ADHD Symptoms, Diagnosis, and Treatment
ADHD (Attention Deficit Hyperactivity Disorder), is characterised by inattentiveness, hyperactivity and impulsiveness’.
ADHD symptoms are often noticed at a young age and more apparent when children start school. Although ADHD symptoms tend to improve with age, some adults can still experience severe symptoms of the disorder. Co-morbidity has been noted in some cases of ADHD, by this I mean, as well as ADHD, some individuals may experience additional problems with cognitive ability or anxiety disorders and difficulty sleeping.
ADHD symptoms fall into two groups; Inattentiveness or hyperactivity and impulsiveness.
In most ADHD cases, individuals have both types of behavioural symptoms. However, some cases are characterized by only one type of behavioural symptoms. E.g. some individuals may present with inattentiveness, but symptoms of hyperactivity and impulsiveness are absent. Such cases are known as attention deficit disorder (ADD). Diagnosis of the subtype of ADHD is more difficult as symptoms aren’t as obvious.
The symptoms of ADHD in children and teenagers are usually more noticeable, for two reasons. Firstly, they are more evident at a younger age and secondly, they occur in multiple situations; home and school.
ADHD Symptoms of inattentiveness:
- A short attention span or easily distracted
- Constantly losing things, making mistakes and appearing forgetful.
- Find it impossible to complete tedious or time consuming task
- Giving the impression that they are not listening or are that they are unable to follow instruction.
- Continuously changing task or activity.
- Find it difficult to organize tasks
ADHD Symptoms of hyperactivity and impulsiveness:
- Unable to sit still (especially in quiet surroundings)
- constantly fidgeting
- being unable to concentrate on tasks
- excessive physical movement
- excessive talking
- inability to wait their turn
- acting without thinking
- interrupting conversations
- little or no sense of danger
These symptoms can have significant consequences in childhood such as poor social interaction, problems with discipline and academic underachievement.
In some cases, alongside ADHD symptoms, children may experience:
- anxiety disorder
- oppositional defiant disorder (ODD)
- conduct disorder
- sleep problems
- autistic spectrum disorder (ASD)
- Tourette’s syndrome
- learning difficulties (e.g. dyslexia)
Adult ADHD Symptoms
Due to lack of research, ADHD symptoms in adults are more difficult to define. Currently the belief held by researchers and health professionals alike, is that ADHD is a developmental disorder; It can’t develop in adulthood, without appearing in childhood first. Symptoms of ADHD tend to begin in childhood, and continue through adolescence and into adulthood. Co-morbid conditions such as depression and anxiety, also persist through to adulthood.
The NHS estimate 15% of people diagnosed with ADHD as children still have a full range of symptoms at 25 years of age.
The symptoms in children and teenagers, are sometime applicable to adults with possible ADHD. Yet the way in which inattentiveness, hyperactivity and impulsiveness affect adults can be very different from the way they affect children.
Hyperactivity tends to decrease in adults, while inattentiveness tends to get worse due to increased pressure of adult life. Adult symptoms of ADHD are far more subtle than childhood symptoms.
The behavioural problems associated with ADHD can also cause problems such as difficulties with relationships, social interaction, drugs and crime. Some adults with ADHD find it hard to find and stay in a job. Want to know more about adult ADHD?
There are number of different specialists that are qualified to conducted a comprehensive assessment to determine whether someone has ADHD such as, child/adult psychiatrists, child/adult psychologists, pediatrician or occupational therapist (with ADHD expertise).
Assessment often includes a physical check-up. This is to rule other possible causes for symptoms. It also includes interviews with the individual and their family and significant others (parents, teachers, partners).
A diagnosis if ADHD depends upon whether the symptoms meet the strict criteria set out the the DSM-V. To be diagnosed with ADHD, symptoms must meet the following criteria:
“Six or more of the symptoms have persisted for at least six months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities. Please note: The symptoms are not solely a manifestation of oppositional behaviour, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), five or more symptoms are required” (ADHD Institute, 2016).
- Symptoms were present before the age of 12
- Symptoms have been noted in at least two different settings – for example, at home and at school
- Symptoms make social, academic and occupational life extremely difficult.
- Symptoms aren’t a part of a developmental disorder or result of difficult phase, and aren’t due to another condition.
Diagnosis in adults
This is more difficult as there aren’t a list of adult specific symptoms. Thus there is a debate amongst healthcare professionals as to whether the diagnostic criteria used for children and teenagers, is applicable to adults.
Current criteria for an adult diagnosis is, having five or more symptoms of inattentiveness, or five or more symptoms of hyperactivity and impulsiveness, that are listed in diagnostic criteria for children with ADHD.
However, an adult diagnosis cannot be confirmed unless symptoms were present from childhood. During assessment, health professionals will look to ascertain whether symptoms were present in childhood. If your an adult and your symptoms are fairly recent, and were not evident during childhood, then a diagnosis of ADHD cannot be made. This is because current school of thought is that ADHD cannot develop for the first time in adulthood.
What causes ADHD?
It is difficult to pin point the exact cause of ADHD. Many factors have been identified that are thought to contribute to ADHD, such as genetics and brain structure. ADHD tends to run in families. Research shows that if one child in a family has the condition, then the parents and siblings in that family, are 4 to 5 times more likely to have ADHD.
Research has also identified structural, functional and chemical differences in the brains of individual with ADHD compared to those without the condition. The brain takes longer to mature in children with ADHD, on average, 2 to 3 years longer. Brain scans have revealed that children with ADHD have reduced grey and white matter. The prefrontal cortex, striatum, basal ganglia and cerebellum tend to be smaller in individuals with ADHD. The development of dopamingeric pathways (pathways that transmit a type of neuro transmitter, dopamine) is also delayed in individuals with ADHD. This combined with the imbalance of dopamine and noradrenaline is believed to contribute to impulsive symptoms of ADHD.
Other possible causes included damage to the brain in the womb or first few years of life, premature birth, low birth weight and substance abuse during pregnancy (drugs, alcohol, smoking). It is important to note, that research is unclear, thus it is difficult to say how these factors contribute to ADHD.
Treatments for ADHD
Treatments can help reduce the problems that occur in day-to-day life by relieving some of the symptoms. The most common treatment modalities are medication and behavioural therapy. A combination of both, can offer the best possible results in terms of management of symptoms.
Medication is most often used in managing ADHD. Although it is a common form of treatment, it is important to note that medication does not cure ADHD. Nevertheless, it can help with concentration, impulse control.
The medications increase brain activity in the regions that play a role in attention and behaviour control. Although the medication can help improve symptoms, individuals may experience side effects such as, increase in blood pressure and heart rate, trouble sleeping, headache, mood swings, loss of appetite, stomach aches, agitation, aggression, dizziness, diarrrhoea, nausea, vomiting, drowsiness, irritability, tiredness and fatigue.
Therapy can be effective in treating anxiety and disorders that occur alongside ADHD. The most common are psychoeducation, behaviour therapy, social skills training and CBT.
Involves encouraging parent and child to talk about ADHD and how it affects them. It can help children and teens to better understand their diagnosis and help them to cope and live with condition.
This type of therapy is most useful for parents, carers and teachers. It involves using a reward system to encourage the the individual to control their ADHD. This type of behavioural management can help encourage more positive behaviours using rewards and discourage negative behaviours by removing the rewards. For teachers, this therapy helps them to plan and structure activities for children with ADHD.
Social skills training
Uses role play to teach children how their behaviour impacts others and how best to behave in social situations.
Cognitive behavioural therapy (CBT)
CBT is a talking therapy. It helps you to manage your problems by changing the way you think, behave and respond to certain situation. CBT can be one-to-one or group based.
Alternative methods of managing ADHD.
Diet – eating a balanced diet can be beneficial in managing and improving symptoms. Some individuals may notice a link between eating certain foods and worsening of symptoms. E.g. caffeine and sugary foods can contribute to symptoms of hyperactivity.
If you have any suggestions or questions, please get in touch or leave a comment below! 🙂
Rupinder is an aspiring Neuropsychologist with a BSc in Psychology and an MSc in Cognitive Neuropsychology. She is interested in how Psychology and Neuroscience can be applied to everyday life. With experience in conducting behavioural and neuropsychological research, she is passionate about using research to improve our understanding of neurological and mental health conditions. Rupinder welcomes feedback and the opportunity to discuss all things Psychology and Neuroscience.