ADHD, also known as Attention Deficit Hyperactivity Disorder, is increasingly common. A few years ago it was estimated that “approximately 9.4% of children 2-17 years of age (6.1 million) had ever been diagnosed with ADHD, according to parent report in 2016.” ADHD is not only common, but its symptoms are sometimes hard to decipher.ADHD includes a variety of behaviors that can be mislabeled as noncompliance, defiance, or sometimes even a learning disorder. ADHD for that reason requires the input of parents, teachers, and counselors when possible before a child is diagnosed with it, to ensure that a full picture of their behaviors has been captured. While some kids might display symptoms more at home, others find it very difficult to control their distracting thoughts in school.
For adults, the same can be true in a work setting. Focusing on menial tasks like writing reports can seem unbearable at times if a person is wrestling with a deficit in their ability to stay focused. ADHD is not just about focus problems, however, but instead, it has several components to it that differentiate what kind of ADHD a person is struggling with. The best way to understand this diagnosis is to first look at the DSM-5’s description of it.
The DSM-5, or the Diagnostic and Statistical Manual of Mental Disorders (5 indicating it is the most recent version available), describes ADHD as a pattern of hyperactive and/or impulsive behaviors that interfere with development or functioning.
A person who is wondering if they have this disorder must meet certain criteria. They must have 6 or more inattention symptoms that have persisted for at least 6 months, and/or 6 or more hyperactive and impulsive behaviors that have lasted for at least 6 months.
Among the first group, you’ll find inattentive behaviors include: missing details, difficulty remaining focused, distracted thinking, poor follow-through on tasks, difficulty organizing tasks, avoidance of tasks that require sustained mental effort, losing things/difficulty keeping track of things, distractions from external stimuli, and forgetfulness in daily activities.
Among the second group of hyperactive/impulsive behaviors you’ll find: fidgeting, a person frequently moving, running or climbing in times when it’s inappropriate, loudly participating in leisure activities, acting as if they are driven by a motor, excessive talking, blurting out of answers before questions are completed, difficulty waiting their turn, and interrupting or intrusion of others.
The DSM also specifies that several inattentive or hyperactive-impulsive symptoms must have been present before the age of 12 and must exist in 2 or more settings (ex: home, school, or work, with friends or relative, etc).
If we break it down a little further, we can distinguish between these two categories the DSM has laid out: inattentive behaviors versus hyperactive/impulsive behaviors. The DSM says: “inattention manifests behaviorally in ADHD as wandering off task, lacking persistence, having difficulty sustaining focus, and being disorganized and is not due to defiance or lack of comprehension.”
By comparison, “Hyperactivity refers to excessive motor activity, (such as a child running about) when it is not appropriate, or excessive fidgeting, tapping, or talkativeness. In adults, hyperactivity may manifest as extreme restlessness or wearing others out with their activity.
Impulsivity refers to hasty actions that occur at the moment without forethought and that have a high potential for harm to the individual (ex: darting into the street without looking). Impulsivity may reflect a desire for immediate rewards or an inability to delay gratification.”
ADHD can also be predominantly one feature over the other (predominantly inattentive or predominantly hyperactive/impulsive presentation). And it can be in what’s called ‘partial remission’, meaning, although the full criteria for ADHD might have been met in the past, currently the individual only displays less than the full criteria for the last 6 months.
The diagnosis can also range anywhere from mild, to moderate, to severe, depending on the number of symptoms that a person is displaying. The DSM also lets us know that “ADHD begins in childhood,” And co-occurring delays in ‘language, motor, or social development’ are common. Associated features may include low frustration tolerance, irritability, or mood lability.”
Many of the features of ADHD can be considered disruptive and at times outright defiant. Teachers and parents and partners alike might find the person they know who has ADHD to be seemingly uninterested in the 9-5 routines we often adhere to.
For this reason, diagnoses such as Oppositional Defiant Disorder (ODD), Intermittent Explosive disorder and other neurodevelopmental disorders are outlined in the DSM-5 as diagnoses to be aware of that could be mistakenly identified as ADHD, and vice versa. The key difference between ODD and ADHD is that ODD individuals tend to display a negative, hostile response to specific tasks, whereas those with ADHD simply are overwhelmed by them.
What Causes ADHD?
Regarding the question, “What causes ADHD?” I find this website extremely helpful (http://www.myadhd.com/causesofadhd.html) in unraveling the origins of ADHD symptoms. Sometimes something as common as ADHD can be categorized as a behavioral problem, one that a child or adult should be able to control.
But when we consider the possibility that someone’s brain is sort of just doing its own thing, it makes more sense why ‘executive functioning’ skills become affected. According to myadhd.com, “Executive functions include such processes as inhibition, working memory, planning, self-monitoring, verbal regulation, motor control, maintaining and changing mental set and emotional regulation. According to a current model of ADHD developed by Dr. Russell Barkley, problems in response inhibition are the core deficit in ADHD. This has a cascading effect on the other executive functions listed above (Barkley, 1997).”
According to Webmd.com “Children born with a low birth weight, born premature, or whose mothers had difficult pregnancies have a higher risk of having ADHD.” Some other reasons these ‘executive functioning’ areas of the brain become inhibited can range anywhere from genetic predispositions, exposure to toxic substances, or brain injury. “Over 25% of the first-degree relatives of the families of ADHD children also had ADHD…Therefore, if a child has ADHD there is a five-fold increase in the risk to other family members.”
And Webmd.com also adds that “If a parent has ADHD, a child has more than a 50% chance of having it. If an older sibling has it, a child has more than a 30% chance.” It is no wonder then why ADHD has become a household code for ‘my child is being rambunctious!’ These behaviors can be caused by several things, any of which can lead to a person feeling their memory, planning, self-monitoring and other skills are challenged.
Does My Child Have ADHD?
Throughout their developmental years, children, adolescents, and teens might display ADHD symptoms differently. If you as a parent would like to know if your child is displaying symptoms, this website offers a comprehensive list of age-specific ADHD behaviors:
Some of the most common symptoms, however, include difficulty paying attention, impulsive speech or actions, distractibility, forgetfulness, and more.
The best way to determine if your child has ADHD is to gather information from various sources. Teachers, counselors, psychiatrists, psychologists and more are great resources for understanding if your child’s behaviors are interfering with their learning.
The Vanderbilt scales are one of the most common evaluation tools used by professionals to discern a child’s ADHD-like symptoms. On this questionnaire, questions are asked about the observer’s perspective of what attention-deficits they might believe the child has. Their answers can reflect specific instances of distractible behaviors they might have encountered one on one when working with the child.
Collectively, after a teacher and caregiver have each filled one of these evaluations out, the results can be discussed with a psychiatrist or psychologist and determine the best next steps to take.
How to Address ADHD Symptoms Once They’ve Been Identified
Once a team of a few adults who interact often and closely with the child has identified shared experiences they have had of the child displaying ADHD symptoms, and a psychologist or psychiatrist has diagnosed them with this, the next step is to determine methods for reducing symptoms. Some interventions include placing a child on an IEP (Individualized Education Program), a 504 plan, and/or medication.
Medication for ADHD
Per www.understood.org, “There are several kinds of ADHD medications. They affect the way parts of the brain communicate with each other. This can help to increase alertness, improve working memory and reduce hyperactivity. While these medications are helpful for many kids with ADHD to varying degrees, they don’t seem to help much at all in some cases.”
Understood goes on to identify the difference between stimulant medications and non-stimulants. While stimulants “target a neurotransmitter (brain chemical) called dopamine, which plays a key role in motivation, it also helps to control movement and emotional responses”.
Nonstimulant medications “work by increasing brain activity of norepinephrine. This is a neurotransmitter that, like dopamine, is linked to attention. Unlike stimulants, however, it may take four to six weeks to show results [stimulants can begin working within an hour of use].
Common stimulant names you might be familiar with include Ritalin, Concerta, and Adderall. Common Non-stimulant names include Strattera and Tenex. For more information visit: https://www.understood.org/en/learning-attention-issues/treatments-approaches/medications/types-of-adhd-medications.
Many individuals with ADHD are still able to enjoy successful, happy lives. Despite its challenges, ADHD can promote creativity, and allow a person to be extremely adaptable, always looking for what’s next.
Psalm 139:13-16 reminds us of God’s hand in our creation: “For you formed my inward parts; you knitted me together in my mother’s womb. I praise you, for I am fearfully and wonderfully made. Wonderful are your works; my soul knows it very well. My frame was not hidden from you, when I was being made in secret, intricately woven in the depths of the earth. Your eyes saw my unformed substance; in your book were written, every one of them, the days that were formed for me, when as yet there was none of them.”
David wrote this psalm, aware that God knew the challenges and joys he would have in life because God made him. If you or someone you know is struggling with the challenges of ADHD, be encouraged that you are known by your Creator and your experiences and way of seeing the world are known to Him better than anyone else.
His desire is for you to be the fullest version of yourself that you were created to be. If you’d like to discuss with someone what that kind of life might look like, feel free to schedule an appointment with me or another counselor at Seattle Christian Counseling today.
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