What You Should Know About ADHD

Unfortunately, ADHD is often poorly understood. When families, teachers, and important others better understand ADHD, children and teens can be better supported and assisted. A firm understanding of ADHD is critical for its effective management. Below are some of the most important facts about ADHD in children and teens.

• ADHD is a complex brain-functioning condition, not an emotional disorder. It is vital that ADHD is clearly understood as a neurobiological condition. Those with ADHD experience focusing, impulsivity and excessive activity levels due to brain issues. Since no one can see a brain without a special scan, ADHD is an invisible but real handicap and disability.

• ADHD is not just a single brain-functioning problem. Individuals with ADHD tend to have a variety of foundational and complicated brain functioning issues, including imbalances of special brain chemicals called neurotransmitters (Brown, 2009), as well as a number of brain areas dysfunctions, including somewhat smaller brain sizes. There also seems to be a shift towards viewing ADHD as a systemic problem within neuronal networks of the brain (Kasparek, Theiner, & Filova, 2015). ADHD is being increasingly understood as problems with altered connectivity within and among multiple large-scale brain networks, rather than just difficulties in distinct and isolated brain regions (Cortese et al., 2012).

• The two most common types of ADHD are Combined ADHD and Inattentive ADHD. Combined ADHD is most prevalent, and causes the classic problems with inattention, hyperactivity, and impulsivity. Children and teens with this condition are more disruptive, excessively active, messy, noisy, immature, and more irresponsible than others their age. Inattentive ADHD is sometimes called “ADD” but it is not the technical term, so it should not be used. Inattentive ADHD mostly causes problems with attention, daydreaming, motivation, and remaining focused, and typically has lesser to no hyperactivity, impulsivity, or behavioral problems.

• ADHD exists across the globe and not just in the United States. Research indicates that about 10% of children ages 2 to 17 have ADHD in the U.S. (Center for Disease Control and Prevention, 2018). The combined type is more common in boys, and is often diagnosed from ages 4 to 7, depending on its severity level. Inattentive ADHD difficulties typically emerge later, from about ages 8 to 12, and it may be identified later or never (Barkley, 2013).

• While ADHD impacts individuals differently, there are some common difficulties. It is a neurodevelopmental condition that can impair many parts of a person’s daily life, including concentration, memory, learning and reading abilities, self-discipline, relationships with others, and performance at school and other activities. It is a disorder of motivation, performance, boredom, organization, frustration, self-control, time management, and poor self-awareness. As a result of these challenges, ADHD can be a disorder of life that causes significant social, family, risk-taking, and academic problems.

• ADHD exists on a continuum of mild, moderate, or severe. The level of severity and the degree of support and treatment received will determine how much they will struggle and suffer with this condition. ADHD frequently presents along with other conditions. If a person has other coexisting disorders, this will impact their functioning as well.

• How ADHD develops is complicated, and multiple genetic and environmental risk factors seem responsible. ADHD is most commonly caused by heredity and a positive family history. It is considered one of the most heritable of all psychological disorders, with heritability estimates of about 70 percent. This means that for all the children and adults with ADHD, it is a result of genetic factors seven out of 10 times. For the remaining 30 percent, the ADHD is likely due to environmental influences (Tarver, Daley, & Sayal, 2014).

• Environmental factors that can play a significant role in the development of ADHD, include exposure to alcohol, cigarettes or illicit drugs during pregnancy. Other factors associated with increased rates of ADHD include head injuries (causing mild or traumatic brain injuries), premature births (about 36 weeks or earlier) and/or low birth weight (about 5 to 5.5 pounds or less), certain birth or pregnancy conditions (such as oxygen deprivation in infants with neonatal respiratory distress syndrome, preeclampsia, or inadequate oxygen before or after birth), certain vitamin and mineral imbalances (such as iron, zinc, magnesium, B and D vitamins, and copper), exposure to neurotoxic substances (such as lead, mercury, or cadmium), and exposure to certain artificial food and beverage additives and preservatives.

• ADHD is considered a foundational disorder that causes increased risks for other coexisting medical, psychological, sleep, and neurodevelopmental conditions. More than any other psychological condition, ADHD appears in combinations with other disorders (Brown, 2009). This unfortunately adds to the challenges and problems that those with ADHD confront daily. Research has found that as many as 67 to 80% of clinic-referred children with ADHD have at least one other psychological disorder, as many as half have two or more other disorders (Pliszka, 2015), and 20% have three or more coexisting disorders (Spruyt & Gozal, 2011). Sadly, these other coexisting conditions may not be identified or treated by providers, and this can cause further difficulties, impairments, and lack of hope.

• Some of the most frequent coexisting conditions that present with ADHD include oppositional defiant disorder (see below), insomnia, inadequate hours of sleep, speech and articulation difficulties, expressive and/or receptive language disorders, fine and/or gross motor deficits, dysgraphia (impaired handwriting disorder), reading and/or math learning disorder, bedwetting, problematic videogame use, depression, anxiety, substance use, sensory processing disorders, fetal alcohol spectrum disorder and fetal drug exposure, and obesity.

• Combined ADHD often causes Oppositional Defiant Disorder (ODD). This is behavioral disorder that can make those with ADHD more difficult to live with and manage. ODD is a pattern of anger, irritability, argumentativeness, and defiance lasting for a minimum of six months (Mayo Clinic Staff, 2015).

• 70 to 80% of children diagnosed with Combined and Inattentive ADHD in childhood will continue to have symptoms by adolescence (Dendy, 2006). As these teens age, between 60 to 70% will have symptoms that continue into adulthood, and the rest may still experience some traits (Hallowell & Ratey, 2005). When teens with ADHD-Combined mature into adulthood, their inattention often remains, but hyperactive and disinhibition symptoms can decline. Others can improve to various degrees, but may still be affected by ADHD (Barkley, 2015). While it is possible for some to outgrow the disorder completely, it is more common that at least some symptoms remain through adulthood.

The ADHDology Treatment Model for Children and Adolescents

So what can be done to address ADHD and its related difficulties? The ADHDology Treatment Model for Children and Adolescents provides a comprehensive approach to addressing all aspects of ADHD.  This model is presented on the “Resources” page of the adhdology.com website.

For more information about the topics in this article, please read my book Treating ADHD/ADD in Children and Adolescents: Solutions for Parents and Clinicians, published by Charles C Thomas, Publishing, LTD.

References

• Barkley, R. (2013). Taking charge of ADHD (3rd ed.). New York, NY: The Guilford  Press. Barkley, R. (2015, March 19). ADHD: Nature, course, outcomes, and comorbidity. Retrieved from continuingedcourses.net
• Brown, T. E. (2009). Developmental complexities of attentional disorders. In T. E. Brown (Ed.), ADHD comorbidities: handbook for ADHD complications in chil dren and adults (pp. 3-22). Arlington, VA: American Psychiatric Publishing, Inc.
• Centres for Disease Control and Prevention. (2018, March 20). Data & statistics (for ADHD). Retrieved from www.cdc.gov/ncbddd/adhd/data.html
• Cortese, S., Kelly, C., Chabernaud, C., Proal, E., Di Martino, A., Milham, M. P., & Cas-tellanos, F. X. (2012, October). Toward systems neuroscience of ADHD: A meta- analysis of 55 fmri studies. American Journal of Psychiatry, 169(10), 1038-1055.
• Dendy, C. Z. (2006). Teenagers with ADD and ADHD: A guide for parents and profess- sionals (2nd ed.). Bethesda, MD: Woodbine House.
• Hallowell, E. D., & Ratey, J. J. (2005). Delivered from distraction. New York: Ballantine  Books.
• Kasparek, T., Theiner, P., & Filova, A. (2015). Neurobiology of ADD from childhood to adulthood: Findings of imaging methods. Journal of Attention Disorders, 19(11), 931-943.
• Mayo Clinic Staff. (2015, February, 06). Oppositional defiant disorder (ODD) – symptoms. Retrieved from https://www.mayoclinic.org/diseases-conditions/oppositional-defiant-disorder/basics/symptoms/con-20024559
• Pliszka, S. (2015). Comorbid psychiatric disorders in children with ADHD. In R. Barkley(Ed.), Attention deficit hyperactivity disorder: A handbook for diagnosis and  treatment (4th ed., pp 140-168). New York, NY: Guilford Press.
• Spruyt, K., & Gozal, D. (2011, April). Sleep disturbances in children with attention-deficit/hyperactivity disorder. Expert Review of Neurotherapeutics, 11(4),  565-577.
• Tarver, J., Daley, D., & Sayal, K. (2014, November).Attention-deficit hyperactivity disorder (ADHD): An updated review of the essential facts. Child: Care, Health, and Development, 40(6), 762-774.