ADD and ADHD

Attention Deficit Disorder and Attention Deficit/Hyperactivity Disorder

ADHD is a neurodevelopmental disorder mostly diagnosed in childhood.  It is estimated that 5 to 11 percent of the adult population in the USA have ADHD and 85% are not diagnosed and are not treated.  Those who have this disorder experience under-employment, problems with finances, scholastic achievement and problems with relationships. Untreated ADHD has been shown to increase risk of substance abuse, rates of car accidents and criminality.


How ADHD is Diagnosed

Diagnosis of ADD or ADHD is made when reported symptoms have been occurring for longer than 6 months and are found to cause significant distress. DSM-5 (Diagnostic Statistical Manual) has criteria for diagnosing ADD/ADHD, which are a set of guidelines all psychiatric providers follow for establishing this diagnosis. An individual with ADHD must have 5 out of 9 symptoms of inattention and or hyperactivity to meet criteria  for the diagnosis. Some symptoms must have been present in childhood or prior to age 12.  Another important criteria is that symptoms are reported to be causing distress in 2 areas of function, such as in relationships and work, or relationships and school or work and school. 

In adults with ADHD hyperactivity looks differently than in kids.  They  tend to feel fidgety, they are often seen tapping their feet or hands.  They report an internal feeling of hyperarousal which is not being able to relax, constant tension and difficulties with turning off the mind and body prior to sleep.  Racing thoughts are commonly reported. Thoughts and emotions are more intense in the ADHD population.

Inattention in ADHD can be explained as attention being paid to many things at once and one cannot select where to focus his or her attention.  ADHD can also be seen as an intention disorder.  You know what needs to be done, but are frozen with procrastination and simply don't do what needs to be done.  It is often talked about as a disorder of performance. 

Impulsivity in ADHD manifests as hasty decision making, acting without thinking, reward seeking and inability to delay gratification. It can be seen as interrupting others excessively, or not being able to wait your turn to speak.

ADHD is not a learning disability and in many cases individuals graduate from high school and college, but often suffer greatly as they take much longer to complete their programs. They are often frustrated with their workload, feel disorganized and impatient.

Low self-esteem is developed due to repetitive failure to complete projects, harsh internal dialogue and criticism from others. Many experience guilt and shame. Many experience anxiety, irritability and mood swings.


ADHD and the Brain

In ADHD, the individual’s nervous system functions well when there is novelty, challenges or urgency.  Important tasks like homework or work projects that don’t excite or arouse interest, will go undone.  Rewards and consequences by themselves are not enough to motivate someone with ADHD. Following parts of the brain are impacted by ADHD:  Prefrontal Cortex, Limbic System, Basal Ganglia and Reticular Activating System. These parts of the brain simply do not have adequate amounts of neurochemicals to function normally.

Skills like planning and organizing are referred to as executive functions.  These are high level skills that are maintained by your prefrontal cortex.  Impairment of your prefrontal cortex affects your ability to execute these skills.  That is primarily the reason ADHD affects the ability to plan, organize and render the individual essentially  time-blind.  We often hear complaints that our friends with ADHD do not prepare for events adequately and are typically late.  

There are also associated risks for ADHD which are environmental, like low birth weight. Genetics play a role in having ADHD, for example having a first degree biological relative with ADHD.


How Medication Works in ADHD

Stimulants like Adderall and Ritalin are the treatment of choice in ADD and ADHD. Medication in ADHD levels the neurological playing field. Stimulant medication helps your ADHD brain to stay focused after you begin a task. Stimulants like Adderall improve frontal lobe activity, by increasing the neurochemicals in the prefrontal cortex.  This is done by blocking the reuptake of norepinephrine and dopamine into the presynaptic neuron and increasing the release of these monoamines into the extraneuronal space.


Web resources on ADHD:

ADDitude (www.additudemag.com)

CHADD {www.chadd.org)


Books to read:

Driven to Distraction by Edward M Hallowell, MD and John J Ratey, MD

Hyper: A Personal History of ADHD by Timothy Denevi

Starting Tomorrow: Get Stuff Done and Have More Fun! By Kim Kensington