a nightmare that lasted years. Some may argue that children with ADHD suffered the most during the pandemic. The lives of children were disrupted in profound ways. 

The stability and carefree life that comes with being a child was suddenly stripped away from them. Their schedules were interrupted, they were removed from their schools, they were forced to wear masks, and stay 6ft. away from other people, and for a while, they could not even go outside for fear of contracting the norovirus through the air. Long gone were the days of playing with other kids at school or at the playground, participating in contact sports, or simply hanging out with friends at the mall, arcade, or each other’s houses. Life simply wasn’t the same. 

More so, parents’ fears, worries, and concerns of their children contracting the virus, increased their children’s stress and anxiety, which in the case of ADHD children only made things worse. Researchers found that children with ADHD experienced a decline in their behavior and well-being during the pandemic. Lockdowns and homeschool took these children away from familiar people and environments, so it makes sense that the seclusion, boredom, anxiety, and frustration caused children with ADHD to exhibit poor behavior. 

The pandemic also made it difficult for doctors to properly diagnose children with ADHD because most visits during that time occurred through telehealth, and because parents afraid of their children getting COVID put off taking their children to for an ADHD evaluation. As a result, some kids with the disorder did not receive a diagnosis and treatment until much later. Because doctors were not getting to see the children in-person, some children with ADHD were misdiagnosed as “just being restless children,” while others were diagnosed with ADHD and did not have. These children received the diagnosis because their symptoms resemble ADHD, but were “just being restless children,” in reality.  

The same could be said for adolescents and young adults, especially college kids. Because some colleges/universities and businesses were closed down, many young people with ADHD struggled with anxiety and stress at not being able to engage in their normal routines. People with ADHD struggle with impulsivity and hyperactivity so being stuck at home due to a layoff or because their college/university closed only heighten these ADHD symptoms, causing emotional distress, anxiety, stress, frustration, restlessness, depression, and anger, in some cases. 

These individuals had no outlet, leading to impulsive behaviors and negative emotions. Researchers found that the biggest complaints of people with ADHD during the pandemic was boredom, a lack of motivation, social isolation, and an inability to engage in online learning (for students). Researchers also found that telehealth and working from home also posed problems for people with ADHD, during the pandemic. People with ADHD tend to be social beings, so being cooped up and away from others was especially taxing for these individuals.

References

1. Mayo Clinic. (2019). Attention-deficit/hyperactivity disorder (ADHD) in children. Retrieved from https://www.mayoclinic.org/diseases-conditions/adhd/symptoms-causes/syc-20350889
2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). Washington, D.C.: American Psychiatric Association.
3. Dryer, R., Kiernan, M., & Tyson, G. (2006). Implicit theories of the characteristics and causes of attention-deficit hyperactivity disorder held by parents and professionals in the psychological, educational, medical and allied health fields. Australian Journal of Psychology, 58(2), 79–92. https://doi.org/10.1080/00049530600730443
4. Silk, T. J., Genc, S., Anderson, V., Efron, D., Hazell, P., Nicholson, J. M., … Sciberras, E. (2016). Developmental brain trajectories in children with ADHD and controls: a longitudinal neuroimaging study. BMC Psychiatry, 16, 1–9. https://doi.org/10.1186/s12888-016-0770-4
5. Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2017). Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry, 17, 1–15. https://doi.org/10.1186/s12888-017-1463-3
6. Fliers, E. A., Franke, B., Lambregts-Rommelse, N. N., Altink, M. E., Buschgens, C. J., Nijhuis-van der Sanden, M. W., … Buitelaar, J. K. (2009). Undertreatment of motor problems in children with ADHD. Child and adolescent mental health, 15(2), 85–90. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2850122/
7. Yu, C., Garcia-Olivares, J., Candler, S., Schwabe, S., & Maletic, V. (2020). New insights into the mechanism of action of viloxazine: Serotonin and norepinephrine modulating properties. Journal of Experimental Pharmacology, 12, 285–300. Retrieved from https://doi.org/10.2147/JEP.S256586
8. Heal, D. J., Gosden, J., & Smith, S. L. (2022). New Drugs to Treat ADHD: Opportunities and Challenges in Research and Development. Current Topics in Behavioral Neurosciences, 57, 79–126. Retrieved from https://doi.org/10.1007/7854_2022_332
9. McGough, J. J., Sturm, A., Cowen, J., Tung, K., Salgari, G. C., Leuchter, A. F., Cook, I. A., Sugar, C. A., & Loo, S. K. (2019). Double-blind, sham-controlled, pilot study of trigeminal nerve stimulation for attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 58(4), 403–411.e3. Retrieved from https://doi.org/10.1016/j.jaac.2018.11.013
10. Sibley, M. H., Ortiz, M., Gaias, L. M., Reyes, R., Joshi, M., Alexander, D., & Graziano, P. (2021). Top problems of adolescents and young adults with ADHD during the COVID-19 pandemic. Journal of Psychiatric Research, 136, 190–197. Retrieved from https://doi.org/10.1016/j.jpsychires.2021.02.009
11. Davoody, S., Goeschl, S., Dolatshahi, M., Davari-Ashtiani, R., Saffarpour, R., Sodeifian, F., & Brand, S. (2022). Relation between ADHD and COVID-19: A narrative review to guide advancing clinical research and therapy. Iranian Journal of Psychiatry, 17(1), 110–117. Retrieved from https://doi.org/10.18502/ijps.v17i1.8055
12. Segenreich D. (2022). The impact of the COVID-19 pandemic on diagnosing and treating attention deficit hyperactivity disorder: New challenges on initializing and optimizing pharmacological treatment. Frontiers in Psychiatry, 13, 852664. Retrieved from https://doi.org/10.3389/fpsyt.2022.852664