The number of attention deficit disorder (ADHD or ADD) diagnoses continue to climb steadily in the United States, up from 7.8 percent in 2003 to 11 percent in 2011. Despite the growing number of individuals with ADHD, it is still a widely misunderstood condition burdened by myths, such as, “you can’t have ADHD if you’re not hyper,” and, “everyone grows out of ADHD eventually.” The fact is, it’s a complex disorder with varying symptoms that morph and persist through adulthood for many people. Here are the facts about ADHD.
What Are The Types Of ADHD?
For many years, ADD was the acronym commonly used to describe Attention Deficit Disorder without hyperactivity — the primarily inattentive subtype. However, ADHD is now the official medical abbreviation for Attention Deficit Disorder, whether the individual is hyperactive or not. The latest Diagnostic and Statistical Manual of Mental Disorders — the 5th edition (DSM-V) — stipulates that all presentations of attention deficit are called ADHD. Medical professionals today further define ADHD diagnoses by quantifying its severity as mild, moderate, or severe, and by labeling its presentation:
- Primarily Inattentive type: People with inattentive ADHD make careless mistakes because they have difficulty sustaining attention, following detailed instructions, and organizing tasks and activities. They are forgetful, easily distracted by external stimuli, and often lose things.
- Primarily Hyperactive-Impulsive type: People with hyperactive ADHD often fidget, squirm, and struggle to stay seated. They appear to act as if “driven by a motor” and often talk and/or run around excessively. They interrupt others, blurt out answers, and struggle with self-control.
- Combined type: People with combined-type ADHD demonstrate six or more symptoms of inattention, and six or more symptoms of hyperactivity and impulsivity.
| ADHD, Primarily Inattentive | ADHD, Hyperactive-Impulsive | ADHD, Combined Type | |
| Inattentive/Poor Attention Span | X | X | |
| Impulsive and/or Hyperactive | X | X |
What is ADHD?
Attention Deficit Hyperactivity Disorder, or ADHD (formerly known as ADD), is defined in the DSM-V as “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, has symptoms presenting in two or more settings (e.g. at home, school, or work; with friends or relatives; in other activities), and negatively impacts social, academic or occupational functioning.”
The ADHD symptoms listed below (taken from the DSM-V) must start by age 12 but can continue throughout adulthood. To merit a diagnosis, a patient must demonstrate at least six of the following symptoms for six months or longer in at least two settings — for example, home and work.
Symptoms of Inattention
- Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
- Often has difficulty sustaining attention in tasks or play activities
- Often does not seem to listen when spoken to directly
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
- Often has difficulty organizing tasks and activities
- Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
- Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
- Is often easily distracted by extraneous stimuli
- Is often forgetful in daily activities – even those the person performs regularly (e.g., a routine appointment)
Symptoms of Hyperactivity/Impulsivity
- Often fidgets with hands or feet, or squirms in seat
- Often leaves seat in classroom or in other situations in which remaining seated is expected
- Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
- Often has difficulty playing or engaging in leisure activities quietly
- Is often “on the go” or often acts as if “driven by a motor”
- Often talks excessively
- Often blurts out answers before questions have been completed
- Often has difficulty awaiting turn
- Often interrupts or intrudes on others (e.g., butts into conversations or games)
Can a person have ADHD without being hyperactive?
Contrary to popular myth, an individual can have ADHD and not be hyperactive. This type of ADHD is diagnosed as ADHD, Primarily Inattentive.
Is ADHD a “new” diagnosis?
No. Although not always known as ADHD or ADD, this inattentive/impulsive-hyperactive group of behaviors has been recognized in the medical community since 1902 by such endearing names as “Defect of Moral Control,” “Minimal Brain Damage,” and “Hyperkinetic Disorder.”
How is ADHD diagnosed?
While there is no single test to check for ADHD, a skilled clinician will use several assessments, evaluations, and interviews to guide him or her to conduct a comprehensive evaluation for an accurate diagnosis.
To determine whether you or your child has the ADHD symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V), a skilled clinician will begin by reviewing the criteria above and conducting a thorough clinical interview using one or more standardized ADHD rating scales.
Most clinical interviews include one or more of the ADHD rating scales, as well as other tests. A proper ADHD test should do two things: determine whether a person has ADHD and rule out or identify other problems — learning disabilities, auditory processing disorders, autism, anxiety, or mood disorders. Depending on your doctor’s concerns, tests may take from an hour to more than eight hours and may require several appointments. Tests used in diagnosing ADHD include:
ADHD rating scales are questionnaires that identify specific symptoms of ADHD that may not emerge in the clinical interview. Answers to the questions can reveal how well a person functions at school, home, or work. The scales are specifically formatted for children, adolescents, and adults. Different rating scales are designed to identify ADHD symptoms in various settings. The most common are the Connors Parent and Teacher Rating Scales and the Vanderbilt Assessment Scale — completed by parents and teachers — for diagnosing children, and the Adult ADHD Self-Report Scale for diagnosing adults.
Intelligence tests are a standard part of most thorough neuropsychoeducational evaluations because they not only measure IQ but also may detect certain learning disabilities common in people with ADHD.
Broad-spectrum scales screen for social, emotional, and psychiatric problems, and they may be ordered if a doctor suspects her patient has anxiety, obsessive-compulsive disorder, or another condition in addition to ADHD.
Tests of specific abilities — language development, vocabulary, memory recall, motor skills — screen for learning disabilities or other processing problems. The doctor may recommend specific tests based, in part, on which kinds of tasks you or your child find easy or difficult.
Computer tests are becoming popular because patients enjoy taking them, and because they can screen for attention and impulsivity problems, which are common in people with ADHD. These “continuous performance tests” (CPT) challenge the patient to sustain attention. A series of visual targets appear on the screen, and the user responds to prompts while the computer measures his or her ability to stay on task. In practice, some experts have found that these tests are better at identifying impulsive symptoms and less successful at flagging symptoms of inattention. The TOVA and the Conners CPT are the most common.
Brain scans. Neuro-imaging procedures, such as positron emission tomography (PET) scans, SPECT scans, and magnetic resonance imaging (MRIs), have long been used in research studies of ADHD. But their use in diagnosing ADHD has not yet been scientifically proven, and is not common.
Finding a qualified ADHD expert isn’t easy. If your physician cannot suggest someone, contact your local chapter of CHADD (chadd.org) for advice and referrals. The best ADHD specialist — whether he or she is a psychiatrist, psychologist, pediatric neurologist, or general practitioner — will have had years of experience in diagnosing and treating ADHD. The first meeting with an ADHD expert should be lengthy. It should start with a long discussion to help her get to know you or your child, and it should take a detailed look at the problems and challenges that led you to seek an evaluation.
How many people have ADHD?
According to the Center for Disease Control and Prevention (CDC), approximately 11% of children ages 4-17 in the U.S. were diagnosed with ADHD by 2011. The National Institutes of Health says that approximately 4% of U.S. adults have a diagnosis of ADHD. That is approximately 14.4 million Americans total.
Can ADHD be cured?
There is no cure for ADHD — it’s treatable, but treatment is not a cure. Even during treatment, patients still have ADHD, and symptoms may return if treatment is discontinued or interrupted.
Recommended treatment includes stimulant or non-stimulant medication, therapy, and some form of behavior modification. The American Academy of Pediatrics recommends medication or behavior therapy, ideally both together, as the optimal ADHD treatment for school-age children.
Do people outgrow ADHD?
While ADHD was once considered a childhood disorder, it is now believed that ADHD continues into adulthood for as many as 75% of children with the disorder.
Up to this point, most scientists hypothesized that when ADHD was diagnosed in adulthood, it was simply missed in childhood. Now, however, researchers wonder if there may be an adult-onset form of ADHD, wholly separate from childhood-onset attention deficit.
Two new studies suggest that adult ADHD is not simply a continuation of childhood ADHD, but actually a separate disorder with a separate developmental timeline. And, what’s more, adult-onset ADHD might actually be more common than childhood-onset. Both of these findings fly in the face of current popular belief, and beg to be verified with more research.
The two studies, published in the July 2016 issue of JAMA Psychiatry (Can Attention-Deficit/Hyperactivity Disorder Onset Occur in Adulthood and Attention-Deficit/Hyperactivity Disorder Trajectories From Childhood to Young Adulthood), used similar methodology and showed fairly similar results. Both found that a high percentage of those diagnosed with ADHD in adulthood didn’t have enough symptoms in childhood to warrant an ADHD diagnosis.
In addition, persistent stereotypes about ADHD have historically meant that individuals with inattentive symptoms are seldom accurately diagnosed on the first try. Many women, in particular, were never diagnosed with ADHD as children but learned later in life that their symptoms of anxiety, depression, or executive function deficits actually trace back to attention deficit.
Is there a biological basis for ADHD?
Yes. Available evidence suggests that ADHD is genetic.
- Children who have ADHD usually have at least one close relative who also has ADHD.
- And at least one-third of all fathers who had ADHD in their youth have children with attention deficit.
- The majority of identical twins share the trait.
Much about ADHD — including the precise cause of the disorder — is still unknown. We do know that ADHD is a brain-based, biological disorder. Brain imaging studies show that brain metabolism in children with ADHD is lower in the areas of the brain that control attention, social judgment, and movement.
Does ADHD have different degrees of severity?
Yes. Some people who have ADHD symptoms are affected only mildly. Others are literally homeless because they can’t keep a job, they have substance-abuse problems, or they have other visible signs of untreated ADHD. When diagnosed, ADHD now often carries a classification of mild, moderate, or severe.
Are there different forms of ADHD?
There is only one official diagnosis, however it does include subcategories: Primarily Inattentive, Primarily Hyperactive-Impulsive, or Combined Type. Some researchers and clinicians have started making distinctions based on the ways ADHD appears in different people. According to Daniel G. Amen, M.D., ADHD is recognizable in seven different subtypes, including Over-Focused ADD and Temporal Lobe ADD. Lynn Weiss, Ph.D., uses three categories to describe ADHD diagnoses. This work is somewhat controversial, but it points out the fact that ADHD affects different people in different ways.
Are there gender differences in ADHD?
Yes. Women are as likely as men to have ADHD, yet the latest research suggests that ADHD causes them even greater emotional turmoil — in part because stereotypes suggest that ADHD is a disorder for boys only. Consequently, women with the condition are more likely than their male counterparts to go undiagnosed (or misdiagnosed), and less likely to receive appropriate treatment. Many women with ADHD live for decades thinking they are depressed, dumb, or ditzy — hurtful labels assigned to them for years.
Men are more likely to have ADHD with hyperactivity. Women are more likely to demonstrate inattentive symptoms, though it’s worth noting that all three subtypes do exist in women and in men.
