What is ADHD?
- Does it mean I can’t sit still, can’t stop talking, can’t remember anything? In some cases.
- Does it mean that I can’t pay attention, can’t focus, can’t be organized? In some cases.
- Does it mean that I have a learning disability? Not necessarily.
- Does it mean that I will never be successful? Definitely NOT!!
Attention Deficit Hyperactivity Disorder
Like most mental health issues, ADHD presents itself with both signs and symptoms. Signs of the disorder are things that every can observe. Signs are the outer behaviors that result from the disorder. Symptoms are the inward, unobservable things that only the person with the disorder is aware of. If someone shows signs of a disorder, it is easier for people to notice and help them. If they experience mostly inward symptoms, they may go for years or even decades without anyone really knowing that they are suffering. This usually leads to problems with self-esteem, depression, and anxiety, as the symptom sufferer feels different from everyone else but isn’t sure why.
In addition to being separated along signs and symptoms, ADHD is also split into three different subtypes, or versions of the disorder. These are identified by the dominant problems in each type. The names are fairly self-explanatory: They are Hyperactive-Impulsive, Inattentive, and Combined.
Below, I’ve split the signs and symptoms into the first two of the subcategories of ADHD, with the third type, Combined, obviously reserved for people who show a number of signs and symptoms for both of the first two types.
- Excessive Fidgeting
- Constant physical movement
- Difficulty sitting still
- Excessive energy
- Difficult time calming down
- Speaking out of turn
- Aggressive behavior
- Emotional reactivity
- Always seems to be on the go
- Feeling like you always need to be doing something
- Easily bored
- Difficulty following instructions
- Slow reading of uninteresting material
- Underperforming on tasks that require sustained mental effort
- In a world of their own
- Careless mistakes
- Mind wandering
- Racing thoughts
- Easily distractible
- Difficulty staying organized
- Difficulty finishing what you start
- Difficulty getting motivated
- Repetitive tasks are almost painful to engage in.
- Always seeking for something new or interesting
- Reading or listening without internalizing information
As you can see, the Inattentive type has a lot of symptoms but far fewer signs that the Hyperactive-Impulsive type. This leads to a lot of underdetection of ADHD, especially in girls. If the child is not causing a disturbance, setting fire to the school, or trying to fly off the roof of the garage, they have a harder time getting on the radar of an adult.
There are many theorized contributing factors to ADHD. These range from genetic causes to poor parenting to overstimulation in our media-saturated culture. However, science is progressing toward a greater understanding all the time. The pie looks like this, as far as we know to this point.
What this means is that there are a number of environmental triggers that appear to have the power to “turn on” the genetic tendency toward ADHD, as is the case in most other mental health conditions. Thus, two people who have had similar experiences may respond very differently.
In a nutshell, ADHD is caused by chronically low dopamine levels in the prefrontal cortex of the brain. Not only is the level chronically low, but the brain also struggles to regulate dopamine in the ADHD brain, meaning that the tap appears to be either all the way off, or jetting full blast.
The prefrontal cortex is responsible for the executive functions of the brain, including planning, impulse control, integrating sensory information, conscious recollection, working memory, attention and focus, and reasoning ability. Obviously, when this part of the brain is running low on fuel (in this case, dopamine), an individual will experience difficulties in these particular tasks. When these difficulties area chronic, this is what we refer to as ADHD.
Successful treatment of ADHD is easily within reach. Studies indicate that when children are treated with the appropriate medication, signs and symptoms of ADHD are removed to the level of normal functioning in 84% of cases. Treatment with medications is not the only avenue of course, though it has the most dramatic effect and the best track record.
The combination of effective medication and life skills instruction in the areas that people with ADHD typically struggle is a powerful and proven approach to managing the disorder. However, people with ADHD, particularly adults who were not diagnosed or treated as children, typically encounter a host of other related mental health problems, such as depression, anxiety, substance abuse, addictive behavior, and relationship problems. In fact, these problems are the ones that most often bring people in for treatment, when in fact, it is the underlying ADHD that appears to be at the root of it all.
Some people are concerned about taking medications. These concerns come from a variety of places. Sometimes people are afraid that they will become addicted or dependent on the medication. Some people view it as a crutch, something that doesn’t really solve the problem but just covers it up. Some people are afraid of the possible side effects of medications. Some people don’t want to have to take a pill in order to be “normal”. Many of these concerns have arisen out of a lack of education and awareness about ADHD medications and many of them have arisen out of a societal separation between mental health and physical health.
Most people would not advise someone to think positive thoughts in order to treat their clogged arteries, arthritis, or diabetes, but when the brain doesn’t produce enough dopamine in the prefrontal cortex (the main contributing factor to ADHD), society expects us to be able to pull up our socks, get our act together, and other helpful metaphors.
ADHD medications are typically effective within half an hour of the initial dose. There are few side effects, though these may vary from person to person. Side effects can be chronic or they can be temporary. A good rule of thumb is to gauge whether the benefits outweigh the side effects by a considerable margin. If they do not, then perhaps changing doses or medications is the answer. If that doesn’t help, then it may be necessary to look at reassessing for the presence of ADHD.
ADHD has been treated with stimulant drugs for almost a century. In the words of one local authority on the subject, treatments in medicine do not persist that long unless they have been demonstrated to be safe and effective. The longevity of these medical interventions attests to both.
Myths of ADHD
We all have a bit of ADHD.
No. We all exhibit behaviors from time to time that a person with ADHD experiences. The difference is the chronic nature of the ADHD experience and the number of those different signs and symptoms. ADHD is the chronic presence of a significant number of these impairments that are resistant to conventional coping mechanisms.
ADHD medications are addictive.
Studies have consistently shown that children with ADHD that are not treated with medication are up to 700% more likely to develop substance abuse problems later in life. This would seem to indicate that taking ADHD medication will lower the risk of addiction, rather than increasing it. Generally speaking, only a minority of ADHD individuals will abuse their medication and in those cases, there are typically other factors involved, including negative peer pressure.
If I’m successful, obviously I don’t have ADHD.
This is patently false. People with ADHD are successful in many walks of life, ranging from the education field to arts and entertainment, to business and mangagement. Many are entrepreneurs, preferring to work for themselves rather than fitting into the expectations placed on them by an employer. However, many of them also seek out employment that is highly structured, using it as an external control on their built-in tendency to wander off task. Typically, individuals who are successful materially and financially who struggle with ADHD have the most difficulty in their interpersonal relationships, the inability to stop working, the inability to relax and unwind without external means (often leading to addictive behavior), and the inability to connect with others on a meaningful level. A weakness is an overdone strength and ADHD is no different.
ADHD is the new fad.
Ironically, this was the knock on ADHD over 20 years ago. Many fads have come and gone in that time but our understanding of ADHD has only grown in depth and breadth. Does this mean that there are more cases of ADHD than before or are we catching it more than we used to? The jury is still out on that question, but the fact remains that ADHD is here to stay and it is no myth.