Attention-deficit / hyperactivity disorder (ADHD)

What is ADHD??

Everybody can have difficulty sitting still, paying attention or controlling impulsive behavior once in a while. For some people, however, the problems are so pervasive and persistent that they impair functioning in important aspects of life: academic, social, home and work. Attention-deficit/hyperactivity disorder (ADHD) is a neurological, developmental and behavioral disorder that affects people across the lifespan.

It is characterized by developmentally inappropriate levels of inattention, impulsivity and/or hyperactivity.  ADHD can be understood as a disorder of self-regulation and executive functioning that affects many areas of life—mood, sleep, eating, focus, prioritizing, memory, emotional reactivity, performance and learning.  More than 75 percent of children with ADHD continue to experience significant symptoms in adulthood. 

Typically, ADHD symptoms arise in childhood.  Many parents report excessive motor activity, impulsivity and inattentiveness in their children which may be difficult to distinguish from behaviors that are typical during childhood.  According to the DSM, several symptoms are required to be present and pervasive.  There are three presentations of ADHD based on how the symptoms present in the person’s behavior—Hyperactive-Impulsive, Predominantly Inattentive, or Combined.

Common Symptoms/How It Impacts Someone’s Life:

  • Delays in independent functioning, behaving younger than peers.
  • Deficits in executive functioning—trouble prioritizing tasks, shifting focus, sustaining effort, managing frustration, and using working memory
  • Being forgetful in daily life
  • Blurting out answers before questions have been completed
  • Difficulty waiting or taking turns
  • Trouble following through or completing tsks
  • Restlessness, acting as if driven by a motor
  • Making careless mistakes
  • Procrastination and avoiding tasks that are tedious and mentally taxing

ADHD symptoms affect people to varying degrees, and a diagnosis includes an indicator of severity.  Clinicians can designate the severity of ADHD as “mild,” “moderate,” or “severe” under the criteria in the DSM.  Though ADHD affects children and adults, the presentation of symptoms and the severity of the disorder can change during a person’s lifetime.

What Can ADHD Look Like?

In Crisis

Adult
Trouble keeping jobs
Conflicted or broken relationships
Self-destructive coping methods (quitting, isolation, substance abuse, excessive spending)
Very low self-esteem

Child
Failing classes
Disciplinary actions at school
Conflicted relationship within the family
Running away
School refusal
Engaging in risky behavior

Struggling

Adult
Procrastinating
Low self-esteem
Poor performance
Missing deadlines
Trouble sleeping
Distracted and anxious
Emotional outbursts Conflict in relationships
Over committing
Misplacing items

Child
Blurting out answers in school
Not turning in assignments
Difficulty making and keeping friends
Low self-esteem
Emotional outbursts Difficulty waiting or taking turns

Surviving

Adult
Just keeping up
Worried
Developing and using strategies for time management
Feeling overwhelmed and exhausted

Child
Trouble siting still or following directions
Feeling bad about ADHD symptoms
Struggling in classes Worried about friendships Hearing lots of criticism

Persevering

Adult
Keeping up
Managing
Using supports
Setting and achieving goals Developing routines
Building skills

Child
Meeting expectations Keeping routines
Using supports
Playing with friends Building skills

Excelling

Adult
Using helpful supports for time management, executive functions, and self-regulation
Joyful
Realizing potential
Social engagement
High performance

Child
High performance
Using supports at school and at home
Close relationships with family
Social engagement
Participating in extra curriculars

Ways to Treat ADHD

There are many helpful treatments for ADHD and research shows
that a combination of approaches or “multimodal treatment” is the most
effective.  This includes:  

  • Parent and child education about diagnosis and treatment, and parent training
  • Learning about ADHD, Executive Functioning and the ways they affect areas of life
  • Behavioral management techniques
  • Medication
  • Therapy
  • Educational program modifications and supports, including IEP or 504 Plans
  • Workplace accommodations
  • Coaching

Universal Precautions (things you can do and plan on your own)

  • Taking care of getting proper sleep and nutrition
  • Minding your physical health (regular check-ups and if applicable, taking prescribed medication)
  • Learning about ADHD, mental health, educational supports, workplace accommodations (the resources below are helpful for this)
  • Working out/including movement and exercise
  • Spending time with friends
  • Journaling
  • Practicing mindfulness
  • Experiencing joy, play and awe

Evidence Based Treatment Options (Therapies):

  • CBT
  • ACT
  • Medication
  • Skills Training (Social, Executive Functioning, Study)

All therapeutic styles will involve learning about:

  • the way our brains operate (the stress response system, expected cognitive impairments when we are under stress),
  • the symptoms of ADHD and ways to address and manage them,
  • the way that thoughts, feelings and behaviors are linked and influence each other.
  • Most therapeutic styles involve exploring without judgment one’s feelings, beliefs, thoughts, and habits in an effort to reframe /expand awareness /experiment with ideas.

This allows the thoughts, feelings and behaviors to change and influence each other in new ways.

If you or someone you know is in Crisis and unable to perform daily activities:

Symptoms may be or become overwhelming and prevent a person from engaging in many of the above interventions. People who are in crisis may require a more intensive treatment plan. When this is the case, call a professional as soon as possible. What happens next might include:

  • Health and Safety Assessment (HSA)—people experiencing a crisis may benefit from a structured interview with a mental health clinician to assess the threats to their wellbeing and provide recommendations regarding seeking treatment.
  • Partial Hospitalization Programs (PHPs)
  • Intensive Outpatient Programs (IOPs)

Resources

CHADD.org. Tremendous treasure-trove of resources and information. Local CHADD chapters:

Add.org. Attention Deficit Disorder Association (ADDA)—excellent website with resources and information for adults with ADHD

https://www.brownadhdclinic.com/the-brown-model-of-add-adhd  An excellent overview of executive functioning and ADHD. The resources section of the website has lots of helpful information

https://www.russellbarkley.org/  A website devoted to education and research on ADHD.

https://developmentaldoctor.com/  Mark Bertin, MD, excellent resources for ADHD, Mindfulness, Self-Compassion, and Child Development in the “Blog and Resources” tab as well as in “Podcasts” under the “Classes and Lectures” tab. 

https://d393uh8gb46l22.cloudfront.net/wp-content/uploads/2018/05/NRC_Bilingual_Educational_Rights_Guide_2012.pdf  Educational Rights for Children with Attention Deficit/Hyperactivity Disorder (ADHD): A Primer for Parents (guide in English and Spanish), an informative guide to requesting and securing services for students published by the National Resource Center of CHADD.

YouTube channels

https://www.youtube.com/channel/UC-nPM1_kSZf91ZGkcgy_95Q/featured  How to ADHD with Jessica McCabe, an independent site for adults dealing with ADHD. Many interviews with top experts, providing helpful information, presented with wit, wisdom, & hope.

https://www.youtube.com/user/additudemag/featured  ADDitude Magazine’s channel, a source of well-vetted expert advice and judgment-free understanding for families and adults managing life with ADHD. 

https://www.youtube.com/user/HelpForADHD/featured  CHADD’s National Resource Center channel providing science-based information on ADHD for families, adults, and health care and education professionals.