ADHD, or Attention Deficit Hyperactivity Disorder, is a neurodevelopmental disorder that affects both children and adults. It is characterized by signs such as difficulty with focus, hyperactivity, and impulsivity.
ADHD can make it challenging to complete tasks, follow through on responsibilities, and interact with others.
It is common for everyone to experience some level of difficulty with attention or controlling impulsive behavior, but for those with ADHD, the problems can be so pervasive and persistent that they can interfere with every aspect of their lives.
The first known documentation of ADHD was from 1902, when it was coined for some children. Since then, the condition has been given numerous names, one of these being attention deficit disorder (ADD).
ADD is often still used today, although the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) only lists ADHD to describe individuals with this disorder, regardless of whether they display signs of hyperactivity.
ADHD is often diagnosed in childhood but can also be diagnosed later in life. It is common for many people to recognize they have ADHD later in life or go their whole lives without a formal diagnosis.
While the signs of ADHD can change with time, they can still interfere with an individual’s functioning, specifically in their relationships, health, work, and finances.
Signs of ADHD
It’s important to understand that experiencing some signs of ADHD does not automatically mean someone has the disorder. Many ADHD signs can be common and relatable, but they do not necessarily indicate ADHD.
Additionally, individuals with ADHD may not exhibit all signs or traits and may have varying levels of each trait depending on the situation. This list of signs is not exhaustive.
General signs
Below are some of the common experiences and traits individuals with ADHD may report:
- Hyper-activity, e.g., not being able to sit still or having racing thoughts
-
Easily distracted, e.g., ‘zoning out’ during conversations or switching focus during tasks
-
Often forgetful, e.g., they may forget birthdays, instructions, or homework
-
Have a low tolerance for boredom and need a lot of stimulation
-
Time management difficulties, e.g., getting to appointments on time and procrastinating on important tasks
-
They may miss important information because they have ‘zoned out’
-
Hyper-focusing on tasks that interest them, to the detriment of their basic needs, such as eating and sleeping.
-
Impulsivity, e.g., reckless spending or interrupting others
-
They may have trouble getting to sleep, staying asleep, and waking up on time
-
Motivational issues
-
Low self-esteem after years of not meeting their and other people’s expectations.
-
Executive dysfunction, e.g., difficulty executing and completing tasks from start to finish
- Difficulties regulating emotions, e.g., difficulty managing strong emotions, sometimes resulting in outbursts
Types
The DSM-5 criteria for ADHD list three presentations of the condition that people with the condition fall into predominantly inattentive presentation, predominantly hyperactive-impulsive presentation, and combined hyperactive-impulsive and inattentive presentation.
Below are the types of presentations and some of the traits associated with each one:
Predominately inattentive presentation
The predominantly inattentive presentation of ADHD is characterized by difficulties in maintaining focus, following instructions, and organizing tasks, often resulting in forgetfulness and distractibility.
Predominately hyperactive-impulsive presentation
The predominantly hyperactive-impulsive presentation of ADHD is characterized by excessive activity, restlessness, impulsivity, and difficulty waiting or taking turns, often leading to disruptive behavior.
Combined hyperactive-impulsive and inattentive presentation
The combined hyperactive-impulsive and inattentive presentation of ADHD is characterized by a significant presence of both inattentive and hyperactive-impulsive symptoms, leading to challenges in multiple areas of functioning.
ADHD In Girls And Women
While ADHD is more commonly diagnosed in males than females, with a typical ratio of 3:1, this discrepancy suggests that many girls with ADHD remain unidentified and untreated, leading to long-term social, educational, and mental health consequences.
A 2020 consensus summarized key points for the detection of ADHD in females:
- Females present with both inattentive and hyperactive-impulsive signs, although hyperactive-impulsive signs may be less severe than in males
- Emotional issues, such as low mood, emotional lability, anxiety, and emotional regulation problems, may be more common or severe in females with ADHD
- Girls with ADHD are vulnerable to bullying, increased school drop-out, academic underachievement, and decreased self-esteem and self-concept
- They may not show as many behavioral problems commonly associated with males, and compensatory behaviors may mask behaviors and impairments
- Dysfunctional coping strategies, such as alcohol or drug use, may be used to deal with emotional problems, social isolation, and rejection
Girls and women with ADHD may become skilled at camouflaging their struggles using compensatory strategies, leading to an underestimation of their underlying problems.
Consequently, females with ADHD are often treated for anxiety or depression before receiving an ADHD diagnosis.
It is crucial not to discount ADHD in females simply because they may not display the behavioral problems commonly associated with males.
What Causes ADHD?
Genetics
There is uncertainty surrounding the causes of ADHD, although it is generally believed to have neurological and genetic origins.
This means that if someone has ADHD, there is a good chance that they have a family member who also has the condition.
Brain differences
Research suggests that there is a structural difference in the brains of those with ADHD compared to those who do not have the condition.
It was found that those with ADHD had reduced grey matter volumes in their anterior cingulate cortex, occipital cortex, cerebellar regions, and bilateral hippocampus/amygdala.
This reduction in grey matter volume could explain why people with ADHD have attentional problems since grey matter is involved in learning, memory, cognitive processes, and attention.
However, whether ADHD is the cause or effect of these brain differences is debatable.
Environmental factors
There are believed to be some factors in the environment that may increase the likelihood of someone having ADHD:
-
Exposure to lead or pesticides in early childhood
-
Premature birth or low weight at birth
-
Brain injury
It has been believed in the past that certain environmental factors may cause ADHD, although these have not been found to be the case.
Some of the factors that do NOT cause ADHD include watching excessive amounts of TV, eating sugar, family stress, parenting styles, and traumatic experiences.
Even though environmental factors such as family stress do not cause ADHD, they can change the way ADHD presents itself and may result in additional problems such as anti-social behaviors.
Researchers are continuing to study the exact relationship between ADHD and environmental factors but point out that there is no single cause that can account for all cases of ADHD.
Dopamine levels
Underlying differences in the brain are likely to be an underlying cause of ADHD, with some researchers looking at dopamine as a possible contributor.
Dopamine is a chemical of the brain that regulates emotional responses and is involved in motivation, feelings of pleasure, and rewards.
People with ADHD may have different levels of dopamine compared to people without ADHD.
Studies suggest that one of the reasons for this difference is that people with ADHD have more of a protein called dopamine transporters in their brain. These proteins can reduce dopamine levels in the brain, which may contribute to ADHD signs.
Studies also suggest that the dopamine pathway involved in reward and motivation may play a role in ADHD.
While more research is needed, some studies have found that a specific type of dopamine transporter may affect certain traits of ADHD, such as mood instability.
Co-existing conditions
More than two-thirds of people who have ADHD also have at least one other co-existing condition.
Occasionally, ADHD may overshadow other conditions, making it harder to notice.
Likewise, the other condition may overshadow ADHD, making it harder to recognize ADHD signs.
Mood disorders
Studies suggest that up to 53.3% of adults with ADHD may also have depression.
Approximately 14% of children with ADHD have depression compared to 1% of children without ADHD. Up to 20% of those with ADHD may also show signs of bipolar disorder.
Typically, the ADHD signs will occur first, followed by the mood disorder, perhaps because of the struggles those with ADHD face.
Anxiety
It is common for people with ADHD to also have a co-existing anxiety disorder. Some anxiety disorders include generalized anxiety disorder, social anxiety, and obsessive-compulsive disorder (OCD).
People with ADHD may find it difficult to keep up with daily tasks and make and maintain relationships, so this could increase anxious feelings as a result.
Likewise, people with ADHD are more likely to experience an anxiety disorder compared to those without ADHD.
Autism
Autism is characterized by differences in social communication, social interaction, and behavior, with a wide range of characteristics such as sensory differences, restricted interests, and repetitive behaviors.
Autism and ADHD are believed to commonly co-occur. It is unclear precisely how common it is, but scientific literature suggests 50-70% of autistic individuals may have co-occurring ADHD.
Tic and Tourette syndrome
It is common for those with Tourette syndrome to have coexisting ADHD.
Tics include sudden, rapid, involuntary movements or vocalizations. Tourette syndrome is rarer but most severe, involving making involuntary noises or movements on an almost daily basis for years.
These extra challenges can make it harder for a child to manage at school and can worsen feelings of anxiety and depression.
Can ADHD be Managed?
ADHD can be managed through medications, therapy, coaching, or self-help methods.
Below are some ways in which ADHD can be managed. Please note this is not an exhaustive list and should not be taken as a replacement for medical advice. Seek support from a health professional if you think you need support for ADHD.
Medication
ADHD medications come in two types: stimulant and non-stimulant. Stimulants may help people with ADHD focus better by increasing dopamine levels in the brain.
Common stimulant medications include Ritalin, Adderall, and Vyvanse. However, these medications can have side effects like addiction, sleep problems, or heart problems.
Non-stimulant medications are not as commonly prescribed as stimulant medications and are more often used for those with severe anxiety.
They work differently than stimulants by blocking the reuptake of neurotransmitters like norepinephrine and dopamine, resulting in increased levels in the brain. Popular non-stimulant medications include Wellbutrin (Bupropion) and Strattera (Atomoxetine).
Behavior therapy
For some, behavior therapy can help people with ADHD learn the skills required to control some of their signs.
The goal of behavior therapy is to replace unhelpful behaviors with more helpful ones. This therapy can teach people strategies to improve problem areas like organization, focus, impulse control, or anything else that is an issue for those with ADHD.
Many find that behavior therapy can help them effectively manage their ADHD signs without using medications. Although behavior therapy does not affect brain chemistry, it can teach people skills that make it easier to navigate at school, work, home, and in relationships.
Cognitive behavioral therapy
According to the Centers for Disease Control and Prevention (CDC), behavioral therapy, as well as cognitive behavioral therapy (CBT), can help people with ADHD.
CBT can help people recognize how their thoughts affect their behaviors so that they can reframe these thoughts so they have more helpful or realistic ones and, thus, more control over their signs.
CBT involves working with a therapist to notice any thought and behavioral patterns, challenge unhelpful thoughts, cope with stress, deal with stressful obligations, and learn new ways to manage everyday life.
As well as helping with ADHD, CBT can help people manage other conditions that may coexist alongside their ADHD, such as mood and anxiety disorders.
Self-help methods
Alongside medication and therapeutic treatments, there are some strategies individuals with ADHD can implement into their lives to help manage or cope with their signs and navigate everyday life:
-
Having a consistent schedule with structure and regular expectations.
-
Making lists of things that need doing daily and adding to them when new ideas emerge.
-
Keeping a calendar and setting reminders to minimize the chance that important events or appointments get forgotten.
-
For children – they can write down homework assignments and keep everyday items such as toys and backpacks in assigned spots, so they are less likely to get lost. A child’s parent can also establish structure around meals, homework, and playtime.
-
Breaking tasks into manageable pieces and ensuring regular break times can help with feeling overwhelmed. Taking breaks when studying or working and leaving the room, going for a walk, or doing another task, can help to let out energy and help with feelings of boredom and lack of focus.
-
Simplify and organize life – e.g., assign specific quiet places to read or undertake a hobby to take a break from everyday chaos.
-
Reduce unnecessary distractions – distractions such as TV and video games could encourage impulsive behaviors and can be better regulated.
-
Undertaking regular exercise can help burn energy and stimulate the brain in a healthy way. This can help to focus attention on specific movements and decrease impulsivity, help concentration, and decrease the risk of anxiety or depression.
-
Regulate sleeping patterns – cutting down on sugar, caffeine, and screen time as much as possible can help with establishing a sleep pattern, as a lack of sleep can exacerbate inattention, hyperactivity, and recklessness.
-
Promoting wait times – pausing to consider actions can encourage thoughtful responses.
-
Breathing exercises in times of feeling overwhelmed or when the brain is having multiple thoughts at once can help to calm down.
-
Other relaxation exercises such as yoga, tai chi, mindfulness, meditation, and spending time outdoors can help calm overactive minds and ease signs.
Further Reading
References
Bonath, B., Tegelbeckers, J., Wilke, M., Flechtner, H. H., & Krauel, K. (2018). Regional gray matter volume differences between adolescents with ADHD and typically developing controls: further evidence for anterior cingulate involvement. Journal of attention disorders, 22( 7), 627-638.
Centers for Disease control and Prevention. (2021, September 23). Attention-Deficit/ Hyperactivity Disorder (ADHD). https://www.cdc.gov/ncbddd/adhd/diagnosis.html.
Dougherty, D. D., Bonab, A. A., Spencer, T. J., Rauch, S. L., Madras, B. K., & Fischman, A. J. (1999). Dopamine transporter density in patients with attention deficit hyperactivity disorder. The Lancet, 354 (9196), 2132-2133.
Grimm, O., Kranz, T. M., & Reif, A. (2020). Genetics of ADHD: what should the clinician know?. Current psychiatry reports, 22, 1-8.
Hours, C., Recasens, C., & Baleyte, J. M. (2022). ASD and ADHD comorbidity: What are we talking about?. Frontiers in psychiatry, 13, 837424.
Jeong, S. H., Choi, K. S., Lee, K. Y., Kim, E. J., Kim, Y. S., & Joo, E. J. (2015). Association between the dopamine transporter gene (DAT1) and attention deficit hyperactivity disorder-related traits in healthy adults. Psychiatric genetics, 25 (3), 119-126.
Johansen, E. B., Killeen, P. R., Russell, V. A., Tripp, G., Wickens, J. R., Tannock, R., Williams, J. & Sagvolden, T. (2009). Origins of altered reinforcement effects in ADHD. Behavioral and Brain Functions, 5 (1), 1-15.
Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2017). Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC psychiatry, 17 (1), 1-15.
Koyuncu, A., Ayan, T., İnce Guliyev, E., Erbilgin, S., & Deveci, E. (2022). ADHD and anxiety disorder comorbidity in children and adults: Diagnostic and therapeutic challenges. Current Psychiatry Reports, 24(2), 129-140.
Langley, K., Fowler, T., Ford, T., Thapar, A. K., Van Den Bree, M., Harold, G., … & Thapar, A. (2010). Adolescent clinical outcomes for young people with attention-deficit hyperactivity disorder. The British Journal of Psychiatry, 196 (3), 235-240.
National Resource Center on ADHD. (2017). About ADHD. CHADD. https://chadd.org/wp-content/uploads/2018/03/aboutADHD.pdf
Rothenberger, A., & Heinrich, H. (2022). Co-Occurrence of Tic Disorders and Attention-Deficit/Hyperactivity Disorder—Does It Reflect a Common Neurobiological Background?. Biomedicines, 10(11), 2950.
Sedgwick, J. A., Merwood, A., & Asherson, P. (2019). The positive aspects of attention deficit hyperactivity disorder: a qualitative investigation of successful adults with ADHD. ADHD Attention Deficit and Hyperactivity Disorders, 11, 241-253.
Volkow, N. D., Wang, G. J., Kollins, S. H., Wigal, T. L., Newcorn, J. H., Telang, F., Fowler, J. S., Zhu, W., Logan, J., Ma, Y., Pradhan, K., Wong, C. & Swanson, J. M. (2009). Evaluating dopamine reward pathway in ADHD: clinical implications. Jama, 302 (10), 1084-1091.e
Young, S., Adamo, N., Ásgeirsdóttir, B. B., Branney, P., Beckett, M., Colley, W., Cubbin, S. Deeley, Q., Farrag, E., Gudjonsson, G., Hill, P., Hollingdale, J., Kilic, O., Lloyd, T., Mason, P., Paliokosta, E., Perecherla, S., Sedgwick, J., Skirrow, C., Tierney, K., van Rensburg, K. & Woodhouse, E. (2020). Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/hyperactivity disorder in girls and women. BMC psychiatry, 20 (1), 1-27.
