National ADHD Awareness

What is ADHD?

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity that interferes with daily functioning. ADHD is one of the most common neurodevelopmental disorders of childhood and can persist into adulthood.

The core symptoms of ADHD include:

• Inattention – difficulty staying focused on tasks, seeming not to listen, avoiding tasks requiring sustained focus
• Hyperactivity – excessive movement, fidgeting, restlessness
• Impulsivity – hasty actions without thought of consequences, difficulty waiting your turn

ADHD arises from differences in brain development and activity in areas that control executive functions like attention, planning, inhibition, and working memory[1]. 

Genetics plays a strong role. ADHD tends to run in families and identical twins share a diagnosis more than fraternal twins. Environmental factors like alcohol and tobacco use during pregnancy may increase risk as well.

ADHD can significantly impact a person’s quality of life. Without proper treatment and support, ADHD can affect school performance, jobs, relationships, and self-esteem. However, evidence-based treatments like therapy, skills training, accommodation, and medication can help people with ADHD thrive.

ADHD Facts and Statistics

• ADHD is estimated to affect around 9.4% of children and 4.4% of adults in the United States[2]. That equals about 6.1 million children and 10.2 million adults.
• ADHD is one of the most commonly diagnosed mental disorders in children. Boys are more than twice as likely to be diagnosed than girls.
• Around 56% of children with ADHD have at least one other mental, emotional, or behavioral disorder[3]. Common comorbid conditions include learning disabilities, anxiety, depression, oppositional defiant disorder, and conduct disorder.
• Without treatment, nearly 40% of children with ADHD will continue having symptoms into adulthood[4]. An estimated 4-5% of adults have ADHD.
• ADHD costs an estimated $120-125 billion annually in healthcare expenses, loss of income, and productivity in the United States[5]. Proper treatment and support can reduce these costs.

Signs and Symptoms

ADHD symptoms typically become apparent in early childhood, before age 12. However, many children are not diagnosed until later. Some less overt symptoms may not be recognized until adolescence or even adulthood.

The core symptoms of ADHD fall into two main categories – inattention and hyperactivity/impulsivity:

Inattention

• Difficulty paying close attention to details or making careless mistakes
• Trouble staying focused during tasks or play
• Not appearing to listen when spoken to directly
• Difficulty following instructions and finishing tasks or chores
• Disorganization and problems managing time
• Avoidance or dislike of tasks that require sustained focus (like schoolwork)
• Frequently losing items needed for tasks
• Easy distraction and forgetfulness

Hyperactivity and Impulsivity

• Fidgeting, squirming, or tapping hands and feet excessively
• Difficulty staying seated when required to (like in class)
• Running around or climbing in inappropriate situations
• Excessive talking
• Difficulty engaging in quiet activities
• Impatience, difficulty waiting their turn
• Frequently interrupting others
• Trouble controlling reactions

In addition to the core symptoms, ADHD is often associated with[6]:

• Learning difficulties and lower academic achievement
• Problems with organization, time management, and planning
• Greater peer conflict and social difficulties
• Increased risk-taking behaviors
• Low frustration tolerance and outbursts of anger
• Problems with regulating emotions
• Difficulty sleeping

For ADHD to be diagnosed, symptoms must be chronic and present in multiple settings (like home AND school) that negatively impact day-to-day functioning. Symptoms can also vary with age and change over time. Hyperactivity tends to diminish with age while inattention often persists.

Types of ADHD

There are three main presentations or subtypes of ADHD:

Predominantly Inattentive

People with this type have more difficulty with disorganization, distraction, and lack of focus/persistence. They may seem absent-minded or “spacey”. Hyperactivity is not as evident.

Predominantly Hyperactive-Impulsive

People with this type have more restlessness and difficulty controlling impulses. They may have greater trouble sitting still and waiting their turn. Focusing isn’t as much of an issue.

Combined Presentation

This type consists of symptoms of both inattention AND hyperactivity/impulsivity. It is the most common ADHD presentation in children. The combined symptoms make it hard for a person to focus and sit still.

While the DSM-5 (Diagnostic and Statistical Manual) lists three presentations, ADHD symptoms can present on a spectrum. Many people have at least some symptoms of all three types.

Causes and Risk Factors

The exact causes of ADHD are not fully known, however, research suggests both genetics and environmental factors play significant roles.

Genetics

ADHD tends to run in families. If a parent has ADHD, their child has around a 50% chance of having it too[7]. Siblings of kids with ADHD are also at increased risk.

Identical twins share ADHD symptoms more than fraternal twins. Differences in specific genes are linked to ADHD – like genes that govern dopamine transmission in the brain[8].

Environmental Factors

Various environmental exposures may increase the risk for ADHD by impacting brain development:

• Alcohol, tobacco, or drug use during pregnancy – These substances can cross the placenta and interfere with fetal brain development.
• Prematurity or low birth weight – Babies born prematurely or underweight are more likely to have ADHD.
• Brain injury – Injury during early childhood may increase risk.
• Chemical exposure – Exposure to toxins like lead or pesticides is linked to greater ADHD risk.

However, while these factors may increase risk, they alone are not enough to cause ADHD in most cases. Many people with ADHD do not have any known environmental risk factors. Researchers continue working to learn more about possible causes.

Adult ADHD

While ADHD starts in childhood, around 60% of children continue having symptoms as adults[9]. Yet ADHD in adults often goes unrecognized and undiagnosed.

The core symptoms of adult ADHD are similar to those in kids – difficulty paying attention, disorganization, restlessness, and impulsivity. However, some key differences include:

• Hyperactivity tends to lessen and turn inward with age. Rather than disruptive behavior, adults may feel internally restless.
• Inattention and disorganization tend to persist and cause greater impairment in adult life with more responsibilities. Adults with ADHD may chronically struggle with tasks like paperwork, paying bills, time management, and planning.
• Impulsivity in adults can lead to problems like unstable relationships, difficulty managing money, and addiction. Adults may have less external structure and guidance to curb impulses.
• Some adults may not have been diagnosed as kids if they had predominantly inattentive type ADHD with less obvious symptoms. They may have slipped under the radar until coping with greater demands.

Treatment for adult ADHD is similar to kids and focuses on medication, therapy, education, skills training, and lifestyle changes. Seeking help improves the quality of life. Without treatment, ADHD can negatively impact relationships, work, and mental health in adulthood.

Getting an ADHD Diagnosis

If you suspect you or your child may have ADHD, discussing this with a doctor is the first step. Primary care providers can screen for ADHD and refer out to specialists for assessment if needed.

ADHD evaluation consists of:

• Physical exam – To check for any medical issues causing symptoms.
• Psychiatric assessment – Going through diagnostic criteria, history, symptoms, and impact on your life.
• Rating scales – You and others who know you well complete standardized scales rating your behavior.
• Neuropsychological testing (sometimes) – Assesses cognitive skills like memory, problem-solving, and attention.
• School and medical records – To corroborate history and difficulties.

This thorough evaluation determines if ADHD is the accurate diagnosis and if other conditions are also present. The more evidence supporting ADHD, the stronger the diagnostic certainty.

Treatment can begin once you have an official ADHD diagnosis. Effective treatments help manage debilitating symptoms and improve functioning.

ADHD Treatment

Though ADHD has no cure, the right treatments can significantly help manage symptoms. Effective treatment plans utilize a multimodal approach including:

Medication

• Stimulants like methylphenidate (Ritalin) and amphetamine salts (Adderall) are first-line medications for treating ADHD[10]. They boost dopamine signaling in the brain that improves concentration, focus, and impulse control in most people with ADHD.
• Non-stimulants like atomoxetine (Strattera), guanfacine (Intuniv), or clonidine (Kapvay) are alternatives if stimulants are ineffective or cause side effects.
• Supportive medications like antidepressants or sleep aids can help treat co-occurring conditions.
• The medication works best combined with therapy, skills training, educational support, and lifestyle changes.

Therapy and Skills Training

• Cognitive behavioral therapy (CBT) helps identify problematic thought patterns and teaches coping strategies.
• Behavioral therapy uses rewards to encourage positive behaviors and habits.
• Social skills training improves interpersonal skills.
• Organization and time management skills help structure schedules, tasks, and environments.

School and Work Accommodations

• Children with ADHD can benefit from individualized education programs (IEPs) providing extra services and accommodations.
• Adults may benefit from workplace accommodations like flexible hours, reminders and checklists, permission to take breaks, noise-reduction headphones, or private workspaces. These allow people with ADHD to better focus on their tasks and limit distractions.

Lifestyle Changes

• Eating a healthy diet, getting good sleep and regular exercise can help maintain focus and mood.
• Creating structure through schedules, calendars, and reminders compensates for ADHD-related disorganization.
• Reducing clutter and distracting stimuli improves the ability to concentrate.

Comprehensive treatment incorporating medication, therapy, school/work support, and lifestyle changes have the greatest success in managing ADHD challenges throughout one’s lifetime.

Tips for Parents of Kids with ADHD

Parenting a child with ADHD comes with unique challenges. However, several strategies can help kids listen better, curb impulsivity, and build important life skills[11]:

Establish structure and routines – Structure creates expectations and predictability that help kids with ADHD feel secure and behave better. Create regular schedules and locations for homework, play, meals, and bedtime. Post visual aids like calendars.

Give clear instructions – Be specific in your requests. Break larger tasks into smaller steps. Have kids repeat back instructions. Check for understanding.

Set up a distraction-free workspace for schoolwork and reading. Limit noise and foot traffic. Allow fidget toys to occupy hands. Minimize clutter.

Use positive reinforcement – Compliment good behavior more than criticizing. Use rewards like stickers or fun activities to motivate.

Pick your battles – Don’t sweat the small stuff. Save your energy for teaching important behaviors.

Take breaks – Balance high-focus activities with movement breaks to expend energy. Alternate sitting with sensory-rich exercises like jumping jacks or using stress balls.

Model skills – Verbally walk through your own thinking process and how you stay organized. Kids learn by example.

Communicate frequently with teachers to coordinate the best interventions and study habits. Many schools now provide organizational coaching.

Cultivate strengths and talents – Encourage hobbies and activities your child excels at to build confidence and self-esteem. Their differences make them unique.

While parenting a child with ADHD takes thoughtfulness and patience, early support helps set them up for success in all areas of life. Remember, they want to do well. With the proper treatment and skills, they can.

ADHD Advocacy and Support Resources

Local and national organizations provide helpful advocacy and support for people impacted by ADHD across the lifespan:

• CHADD – Children and Adults with Attention Deficit/Hyperactivity Disorder – www.chadd.org
• ADDitude Magazine – www.additudemag.com
• Understood – www.understood.org
• ADDA – Attention Deficit Disorder Association – www.add.org

These reputable non-profits offer informative articles, webinars, virtual conferences, professional directories, support groups, and scholarships for individuals and families managing ADHD. 

They empower those with ADHD by providing science-based information to better understand their condition, connect with others, and advocate for their needs.

The Future is Bright

While ADHD certainly comes with challenges, the future is bright for those who take proactive steps to manage their symptoms. Seeking diagnosis opens doors to effective treatments and support systems. 

Embracing strengths and talents breeds confidence. Building practical life skills prepares one to navigate school, careers, and relationships successfully.

With the right interventions, people with ADHD can achieve their full potential and make unique contributions to the world. We all have room to grow. Here’s to actively create the life you want to live!

References

[1] Magnus W, Nazir S, Anilkumar AC, et al. Attention Deficit Hyperactivity Disorder. [Updated 2023 Aug 8]

[2] Danielson, Melissa L et al. “Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016.” Journal of Clinical Child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53 vol. 47,2 (2018): 199-212. doi:10.1080/15374416.2017.1417860

[3] Larson, Kandyce et al. “Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007.” Pediatrics vol. 127,3 (2011): 462-70. doi:10.1542/peds.2010-0165.

[4] Barbaresi, William J et al. “Long-term school outcomes for children with attention-deficit/hyperactivity disorder: a population-based perspective.” Journal of developmental and behavioral pediatrics : JDBP vol. 28,4 (2007): 265-73. doi:10.1097/DBP.0b013e31811ff87d

[5] Doshi, Jalpa A et al. “Economic impact of childhood and adult attention-deficit/hyperactivity disorder in the United States.” Journal of the American Academy of Child and Adolescent Psychiatry vol. 51,10 (2012): 990-1002.e2. doi:10.1016/j.jaac.2012.07.008

[6] American Psychiatric Association. “What is ADHD?.” American Psychiatric Association, 2022, https://www.psychiatry.org/patients-families/adhd/what-is-adhd.

[7] Franke, B et al. “The genetics of attention deficit/hyperactivity disorder in adults, a review.” Molecular psychiatry vol. 17,10 (2012): 960-87. doi:10.1038/mp.2011.138

[8] DiMaio, Salvatore et al. “Dopamine genes and attention-deficit hyperactivity disorder: a review.” Journal of psychiatry & neuroscience : JPN vol. 28,1 (2003): 27-38.

[9] Faraone, Stephen V, and Joseph Biederman. “Can Attention-Deficit/Hyperactivity Disorder Onset Occur in Adulthood?.” JAMA psychiatry vol. 73,7 (2016): 655-6. doi:10.1001/jamapsychiatry.2016.0400

[10] Cortese, Samuele et al. “Practitioner review: current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents.” Journal of child psychology and psychiatry, and allied disciplines vol. 54,3 (2013): 227-46. doi:10.1111/jcpp.12036

[11] Sternhagen, Tyler et al. “Parenting Children with ADHD.” South Dakota medicine : the journal of the South Dakota State Medical Association vol. 73,7 (2020): 296-304.