Unfortunately, ADHD is often poorly understood. When families, teachers, and im-portant 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 small-er 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 connec-tivity within and among multiple large-scale brain networks, rather than just diffi-culties 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 irre-sponsible 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 indi-cates 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. In-attentive 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 dai-ly life, including their concentration, memory, learning and reading abilities, self-discipline, relationships with others, and performance at school and other activi-ties. It is a disorder of motivation, performance, boredom, organization, frustra-tion, 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 psycholog-ical 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 environmen-tal 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 ear-lier) and/or low birth weight (about 5 to 5.5 pounds or less), certain birth or preg-nancy conditions (such as oxygen deprivation in infants with neonatal respiratory distress syndrome, preeclampsia, or inadequate oxygen before or after birth), cer-tain vitamin and mineral imbalances (such as iron, zinc, magnesium, B and D vit-amins, and copper), exposure to neurotoxic substances (such as lead, mercury, or cadmium), and exposure to certain artificial food and beverage additives and pre-servatives.
• 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 psy-chological 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 pro-viders, 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, insomnia, chronic 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, depres-sion, 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 be-havioral 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 child-hood 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 re-mains, but hyperactive and disinhibition symptoms can decline. Others can im-prove 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 com-mon 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.
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