Attention Deficit Hyperactivity Disorder (ADHD) is a disorder identified by a pervasive pattern of inattention, lack of focus and impulsivity/hyperactivity that affects executive functioning -- basic functions of the brain that includes memory, organization, time management and concentration.While it is typical for individuals – particularly children – to exhibit hyperactive, energetic behaviors at times, those with ADHD display intense, more consistent symptoms that interrupt daily life and can cause significant impairment in all areas of their life, affecting family dynamics and social interactions.ADHD was originally believed to be a childhood disorder in which kids would eventually grow out of, but more research has shown that ADHD can last a life time and change from hyperactivity/impulsivity behaviors in kids to more inattention, lack of focus and disorganization in adults.While more than 16 million Americans suffer from ADHD related symptoms, many go undiagnosed and struggle with school work, workplace functioning and relationships. ADHD symptoms can manifest as early as 6 years old and symptoms must be present and consistent for at least six months for a clinical diagnosis. While there is no cure, medication management, psychotherapy and parental education and training can help reduce and manage symptoms and behaviors.Clarity Clinic specializes in ADHD assessment and treatment, including medication evaluation and management, as well as psychotherapy.
Attention Deficit Hyperactivity Disorder (ADHD) and Attention Deficit Disorder (ADD) are often used interchangeably, but there is a difference. ADD is a type of ADHD, that doesn’t include the hyperactivity component – constant movement or fidgeting. However, ADD is no longer considered a separate disorder in the medical community and is lumped under ADHD with the subtype “Predominantly Inattentive.” Those with this subtype typically struggle with focus, concentration and struggle with organizational issues but lack hyperactivity or impulsivity traits.
What are Executive Functions?
Executive functions are a set of mental processes that help you achieve your goals and manage yourself. Executing functioning skills tap into the frontal lobal part of your brain that is responsible for organization, memory, impulse control, concentration and focus and detail orientation. When executive function skills aren’t working correctly, it can affect major life functions including learning, interactions with others and being able to take initiative and work independently.
Because ADHD affects executive functioning skills, those struggling with ADHD symptoms often have trouble:
· Keeping track of details and/or day-to-day appointments
· Initiating goal-oriented behavior, such as finishing a project or cleaning your room
· Maintaining focus, such as be able to watch a movie or read a book
· Regulating emotions often lashing out to others and without mindful responses.
· Difficulty with recall or short-term memory, often time forgetting what they wanted to say or misplacing things.
What Causes ADHD?
There have been no definitive conclusions to the cause of ADHD, but researchers believe there are a number of risk factors that have been identified as contributing factors. Those include:
Genetics – ADHD has been identified as having a genetic component with higher rates of the disorder in children and adults whose relatives also have ADHD. Based on family studies, adoption studies and twin studies, there is high heritable factor of ADHD.
Exposure to environmental substances – Studies have shown higher rates of ADHD in those who were exposed to lead and other toxic substances in utero.Drug use and smoking during pregnancy. Mothers who smoked tobacco or used drugs throughout their pregnancy may be a contributing factor to their children being diagnosed with ADHD.However, there is no evidence to suggest that poor parenting or diet causes ADHD, but continuous studies are being conducted to determine if dietary factors can exacerbate symptoms.
Signs and Symptoms of ADHD
Those with ADHD have a persistent pattern of symptoms that include:
· Difficulty paying attention (Inattention)
· Overly active (Hyperactivity)
· Acting or doing without thinking things through (Impulsivity)
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a reference manual used by health care professionals as the authoritative guide to the diagnosis of mental disorders – there are three subtypes to ADHD:
· Predominantly inattentive. The majority of symptoms fall under inattention.
· Predominantly hyperactive-impulsive. The majority of symptoms are hyperactive and impulsive.
· Combined. The most common type of ADHD, this subtype is a combination of inattentive symptoms and hyperactive-impulsive symptoms.
Inattention means a person has difficulty focusing, has trouble staying on task, lacks organization skills and has reduced memory functioning.
The DSM provides an overview of inattention symptoms:
· Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
· Often has trouble holding attention on 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 (e.g., loses focus, side-tracked).
· Often has trouble organizing tasks and activities.
· 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
Hyperactivity can be described as a child or adult who is having trouble sitting still with a constant need to move about. The person may exhibit excessive fidgeting, tapping or talking, including in appropriate situations, i.e. school. These type of behaviors are prevalent primarily in children. For adults, hyperactive symptoms may manifest in extreme restlessness, inability to relax and the need for constant activity.
Impulsivity means a person makes quick decisions that occur without thoughtfulness or consideration and may have a higher potential for harm or negative consequences. Many times these decisions are made for immediate gratification or reward. Those with impulsivity tend to interrupt others in conversation and overtalk.
The DSM highlights that those with symptoms of hyperactivity-impulsivity:
· 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 blurts out an answer before a question has been completed.
· Often has trouble waiting his/her turn.
· Often interrupts or intrudes on others (e.g., butts into conversations or games)
Testing for ADHD
A diagnosis of ADHD requires an evaluation by a licensed clinician such as a psychiatrist or psychologist who specializes in ADHD. At Clarity Clinic, we offer ADHD diagnosis and treatment for children, teens, and adults aimed at understanding issues of inattention, impaired concentration, hyperactivity, and restlessness. These problems are not by definition a sign of ADHD but instead can indicate depression, anxiety, or some other mental health condition entirely. Sometimes these symptoms may be altogether subclinical and simply reflect normative shifts in cognitive functioning.
Additionally, Clarity Clinic offers comprehensive educational and psychological testing to assess a variety of functions – social, developments, memory, cognitive – to rule out any other medical or psychiatric conditions before diagnosing ADHD.
Treatment for ADHD
While there is no cure for ADHD, pharmacological and psychotherapy treatments have been shown to reduce symptoms and improve overall functioning. Clarity Clinic clinicians ensure a proper diagnosis to determine the source and nature of the attention deficits that kids and adults experience and guide them towards the proper treatments, including pharmacological and non-pharmacological interventions.
Our psychiatrists ensure a proper diagnosis and take care in specialized medication management for clients treating ADHD through pharmacological treatment.
Our psychotherapists work in conjunction with the treatment team to individually tailor the treatments and therapies, which may include cognitive-behavioral psychotherapies, learning time-management strategies, and learning appropriate self-care. Our therapists also include psychoeducational training with parents and caregivers to provide at-home strategies to reduce maladaptive behavior and provide structure and routine to those struggling with ADHD symptoms. Also because ADHD can also affect the overall family system, causing conflict and secondary family issues, we provide family therapy to identify skills to strengthen the unit as a whole.
While there is no evidence to suggest that poor parenting causes ADHD, parents play an important role in providing structure, routine and teaching and modeling skills to help children achieve their highest potential.
Additionally, because ADHD can affect relationships in adults, causing conflict and turmoil, Clarity Clinic’s marriage and family therapists can work with couples to identify and recognize how ADHD symptoms can contribute to destructive cycles and negative interactions and finding more constructive ways to manage those negative interactions.
Medication management coupled with psychotherapy has proven to be an effective treatment in reducing symptoms of ADHD and improve overall functioning.
Medications to treat ADHD include:
In general, stimulant medicines improve symptoms in about 70 out of 100 people who have ADHD. There are often quick and dramatic improvements in behavior. Stimulants are the most common type of medication prescribed for ADHD. While many people have concerns about these medications, they have the longest track record with the most research to back up their effectiveness
Adderall, known by the generic name Dextroamphetamine-Amphetamine, is a stimulant used to treat ADHD. Adderall improves the part of the brain that control executive functioning, helping those struggling with ADHD symptoms increase focus and concentration, reduce impulsive behaviors and help with organization and task completion.
Vyvance, known by the generic name lisdexamfetamine, is also used to treat ADHD. Also a stimulant, Vyvance has been shown to restore neurotransmitters in the brain to help increase focus and concentration, reduction in restlessness and improve organization skills
Concerta is also part of the stimulant class of drugs used to treat ADHD. Known by the generic name methylphenidate, Concerta works by changing certain types of chemicals in the brain that can improve executive functioning skills including focus and concentration, listening skills and reduction in impulsive behavior. can also improve improves brain functioning
Non stimulants have been proven successful in the treatment of ADHD and are designed for children and teens or those who do not want to stimulants to treat their symptoms.
Strattera, known by the generic name atomoxetine, is a non-stimulant medication used to treat ADHD. -Straterra has been approved for children and teens, as well as adults and has been shown to improve attention and focus and reduce impulsive behavior and hyperactivity.
Clonidine ER, or generically known as Kapvay, is also a non-stimulant ADHD medication approved for children and teens. Clonidine has also been shown to reduce ADHD symptoms, including distractibility, restlessness and hyperactivity, as well as improve focus and concentration.
Antidepressants. Certain antidepressants are sometimes also recommended as many times those struggling with ADHD have co-existing disorders, such as depression.
According to studies, taking medicine for ADHD doesn't increase the risk for substance abuse later. Many studies have found less alcohol and drug abuse in children and teens with ADHD who had taken stimulant medicines than in those who didn't receive medicine. But because ADHD medications aren’t a cure, they must be taken on a continual basis, otherwise the symptoms will return.
At Clarity Clinic, we have highly trained staff who specialize in diagnosing and treating ADHD. To schedule an appointment, click on one of the specialists below to schedule an initial evaluation to and discuss assessment, diagnosis and treatment options.
For more information on ADHD, below are several additional resources to help learn more about the disorder.