Attention Deficit Hyperactivity Disorder – how it works and the impact it holds.
Understanding ADHD
ADHD stands for Attention Deficit Hyperactivity Disorder. Over the years, there have been many changes in how it has been defined, diagnosed, and treated.
Today, ADHD is recognized as a complex neurodevelopmental disorder with a range of symptoms that can affect individuals across the lifespan.
Many experts consider English pediatrician Sir George Frederic Still’s 1902 lectures to be the scientific starting point of ADHD’s history. Still discussed 20 cases of children with a “defect of moral control […], without general impairment of intellect and without physical disease.” He listed nine different ways in which a so-called ‘lack of moral control’ could be shown – namely passionateness, spitefulness, jealousy, lawlessness, dishonesty, mischievousness, shamelessness, sexual immorality, and viciousness – and added that their shared quality is self-gratification.
Although most of these symptoms are not directly associated with the current concept of ADHD, many experts still agree that a delay of gratification is extremely challenging for children with ADHD.
Types of ADHD
There are currently three main subtypes of ADHD: predominantly inattentive type, predominantly hyperactive-impulsive type, and combined type.
Inattentive ADHD previously went by the name ADD, which stands for Attention Deficit Disorder. People with this type often have severe difficulty paying attention to details or following instructions. They may also be very easily distracted or forgetful.
The hyperactive-impulsive subtype is characterized by excessive movement and talking. People with the hyperactive-impulsive type tend to fidget, talk excessively, act impulsively without thinking about the potential consequences, and struggle to sit still for long periods of time.
Finally, those with the combined type experience both sets of symptoms.
Recent research suggests that ADHD can manifest differently depending on gender; boys are more likely to display hyperactivity while girls often show signs of inattention.
ADHD Up Close
According to clinical psychologist, Russell Barkley, ADHD has a neurological basis that leads to a state of disinhibition resulting in three characteristic symptoms: distractibility, impulsivity, and hyperactivity. People with ADHD are unable to inhibit incoming stimuli, leading to distractibility, and they struggle with controlling their outgoing impulses, resulting in impulsivity and hyperactivity.
For example, someone with ADHD may find it difficult to stay focused on a task and tends to become easily distracted by external stimuli such as sounds or movements. They may also find it hard to organize their time or belongings, leading to procrastination or forgetfulness. In social situations, they may struggle with impulsivity, interrupting others, or acting on their immediate impulses without considering the consequences.
Of course, everyone can be inattentive, hyperactive, and impulsive at times, but with ADHD, as well as other neurodevelopmental conditions, these behaviors are persistent and show a divergence from typical cognitive milestones.
Diagnosing ADHD
Diagnosing ADHD has evolved significantly over the years. Currently, it typically involves a comprehensive evaluation that includes interviews with the individual and their family, an assessment of the symptoms, psychological testing, and a review of their medical, familial, and behavioral history.
Diagnostic criteria are established by professional organizations such as the American Psychiatric Association and are based on observed symptoms and impairments in daily functioning.
In addition to clinical assessments, neuropsychological tests such as Continuous Performance Tests (CPTs) are often used to measure attention span and impulsivity levels.
Although CPTs are widely used and are considered the “gold standard” for the diagnosis of ADHD, some studies suggest that these tests may not be a reliable tool when it comes to testing adults with ADHD.
Complex ADHD
ADHD rarely appears in isolation. ‘Complex ADHD’ is a relatively new term that reflects this understanding.
Research has shown that ADHD commonly co-occurs with other psychiatric, learning, or neurodevelopmental conditions. In fact, it’s more common for someone with ADHD to have at least one co-existing condition than to have ADHD alone. Adults with ADHD may have up to 80% chance of having at least one co-existing psychiatric disorder, while another study shows that 60-100% of children with ADHD have at least one co-occurring condition.
Comorbid conditions are when two or more conditions occur in the same person at the same time. This is also known as a ‘dual diagnosis’.
The most common ADHD comorbidities are learning disabilities, anxiety, depression, sensory processing disorder, and oppositional defiant disorder.
Comorbidities often mimic or obscure each other’s symptoms, making it difficult to accurately diagnose and treat. In addition, because the disruptive behavior frequently becomes the focus, other conditions like anxiety and depression are more likely to be overlooked.
Culture and Gender
Cultural attitudes towards behavior can play a significant role in the diagnosis of ADHD, as perceptions of hyperactivity and appropriate childhood behavior can vary widely. In the United States, for example, African-American and Latino children have lower odds of having an ADHD diagnosis and of taking ADHD medication when compared with white children.
Additionally, mental illness can be stigmatized in some cultures, preventing individuals and families from seeking help, particularly in educationally disadvantaged populations.
One’s gender can also play a role. Males have a higher worldwide prevalence of ADHD, but females often go undiagnosed or misdiagnosed because their symptoms don’t fit traditional stereotypes. They also tend to show them in a less disruptive way. Examples are expressing hyperactivity by being extremely talkative.
Finally, culture and gender may also interact due to gender stereotypes within different cultures.
ADHD in adults
Estimates of the worldwide prevalence of ADHD are around 6 in 100 children and adolescents and 3 in 100 adults. For a long time, it was believed that this difference was due to children with ADHD simply growing out of the condition.
However, it has been suggested that the two groups may not be the same, meaning that adult ADHD is not just a continuation of the childhood disorder. Or to put it differently: adults with ADHD may not simply be children with ADHD who grow up.
The majority of children and adolescents who are diagnosed with ADHD are male, but in adults, women and men are diagnosed with equal frequency.
The findings that ADHD is sometimes diagnosed later in life, even without apparent symptoms in childhood, has raised the question of whether this explains why more women are being diagnosed with ADHD, despite boys outnumbering girls among children.
Research is being conducted into three main possible reasons for this.
Were the symptoms masked in childhood due to protective influences, such as parental guidance or good grades?
Was the person previously misdiagnosed with something else, such as anxiety or depression?
Or is there an entirely adult form of ADHD that has not been medically identified yet?
The Myth of ADHD
Over the past decades, the rate of ADHD diagnosis has increased dramatically, and so has the prescription of medications to treat it. In his book The Myth of the ADHD Child, psychologist Thomas Armstrong puts this into question by making the controversial argument that many behaviors labeled as ADHD are simply a child’s response to complex social, emotional, and educational influences.
By labeling a child with ADHD, we may therefore be ignoring the underlying issues that are contributing to their behavior. The label can give a false sense of understanding and control, when in reality, we may not fully understand the complexity of the situation at all.
Armstrong’s perspective has received both support and criticism. Some argue that it minimizes the struggles of individuals who have ADHD and need support, while others agree that the diagnosis has been overused and may be inappropriate for some individuals.
Overall, the debate around the nature of ADHD remains complex and multifaceted, with ongoing discussion around the role of social, environmental, and biological factors in its development.
