Understanding ADD & ADHD
In many ways, attention deficit disorder and attention-deficit/hyperactivity disorder have become common catch-all terms for any inability to pay attention, whether seriously or in a joking manner. However, this ubiquity has perhaps downplayed the severity of an ADD/ADHD diagnosis for those seeking a reprieve from symptoms. For the 13 percent of men and 4 percent of women living with ADHD, the effects of this disorder are all too real.
In actuality, ADHD can be a serious condition that affects everything from academics to job performance. Without proper treatment, those affected can find themselves struggling to live a normal life with next to no explanation for struggles like trouble concentrating, retaining information or sitting still for long periods of time.
While a diagnosis of ADHD isn’t generally a reason to seek residential mental health care, ADD or ADHD in conjunction with another mental disorder can create serious issues that require dedicated treatment. At FHE Health, we offer a specialized course of care for ADHD as well as co-occurring disorders like mental health challenges or substance use disorders, providing the support necessary to help our community members live full and healthy lives.
What Are ADD and ADHD?
ADHD, or attention-deficit/hyperactivity disorder, is a brain-based disorder that manifests through an inability to sit still, focus on details, control behavior or process information normally. Most frequently diagnosed in children, ADHD can be present in adults as well, with some individuals failing to receive a diagnosis until age 20 or later.
ADD and ADHD were originally categorized as two separate and distinct disorders, but the thinking behind diagnoses has now changed. As of 1994, ADD is considered a subset of ADHD, referring to a form of ADHD that doesn’t show signs of hyperactivity like regular fidgeting. However, most doctors choose ADHD as a diagnosis for all affected individuals due to the variable nature of this condition.
While ADHD can look different for many people, common symptoms include:
- Inattention, including disorganization, trouble focusing, regular daydreaming and difficulty paying attention when spoken to
- Impulsivity, including making decisions without taking time to consider the possibility for harm or long-term consequences, interest in immediate reward and regular interruptions in conversation
- Hyperactivity, including fidgeting instead of sitting still, talking at inappropriate times and constant movement
The Diagnostic and Statistical Manual of Mental Disorders (DSM) breaks out the subtypes of ADHD as follows:
- ADHD with a predominantly inattentive presentation; this form used to be known as ADD
- ADHD with a predominantly hyperactive and impulsive presentation; this form is more associated with a traditional definition of ADHD and is far more noticeable
- ADHD with a combined presentation with both inattentive and hyperactive traits
Some individuals diagnosed with ADHD don’t demonstrate hyperactivity, much like in past ADD diagnoses. For some parents with children with ADHD, this cross-over can be challenging to comprehend, particularly for those who are aware of the prior split between ADD and ADHD.
The Commonality of ADD/ADHD
ADHD is a common disorder diagnosed in both children and adults alike, depending on medical treatment and the age at which symptoms appear. The common nature of ADHD has only increased in recent years as symptoms and indicators have become clearer and better defined.
According to the American Psychiatric Association, approximately 5 percent of children have ADHD, but other studies have estimated closer to 6.5 to 7 percent. One parent study noted it in around 10 percent of children. Currently, 6.1 percent of children in the United States are being treated with drugs for ADHD. Over the past eight years, the rate of diagnoses has increased by 42 percent.
Symptoms of ADHD begin to manifest between ages 3 and 6, with most diagnoses occurring at age 7. Severe ADHD is often diagnosed earlier, about age 5. Males are three times more likely than females to be diagnosed, with 13.4 percent of men diagnosed with ADHD over their lifetimes. Despite a prevalence early in life, ADHD isn’t limited solely to children; around 4 percent of American adults live with ADHD.
While ADHD appears to affect children of varying races roughly evenly, some states have higher diagnosis rates than others. Notably, ADHD presence is higher in the Midwest, with Kentucky, Arkansas and Louisiana boasting the highest rates of ADHD, about 13 to 15 percent.
Due to the expense of medication and physician visits, ADHD is not a low-cost disease. One study indicates that the cost of illness per person, per year, averages $14,576, for a national total of $42.5 billion. Other factors can include educational expenses, issues of juvenile justice and loss of work.
What Causes ADHD?
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 the ways in which 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.
In addition to a possible genetic link, problems in pregnancy may also predispose a child to ADHD. Children who are born prematurely, have a low birth weight or have a mother who had birth complications may have a higher likelihood of ADHD. The same is true for children with head injuries to the frontal lobe or who were born to mothers who drank and smoked during pregnancy.
Despite common perceptions, eating a lot of sugar or watching television do not affect ADHD.
Treatments for ADHD
ADHD treatments depend on the individual child, the physician or therapist in question, and the subtype of ADHD. This can include therapy, medication or a combination of both.
Therapy is a common first-line defense for ADHD and is frequently utilized before pursuing medication. Behavioral therapy is standard for ADHD, with therapists providing support for children and their families by correcting negative behaviors and replacing them with more positive outlets. This process can also be called parent training due to the role parents play in the therapeutic process and the ongoing home-based guidance required for sustainable results.
At the core of all of these programs, parents are taught to praise children when behavior is appropriate and provide more consistent consequences when negative actions are displayed.
Common models for parent training include:
- Parent-Child Interaction Therapy (PCIT)
- Parent Management Training (PMT)
- Positive Parenting Program (Triple P)
Medication is a frequent solution for children with ADHD and often involves the use of central nervous system stimulants that increase the amount of norepinephrine and dopamine in the brain. Typical examples include amphetamine-based stimulants such as Adderall and methylphenidate drugs such as Ritalin.
Non-stimulant drugs are also an option and are most frequently used when stimulants aren’t improving symptoms. These kinds of drugs are designed to boost norepinephrine, which is shown to enhance concentration. The most common example is atomoxetine, known by the trade name Strattera.
Treatment for ADHD and Dual Diagnosis
In around one-third to one-half of ADHD cases, the condition lasts into adulthood. These individuals are statistically more likely than the general population to develop alcohol and substance abuse issues and other co-occurring disorders.
Around 40 percent of those with ADHD also demonstrate signs of Oppositional Defiance Disorder while 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 and anxiety 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.
At FHE Health, our expert therapists and neuro-rehabilitation resources can address ADHD in conjunction with substance use and mental health disorders, providing tools to live a better life. Please contact us today to learn more.