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Understanding ADHD: The
ABC's of Attention-Deficit/
Hyperactivity Disorder

A close-up of a piece of paper with words adhd

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that impacts an individual’s various executive functioning abilities such as the ability to focus and be organized as well as manage impulses and activity levels. Understanding the basics of ADHD is crucial for recognizing its signs, seeking appropriate treatment, and supporting individuals affected by it.

What is ADHD?

ADHD is characterized by persistent patterns of inattention and/or hyperactivity/impulsivity that interfere with functioning in two or more settings (home, work, school, etc). There are three presentations of ADHD: predominantly inattentive presentation, predominantly hyperactive/impulsive presentation, or combined presentation (both inattention and hyperactivity impulsive symptoms present).

For a diagnosis of ADHD, symptoms must be present before age 12 and while it's commonly diagnosed in childhood, symptoms can persist into adolescence and adulthood. The exact cause of ADHD is not fully understood, but it's believed to involve a combination of genetic and environmental factors (APA, 2022).

A child struggling to study while an older woman is helping

Is ADHD Genetic?

Research suggests a strong genetic component to ADHD, with heritability estimated to be around 70-80% (Faraone et al., 2005). Individuals with a family history of ADHD are more likely to develop the disorder themselves. However, environmental factors such as prenatal exposure to toxins, maternal smoking during pregnancy, premature birth, and early childhood trauma may also contribute to its development (Thapar et al., 2013). The exact cause of ADHD is multifaceted and not fully understood. It involves a complex interplay of genetic, neurological, and environmental factors (Bonvicini et al., 2016). Neuroimaging studies have identified differences in brain structure and function in individuals with ADHD, particularly in regions responsible for attention, impulse control, and executive function (Frodl & Skokauskas, 2012).

What are the signs of ADHD?

The three presentations are predominantly inattentive presentation, predominantly hyperactive/impulsive presentation, or combined presentation (both inattention and hyperactivity impulsive symptoms present). The signs of ADHD vary depending on these subtypes. These symptoms often manifest across different settings, such as home, school, work, and social environments. Below are the common signs of ADHD.

Signs of Inattention ADHD

Difficulty sustaining attention
Being easily distracted
Overlooking details
Forgetfulness
Difficulty organizing tasks

Signs of Hyperactivity ADHD

Restlessness
Fidgeting
Excessive talking
Inability to stay seated
Constantly being "on the go"

Signs of Impulsivity ADHD

Acting without considering consequences
Interrupting others
Having difficulty waiting for turns
Making hasty decisions

Course of ADHD

ADHD is a neurodevelopmental disorder, meaning symptoms present in the early developmental period, typically beginning in toddlerhood or elementary school age. Over the course of an individual's life, hyperactivity typically lessens or becomes less obvious while problems with restlessness, inattention, difficulties with executive functioning (i.e. time management, planning, and organizing), and impulsivity may continue. A large portion of children with ADHD will continue to have symptoms that impair various aspects of their life (i.e. relationships, school, work, home life) into adulthood (APA, 2022). Because symptoms of ADHD can overlap, mimic, and co-occur with other mental health conditions (see Assessment of ADHD), receiving a thorough assessment is often vital to receiving an accurate and timely diagnosis and treatment of symptoms (APA, 2022).

Additionally, some individuals may not receive a diagnosis till adulthood due to a variety of factors, such as lack of screening or resources, having subthreshold symptoms that do not get exacerbated until the increased demands in adolescence or adulthood, as well as having other mental health conditions that mimic, overlap, or impact ADHD symptoms (Asherson et al., 2019). Some populations (i.e. women, racial and ethnic minorities, individuals with high IQs, and individuals presenting with more inattentive or internalized symptoms) may also be misdiagnosed or not diagnosed until adulthood due to various factors such as stigma, biases, and using coping or compensatory strategies to mask their symptoms (Asherson et al., 2019; Attoe et al., 2023; Coker et al., 2016). Therefore, various factors can make it challenging to recognize the underlying condition, which is often why a thorough assessment is necessary.

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Assessment of ADHD

Diagnosis and treatment of ADHD often begin with a screening for and a comprehensive assessment of symptoms, history, and functional impairment. At the Minnesota Clinic for Health and Wellness psychological testing is available. Referrals can be made for any further testing, if needed, such as neuropsychological testing. Further testing is often needed as ADHD can be co-occurring with and need to be differentiated from other neurodevelopmental disorders (i.e. Autism Spectrum Disorder, Learning Disorders), behavioral related disorders (i.e. oppositional defiant disorder), and mood-related disorders (i.e. anxiety, depression, bipolar disorder) for an accurate diagnosis. Testing can also help clarify an individual's strengths and areas of growth, provide school or work accommodations, and sometimes is needed to pursue medication treatment.

Treatment of ADHD

MEDICATION

Both stimulant and non-stimulant medications can be prescribed to manage symptoms. Like all medications, prescriptions for ADHD have pros and cons to consider which can be assessed for and discussed with a medication provider. To learn more about navigating medications read: Navigating Medication and Management in Mental Health: Your Essential Guide.

Behavioral Interventions

Therapy

Therapy plays a crucial role in managing ADHD by teaching individuals practical skills and strategies to cope with symptoms and improve overall functioning. Below is a list of types of therapy that are supportive for patients with ADHD:

Cognitive-Behavioral Therapy (CBT): CBT helps individuals identify and challenge negative thought patterns, develop problem-solving skills, and implement behavioral strategies to manage impulsivity and improve focus.

Parent Training: For children with ADHD, parent training programs provide education and support to parents in implementing effective behavior management techniques at home.

Social Skills Training: Group therapy or social skills training programs help individuals with ADHD develop interpersonal skills, such as communication, empathy, and conflict resolution, to enhance social relationships and peer interactions.

Occupational Therapy: Occupational therapy can be highly beneficial for individuals with ADHD by addressing specific challenges related to attention, executive function, and sensory processing.

Educational Interventions

Accommodations in school settings through Individualized education plans (IEPs) or 504 plans can provide support tailored to the individual's needs, such as extended time for tasks or preferential seating.

In conclusion, ADHD is a complex neurodevelopmental disorder that requires a comprehensive approach to diagnosis and treatment. Understanding the ABC's of ADHD and collaborating with professionals specializing in this disorder can lead to a more tailored and effective mental health journey.

Ultimately, the key to successful ADHD treatment lies in finding a therapeutic approach that resonates with the individual and addresses the specific challenges they face. If you or someone you know has ADHD and you’re unsure of where to start, please give us a call at the Minnesota Clinic for Health and Wellness and our trained staff will ask you specific questions in order to direct you to the right type of therapy or service.

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Reference List

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Asherson, P. & Agnew-Blais, J. (2019). Annual research review: Does late-onset
attention-deficit/hyperactivity disorder exist? Journal of Child Psychology and Psychiatry, 60(4), 333-352.

Attoe, D.B., & Climie, E.A. (2019). Miss. Diagnosis. A systemic review of ADHD in adult women. Journal of Attention Disorders, 27(7), 645-657.

Bonvicini, C., Faraone, S. V., & Scassellati, C. (2016). Attention-deficit hyperactivity disorder in adults: A systematic review and meta-analysis of genetic, pharmacogenetic and biochemical studies. Molecular Psychiatry, 21(7), 872-884. https://doi.org/10.1038/mp.2016.74

Coker, T. R., Elliot, M.N., Toomey, S.L., Schwebel, D.C., Cuccaro, P., Tortlero Emery, S., Davies, S.L., Visser, S.N., & Schuster, M.A. (2016). Racial and ethnic disparities in ADHD diagnosis and treatment. Pediatrics, 138(3), 1-18.

Faraone, S. V., Perlis, R. H., Doyle, A. E., Smoller, J. W., Goralnick, J. J., Holmgren, M. A., & Sklar, P. (2005). Molecular genetics of attention-deficit/hyperactivity disorder. Biological Psychiatry, 57(11), 1313-1323. https://doi.org/10.1016/j.biopsych.2004.11.024

Frodl, T., & Skokauskas, N. (2012). Meta-analysis of structural MRI studies in children and adults with attention deficit hyperactivity disorder indicates treatment effects. Acta Psychiatrica Scandinavica, 125(2), 114-126. https://doi.org/10.1111/j.1600-0447.2011.01786.x

Thapar, A., Cooper, M., Eyre, O., & Langley, K. (2013). What have we learnt about the causes of ADHD? Journal of Child Psychology and Psychiatry, 54(1), 3-16. https://doi.org/10.1111/j.1469-7610.2012.02611.x

Understanding ADHD: The ABC's of Attention-Deficit/ Hyperactivity Disorder