Mental Health: ADD & ADHD

What Is ADHD?

Attention-deficit/hyperactivity disorder, or ADHD, is among the most common brain-based disorders. While it can look differently for different people, its most common symptoms include inattention, impulsivity and hyperactivity. It generally manifests through an inability to sit still, focus on details, control behavior, or process information normally. While it’s typically diagnosed in children, this disorder can be present in adults as well. In fact, about 60 percent of children with ADHD carry this condition with them through adulthood. Some individuals aren’t diagnosed or receive treatment for ADHD until age 20 or later.

“ADHD is a mental health disorder, more specifically it is a neurological, psychological, and psychiatric disorder that can benefit from diagnosis and treatment from mental health professionals,” stated Dr. Beau Nelson, DBH, LCSW, Chief Clinical Officer at FHE Health, a nationally recognized behavioral health provider.

Are There Different Types of ADHD?

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), there are three different types of ADHD, depending on which symptoms are strongest in the individual. These subtypes are as follows:

• ADHD with a predominantly inattentive presentation: For individuals with this subtype, staying organized and finishing tasks is particularly challenging. The person may also have a difficult time tracking conversations, following instructions, or paying attention to details.
• ADHD with a predominantly hyperactive and impulsive presentation: This form is associated with a traditional definition of ADHD and is far more noticeable. Someone with this subtype generally fidgets and talks a lot. They may have a difficult time sitting still (such as while eating a meal or working at a desk) and may be more prone to accidents and injuries. Children with this disorder may run, jump and climb constantly, while adults with this disorder may frequently interrupt others, appear restless, or seem to have boundless energy.
• ADHD with a combined presentation: With combined presentation, the person has equally present inattentive and hyperactive traits.

ADHD vs. ADD

Not everyone with ADHD demonstrates high energy levels and has a difficult time controlling their impulses. Attention-deficit disorder, or ADD, is an outdated diagnosis that was typically given to those who had difficulty staying on task or paying attention to details. The DSM-5 doesn’t provide criteria for ADD, and only ADHD is recognized by the American Psychiatric Association. Instead of being diagnosed with ADD, an individual may be diagnosed with ADHD with predominantly inattentive presentation.

How ADHD Affects Everyday Life

For both children and adults, ADHD can have a profound impact on everyday life and make it difficult to complete routine tasks, perform well at school or work, and maintain healthy relationships. While every person’s experience with ADHD is different, there are some common challenges that those with this condition face.

Struggle with Setting Limits on Behavior

Many researchers believe that the brains of those with ADHD produce an insufficient amount of dopamine, the hormone involved with the brain’s pleasure center. As a result, someone with this condition may find ways to temporarily increase their dopamine levels to feel good. This may mean that they have a difficult time setting limits on behaviors like eating, using recreational drugs or alcohol, spending money, playing video games, or watching television.

Sleep Problems

ADHD can have a profound impact on someone’s ability to get quality sleep each night. Research shows that ADHD can disrupt the individual’s internal clock, called the circadian rhythm. This makes it difficult for the individual to fall asleep and wake up at regular times. Those with ADHD are also more likely to snore, have sleep apnea, or experience restless leg syndrome.

Struggle to Maintain Employment

While workplaces and job descriptions vary, most jobs require workers to be organized, arrive at their scheduled time, and be attentive and focused on their tasks. ADHD can make all of this very difficult. It can also cause the individual to be forgetful and distracted, which can lead to poor time management and missed deadlines. Ultimately, this may prevent the worker from meeting their employer’s expectations, jeopardizing their job security.

Financial Problems

The same challenges that can result in job loss—difficulty paying attention to details, remembering due dates, and being organized—can also result in financial problems. For someone with ADHD, keeping up with billing statements and managing a budget are more difficult.

Maintaining Relationships

Learning to effectively communicate is a lifelong process for many couples, but when one person has ADHD, it can be especially difficult. The person with the condition may feel like they’re constantly nagged and criticized, while their partner may feel frustrated as they try to deal with traits like disorganization, forgetfulness, and inattentiveness. This can place tremendous strain on a relationship.

Regulating Emotions

One way that ADHD affects the brain is that it makes it harder for the individual to control how they respond to things. This may cause them to worry over minor things or lash out in annoyance or anger.

How Is ADHD Diagnosed?

If someone suspects that they or their child has ADHD, the first step that they should take is to talk to their primary care provider or a mental health professional. To help diagnose ADHD, healthcare providers use the guidelines in the DSM-5.

The DSM-5 outlines a variety of symptoms that must be present to diagnose someone with ADHD. A child up to age 16 has to display at least six symptoms of inattention and six symptoms of hyperactivity or impulsiveness, and those aged 17 and older, including adults, have to display at least five of each.

Some of the symptoms of inattention include making careless mistakes in work, schoolwork, and other activities; not listening when directly spoken to; avoiding, disliking, or being reluctant to work on activities that require mental effort; and being forgetful in daily activities. Symptoms of hyperactivity or impulsiveness include excessive talking, feeling restless, fidgeting, and interrupting or intruding on others.

While ADHD is commonly associated with childhood, it commonly lasts into adulthood. For adults with ADHD, some symptoms may present a bit differently. For example, while a child may run or climb at inappropriate times, an adult may appear extremely restless.

Is ADHD Genetic?

ADHD isn’t a condition that can be caught or contracted from others. It’s biologically determined. Research indicates that neural pathways in the brain, or how neurotransmitters move and act upon various areas of the brain, are different in those with ADHD. Some studies theorize that dopamine may play a role.

While scientists and doctors understand some of these mechanisms behind ADHD, the exact cause isn’t known. Researchers aren’t sure whether ADHD is solely inherited or if a particular gene sequence or mutation of genes causes it.

ADHD is known to run in families, with 30 to 50 percent of parents with ADHD producing a child who also has ADHD. There is a further commonality between siblings, with one child’s chances of having ADHD rising by 30 percent if a sibling has it.

Are There Contributing Factors to ADHD?

In addition to genetics, research indicates that there may be some other factors that may increase someone’s risk of having ADHD. These include:

• Exposure to environmental toxins like lead, which is commonly found in paint and pipes in older homes
• Maternal drug, alcohol or tobacco use during pregnancy
• Premature birth
• Overall parental health; a child may have a slightly higher risk of ADHD if their parent has a condition like alcohol use disorder or conversion disorder
• Head injury at a young age
• Being born with a serious heart condition

Co-occurring Disorders with ADHD

Adults with ADHD are at an increased risk of having other mental disorders and developing alcohol and substance abuse issues. About half of adults with ADHD also have an anxiety disorder, around 40 percent demonstrate signs of Oppositional Defiance Disorder, and 20 to 25 percent of adults have a conduct disorder. Thirty-eight percent of patients have a co-occurring mood disorder, with 47 percent of ADHD adults showing symptoms of depression. Sleep disorders are also common in both children and adults with ADHD.

Treatment for a dual diagnosis often requires treating the symptoms of both conditions concurrently to mitigate all side effects rather than simply what is evident on the surface. Through customized courses of care created around the unique specifications of each patient, it is possible to address signs of ADHD and simultaneously provide treatment options that mitigate other health challenges.