ADHD: Facts and Myths Across the Lifespan

1. Defining ADHD
2. Diagnostic Criteria
3. Data
4. ADHD in childhood
5. ADHD in adulthood
6. Treatment
7. Interventions
8. Facts & Myths
9. Conclusion

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What is ADHD

Per the CDC, Attention Deficit- Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood. ADHD typically includes attention difficulty, hyperactivity and impulsivity that interferes with daily functioning and development in a person.

Three Types:

• Predominantly inattentive presentation
• Predominantly hyperactive-impulsive presentation
• Combined Presentation: Inattentive & hyperactive/impulsive behaviors

Diagnostic Criteria

• Children up to 16 years old must present with 6 or more of the following symptoms
• Those 17 years old and older must present with 5 or more of the following symptoms
• Symptoms must be present before age 12
• Symptoms are present in more than one setting (home, school, work)

Inattentive Presentation

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Often has trouble holding attention on tasks or play activities.

Often does not seem to listen when spoken to directly.

Often has trouble organizing tasks and activities.

Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.

Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).

Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).

Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

Is often easily distracted

Is often forgetful in daily activities.

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Hyperactive-Impulsive Presentation

Often fidgets with or taps hands or feet, or squirms in seat.

Often leaves seat in situations when remaining seated is expected.

Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).

Often unable to play or take part in leisure activities quietly.

Is often “on the go” acting as if “driven by a motor”.

Often talks excessively.

Often has trouble waiting their turn.

Often blurts out an answer before a question has been completed.

Often interrupts or intrudes on others (e.g., butts into conversations or games

Causes of ADHD

1. Genetics: ADHD can run in families.
2. Environmental factors: Certain environmental factors can increase risk like lead exposure commonly found in older buildings, pipes, and paint.
3. Problems during development: Problems in the central nervous system during key moments of development.

Risk Factors of ADHD

• You have blood relatives, parents or siblings, with ADHD.
• Mother smoked, drank alcohol, or used drugs during pregnancy.
• Being exposed to environmental toxins such as lead as a child.
• You were born prematurely.

Data and Comorbidities

• About 6 million children ages 3-17 have been diagnosed with ADHD in the U.S.
• Boys are more likely to be diagnosed with ADHD compared to girls (13%/6%)
• Data collected in 2016 showed that 6 in 10 children with ADHD had at least one other mental, emotional, or behavioral disorder
• Most common: Conduct Disorder, Oppositional Defiant Disorder, Anxiety, Depression, Autism Spectrum Disorder.
• According to the NIH, about 20-60% of individuals with ADHD also have a learning disability like dyslexia, auditory processing disorder, etc.

ADHD in Childhood

https://www.youtube.com/watch?v=N2-nnHGlPbc

Differences in ADHD between boys and girls

https://www.youtube.com/watch?v=TKwvcuRbkU8

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ADHD in Adulthood

Symptoms:

• Impulsiveness
• Disorganization and problems prioritizing
• Poor time management skills
• Problems focusing on a task
• Trouble multitasking
• Excessive activity or restlessness

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• Poor planning
• Low frustration tolerance
• Frequent mood swing
• Problems following through and completing tasks
• Hot temper
• Trouble coping with stress

ADHD in Adulthood

• Symptoms must’ve started in childhood at age 12 years or earlier.
• Hyperactivity may decrease but difficulty with impulsiveness, restlessness, and difficulty paying attention may continue.
• Everyday tasks may be challenging. For example, due to difficulty with focus and prioritizing deadlines or social plans may be missed. Additionally, due to difficulty with impulsivity waiting in line, driving in traffic to mood swings, and outbursts of anger may be an issue.
• Treatment is similar to childhood treatment: medication, psychotherapy, and treatment of potential comorbid conditions like anxiety, depression, etc.

ADHD in Adulthood

https://www.youtube.com/watch?v=Am-XbS0y0hE

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Therapeutic Treatments

Behavioral: Examples are Positive Parenting Program (Triple P) & Parent Child Interaction Therapy (PCIT)

Skills Training: Focus on executive functioning and skill building such as time management, organization, social/communication skills, emotional regulation.

* Therapeutic treatment can be obtained in a variety of settings like school-based therapy, private practice, or community-based services.

Medication: Most commonly prescribed are stimulants like Adderall, Dexedrine, and Methylphenidate (medication concerns should be addressed with a medical provider).

* Remember to consult with your preferred healthcare provider to explore your treatment options.

Parent-Child Interventions

Triple P: The program supports parents who have concerns about their child’s behavior or development across various settings. It’s designed into 10 sessions primarily focused on a range of parenting strategies to promote and develop positive behavior for their child.

PCIT: Evidenced-based treatment program designed for caregivers and children between 2-7 years old who are experiencing behavioral, social, and/or emotional difficulties. Designed into two parts with the focus on the enhancement of the parent-child relationship, and the development of the caregivers' behavior management skills.

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Interventions in the Home

• Establish and maintain structure by creating a routine. This may include a homework schedule, designated dinner time, routines for playing, and a bedtime.
• Create a detailed lists for tasks you want completed.
• Use praise and focus on pointing out accomplishments rather than mistakes.
• Create a rewards system at home (ie token economy)

Rewards System

The goal of a token economy or rewards system is to help change behaviors in resistant children and adolescents. The purpose is to reward a child for positive behaviors with a token (ie sticker). The tokens collected can later be exchanged for an agreed upon reward.

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Tips for creating a rewards system

• Start Slow: Avoid overwhelming your child by choosing a small number of behaviors you want to work on (1-2 at a time)

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• Desired behaviors should be clearly defined to the child: Be as detailed as possible when assigning chores or asking for a change in behavior (ie use a picture of what you want their room/ backpack to look like)

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• Tokens awarded should not be taken away: doing so may result in the child giving up or feeling as though their efforts are useless. A child may interpret this as punishment

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Continued

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• Do what you say and Collaborate: Build and maintain trust with your child by following through with rewards that are promised and do not give into giving rewards for behaviors that are not achieved. Collaborating on a list of realistic rewards with your child will help you to stick to your word and can help motivate your child more.

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• Be Patient: It takes time to adjust to a rewards systems, you will not see change overnight.

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Interventions/Accommodations in school

IEP Plans: Provide individualized special education services to meet the specific needs of students.

504 Plans: Provide services and changes to the learning environment to meet the needs of the student as adequately as other students.

*Eligibility requirement must be met to qualify for these accommodations.

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Facts & Myths

Myth: ADHD is caused by poor parenting

Fact: ADHD tends to run in families, in most cases, the genes you inherit from your parents are a significant factor in developing ADHD. For example, parents and siblings of someone with ADHD are more likely to have ADHD themselves. Groups at higher risk of developing ADHD: individuals who were born prematurely or at a low birth weight, those with epilepsy, and those with brain damage (either while in the womb or later in life).

Myth: ADHD is being overdiagnosed:

Fact: As a society, we are more attuned to children’s struggles and will investigate the issue (seek assessment).

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Facts & Myths

Myth: Brain imaging can diagnose ADHD

Fact: The National Institute of Health does not recommend imaging (ex: x-ray or MRI) because our current technology is not advanced enough for diagnostic. Please note, therapists, psychiatrists, neurologists, or primary care doctor will use other tools to diagnose ADHD.

Myth: Only young boys get ADHD

Fact:

• Boys usually get diagnosed earlier because they more commonly display hyperactive/impulsive symptoms.
• Girls more commonly have the inattentive type, typically noticed around fourth/fifth grade where the child is expected to be more organized & work independently.
• Approximate ratio in males than in female is 2:1 in children and 1.6:1 in adults.

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Facts & Myths

Myth: Sugar causes ADHD

Fact: Sugar consumption has not been linked to ADHD development. However, high sugar consumption can lead to temporary hyperactive or inattentive behaviors due to insulin spike (aka: food coma or sugar high).

Myth: No one really needs medication for ADHD

Fact: ADHD medication will not cure ADHD but it will improve symptoms of inattention, hyperactivity, and impulsivity. Per a study published in BMJ, medication can improve school performance and quality of life. The most notable risks were decreased appetite and sleep problems which are considered “non serious adverse effects” but can be discussed with the individuals medical doctor.

Facts & Myths

Myth: ADHD medication is addictive.

Fact: ADHD medication is prescribed by a medical doctor who is monitoring the effects of the medication on their client and making changes if necessary. ADHD medication works almost instantly and does not require titration when stopping the medication. ADHD medication has been found to be a protective factor against substance use with individuals diagnosed with ADHD.

Myth: People with ADHD are lazy/irresponsible.

Fact: Individuals (children and adults) with ADHD have issues with the dorsal anterior cingulate cortex (portion of the brain) that works very hard but less efficiently than someone without ADHD. The networks in this area are disrupted and make things like organization, executive function, impulse control, focus, etc very difficult. Please note, often individuals get negative feedback about their efforts from family, school staff, and friends because they are not producing the results that are expected from them. The idea is that individuals with ADHD need to “try differently” vs “trying harder” and those surrounding the individual with ADHD should attempt to implement empathy.

Facts & Myths

Myth: No accommodations can be made at school or in the workplace for individuals with ADHD.

Fact: Federal law protects individuals with ADHD through Section 504 of The Rehabilitation Act of 1973 (school), The Individuals with Disabilities Education Act (school & workplace), & The Americans with Disabilities Act (workplace) to make appropriate accommodations in both settings.

Myth: My life/child’s life will not be normal.

Facts: With treatment, individuals with ADHD can experience a great quality of life. Treatment may include medication, psychotherapy, behavioral therapy, skills training.

References

ADHD medication for kids: Is it safe? does it help?. Harvard Health. (2016, March 4). https://www.health.harvard.edu/blog/adhd-medication-for-kids-is-it-safe-does-it-help-201603049235

Centers for Disease Control and Prevention. (2023, March 30). Learn about attention-deficit / hyperactivity disorder (ADHD). Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/adhd/index.html

CHADD. (2018). Understanding ADHD - CHADD. CHADD. https://chadd.org/understanding-adhd/

Harpin, V. A. (2005, February 1). The effect of ADHD on the life of an individual, their family, and community from preschool to adult life. Archives of Disease in Childhood. https://adc.bmj.com/content/90/suppl_1/i2

Kim, Y., & Chang, H. (2011, June). Correlation between attention deficit hyperactivity disorder and sugar consumption, quality of diet, and dietary behavior in school children. Nutrition research and practice. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3133757/

Mayo Foundation for Medical Education and Research. (2023, January 25). Adult attention-deficit/hyperactivity disorder (ADHD). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/adult-adhd/symptoms-causes/syc-20350878

NHS. (n.d.). NHS choices. https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/causes/#:~:text=Genetics,factor%20in%20developing%20the%20condition.

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