What is ADHD?
ADHD is a developmental impairment that is reported to negatively affect 11% of children and 5% of adults. Though recent findings have reported that these numbers may be massively under-reported, especially in women and minorities.
What is ADHD?
ADHD stands for attention deficit hyperactivity disorder. Some doctors and scientists consider ADHD to be a complex brain neurotype, however, it is considered in the DSM-5 to be a developmental impairment of the brain’s self-management system. The primary issue with ADHD is that there is a lack of dopamine production or dopamine is absorbed too quickly. Most people with ADHD are born with it and it is something that we live with for the rest of our lives.
Some of the most prevalent symptoms that we see with people that have ADHD are issues with impulsivity, emotional dysregulation, focusing, and organization.
There have been many advances in neuroscience, brain imaging, and clinical research that have shown us a few important things: ADHD is not a behavior disorder. ADHD is not a mental illness. ADHD is not a learning disability. The structure of the brain in people with ADHD differs from that of people who are considered “neurotypical”. There are specific genetic components that have been identified that exist in people who have ADHD that show that if a child has ADHD, there’s a statistically high likelihood that one or both of the parents have ADHD.
The CDC reports ADHD affects approximately 11% of children and almost 5% of adults in the U.S. This number is likely very under-reported as there are many cases where ADHD is misdiagnosed as other mental illnesses. Along with this under-reporting via misdiagnosis, especially in women, these statistics also do not take into consideration the socioeconomic factors, lack of access to healthcare for people of color, in poverty, and rural areas of our country. There is also a cultural misunderstanding about the importance of mental health, and many cultures have unrealistic expectations of what it means to be “a strong person”.
These factors all contribute to a massive underrepresentation of the affects of ADHD on minority populations in our country.
How is ADHD Diagnosed?
There are a lot of different ways to diagnose ADHD. One thing that many professionals advise is that people who suspect they have ADHD need to see a psychiatrist to get diagnosed. Many general practitioners, especially older doctors, may have never been trained to recognize Adult ADHD, so if you have access to a psychiatrist, try to work with them to get diagnosed.
If you do not have any choice, then a general practitioner will work, but be clear that you think that you have ADHD and ask to get tested for it.
What to Expect When Getting Diagnosed?
When you are working with a psychiatrist to get diagnosed, they will do a number of things to figure out what you are dealing with when it comes to ADHD.
They will use diagnostic questionnaires to determine the type and severity.
Questionnaires of personal observation from loved ones.
Regarding children, there may be additional interviews with teachers, parents, and other adults.
They will sometimes refer you to get tested for certain environmental factors and medical conditions that can mimic ADHD symptoms, such as:
High lead levels
Autism Spectrum Disorder
Borderline Personality Disorder
This is to rule out these other issues that are commonly found to have similar symptoms to ADHD but must be treated differently.
Types of ADHD
Diagnostically, there are 3 classifications or presentations of ADHD. Part of the work that a psychiatrist will do during the initial testing is determining what types or “presentations” of ADHD you have.
Hyperactivity & Impulsivity Type
Combined type that has an equal mix of the above types.
These may not stay consistent as a child gets older, which is why we see some adults who were not diagnosed in school seem to have an explosion of ADHD symptoms as they get older. This is due to ADHD traits being exacerbated by different things that people face; ongoing frustration and stress, ongoing trauma from abusive relationships, and the chaotic change that happens from transitioning from the ordered life of school to the chaotic environment of college and being in the workforce.
Children who have not been given the tools to cope with their emotions, learn how to organize their lives in practical ways, and how to channel their stress and frustration into constructive pursuits, become adults who often find themselves overwhelmed by the world around them.
Hyperactivity & Impulsive Type
This is the most common example that people think of when they think of someone who has ADHD. They may have a hard time sitting still, no impulse control, and frequent outbursts of behaviors. They may seem slightly manic, talk a lot, interrupt others, and may be aggressive if they perceive that someone is being antagonistic or overly-critical.
Some people with ADHD have difficulty focusing, finding instructions difficult to follow, being easily distracted, and forgetting things often. They may lose things regularly and seem flighty and hard to keep up with in conversations. If they feel people are being antagonistic or overly critical, they may seem to retreat into themselves or become reclusive.
This type is often misdiagnosed or even missed because these behaviors are not as easily recognized by general practitioners, friends, & spouses.
People with this type of ADHD have a fairly equal combination of multiple aspects of the above. In the diagnostics that psychiatrists do, they will assign this if the person meets a high percentage of symptoms from the two main types of presentations.
Symptoms of ADHD
The DSM-V (Diagnostic & Statistical Manual of Mental Health Disorders), which is used by psychiatrists and mental health professionals to diagnose mental health issues, has listed out 9 criteria for Hyperactive and Inattentive presentations of ADHD.
To be diagnosed with ADHD, a person has to meet 6 of the symptoms from the lists below, along with that, there has to be a history of ADHD symptoms that have been persistent for at least the past 6 months, which is why family members will often be included in the diagnosis. They will want to find out if there were any presentations in school, and how they have affected a person’s life recently. For many adults, these presentations may have impeded their development, and psychiatrists will often take into consideration how disruptive the symptoms have been and how consistent they are.
The 9 Symptoms of Hyperactive
People who have this type of ADHD presentation often:
When having to sit, they may squirm or fidget with their hands with pencils or pens, or shake their legs.
Leave their seat, pacing around when it may seem unnecessary, for example: during meetings or in conversations.
Feel restless and unsettled.
Not be able to engage in activities that are boring, repetitive, even during rest.
Move a lot, constantly on the go, not comfortable sitting still or in one place. This also applies to living in one place, may have a need to move around a lot, or move furniture around frequently.
Ask awkward questions or intrude in the middle of conversations. Often, they interrupt conversations and may take over the conversation.
Seems to talk excessively, about random subjects, moving from subject to subject, seemingly at random.
Have an impulsive need to answer questions or make their points mid-conversation.
Do not wait for their turn, often moving in front of people who have been waiting.
The 9 Symptoms of Inattentive
People with this type of ADHD presentation often:
Make mistakes while doing simple tasks, especially repetitive tasks. They may miss what seem to be simple details that are obvious to others. For example: missing messes around the house or turning in incomplete or inaccurate projects at work.
Have difficulty paying attention. Their minds may wander off during meetings, when talking to friends or family, or they may have difficulty reading about things that they do not enjoy.
Seem forgetful about doing things regularly, for example, scheduling appointments, returning calls or texts, paying bills, or even doing daily chores.
Do not seem to be able to complete things, even if given instructions. Often, not completing chores, starting tasks and not finishing them, or being easily distracted.
Express that organization seems to annoy them, and they seem to always have chaotic messes around them. Their houses may be constantly messy and their offices disorganized. They may miss appointments often and have a poor understanding of the passage of time.
Get frustrated with tasks that require a lot of mental effort and create a lot of stress and avoid them. For example, preparing reports on time, completing forms, or making appointments.
May lose things like wallets, phones, keys, and various other small items that they use daily.
Are distracted by things happening around them, like kids running around, or multiple sources of sounds or visual inputs, and have a hard time tuning these things out.
Seem to miss things that are said directly to them, even without obvious distractions. “Excuse me? Can you repeat that? “, or ”Sorry, I was thinking about something else. “, are prime examples of people who deal with this issue.
Known ADHD Causes
Our current knowledge base hasn’t been able to discover a singular cause for ADHD. There are a lot of different things that go into having ADHD, and pinning down just one cause has been the white whale for many scientists and doctors.
What we do know is that there are genetic factors most of the time with people with ADHD. For example, a child with ADHD has a 25% chance of having a parent with ADHD.
There are specific genetic markers that have roots that go far back into our genetic history, and this has caused many different theories to come forward that point out that it may not be a defect, but a past adaptation that was advantageous in certain cultures. Some people, such as Thom Hartmann, have posited that ADHD’s genetic components may be related to Hunter-Gatherer ancestors, and show that there is a relationship between genetic similarities between people with ADHD and existing nomadic hunter-gatherer cultures.
We also know that there are environmental factors that affect the likelihood of people having ADHD(2):
Significant head injuries.
Children with epilepsy.
Mother’s being exposed to alcohol, smoking, lead in the bloodstream, and certain illnesses such as measles.
Trauma from childhood abuse can exacerbate many symptoms of ADHD and has been found to be a good indicator of the likelihood of ADHD in adults.
Whether trauma activates genetic predispositions for ADHD, or if trauma makes the ADHD symptoms worse, or a combination of both, it is unknown, there is no concrete data to prove either/or. What we do know is that children who have ADHD are 30% more likely to suffer from abuse, with the average child with ADHD getting 20,000 more negative criticisms by the age of 10 than their neurotypical counterparts.
How Is ADHD Treated?
Treating ADHD isn’t a simple process. There’s no single way to do it, and each person who has ADHD will need to discover how to manage their ADHD effectively. What we do know is that working with a psychiatrist, working with a therapist, and working with a coach are all effective ways to manage ADHD overall.
Working With a Psychiatrist
The first step is to get diagnosed. This is important because not only do we have to understand what kind of ADHD you have, a psychiatrist can also work with you to discover if there are other comorbidities that are often found with people with ADHD. This is important, as some medications for ADHD can cause symptoms of other comorbidities to get significantly worse. For example, a stimulant such as Adderall or Ritalin can negatively affect bi-polar symptoms and anxiety symptoms.
Knowing what type of ADHD you have and what comorbidities you have will allow them to create a treatment plan that can take these issues into consideration.
There are different types of ADHD medications, both stimulants and non-stimulants, and they work in different ways. There are
Short-acting - which is taken a few times a day
Intermediate - which may be taken twice or so a day
Long-acting - which is taken once a day.
This is why it’s important to work with a psychiatrist because many medications may have certain side effects and sometimes do not work as effectively depending on what comorbidities or other health issues you may have. You need to keep track of how you’re feeling and take the medications as prescribed. Sometimes it may take a week or more for the medications to work. However, with most stimulants, many people report that they alleviate symptoms fairly quickly, even within one day.
Working With a Therapist
Therapy is massively important in managing Adult ADHD. In many cases, cognitive-behavioral therapy is incredibly helpful with ADHD. CBT works with the assumption that our interpretation of life’s events affects how people behave and feel. This is important, as many of our biggest issues with emotional dysregulation with ADHD are based on how we perceive our world, how our memory works, and how stress and frustration can cause emotional outbursts.
Therapy is also important because we have to develop coping mechanisms for the trauma that we have dealt with all of our lives and develop an understanding of our triggers that can cause us to fall into depression or act out in our frustrations. They can also help us channel our emotions and frustrations into constructive methods and reduce our overall stress.
Working With a Coach
If psychiatrists are the medical, and therapists are the emotional, ADHD Life Coaches are the practical aspect of managing ADHD. So many people over the age of 30, and quite a few between 25 and 30, never learned the basics of how to manage their ADHD. They never learned how to use their methods to organize their lives. How to set up schedules, how to set up tasks, and how to prioritize things. They never learned how to communicate how their ADHD works and how to advocate for themselves. These adults never had the opportunity to discover the accommodations that they needed, not just in the workplace but also in their personal life. This is where life coaching comes into play.
Speaking of personal life, one of the biggest ways to manage your ADHD is to have a strong personal support group around you. Friends, family, peers, and support groups who actively work with you to help give you support have been shown to be the most important aspect of managing your ADHD.
There's a lot of tips and tricks that you can learn working with an ADHD Life Coach, such as the importance of exercise and proper diet, of being outside, how to make and keep friends, and certain supplements that can be added to their daily meds to help with cognitive support.
To manage your ADHD you have to learn all of this, and an ADHD Life Coach can help you with this and so much more.