| Written by Jessica Lelinho, MA, LPC, NCC, LCADC, C-DBT

Do you feel like your brain is moving fast? Feel like you’re never able to focus on one task or even concentrate? I think it’s safe to say that at times we all get easily distracted in some way or another. But when we feel like our distractions are contributing to hindering the completion of tasks or homework or work deadlines, then we need to talk to someone about our difficulties.

What is ADHD?

The American Psychological Association defines ADHD, or attention-deficit/hyperactivity disorder, as a behavioral condition in which focusing on everyday requests and routines is challenging. People with ADHD typically have trouble getting organized, staying focused, making realistic plans, and thinking before they act. Individuals with ADHD may be fidgety, noisy, and unable to adapt to changing situations. Children with ADHD can be defiant, socially inept, or aggressive. 

Difference Between ADD/ADHD

The Child Mind Institute distinguishes that ADD is an older term and is no longer used. Initially, up until 1987 the term ADD was used and in 1987 the word “hyperactivity” was added. Prior to the addition of “hyperactivity” the child would be diagnosed with ADD, either with or without hyperactivity. Starting in the early 1990s the child would be diagnosed with ADHD. From the early 1990s until recently, the diagnosis included one of three types: inattentive type, hyperactive/impulsive type, or combined type. A lot of individuals still utilize the old term due to it being a habit or to refer to an individual who does not have the hyperactivity component. Essentially, the only difference is the type of ADHD that an individual possesses. 

Symptoms of ADHD

NHS identifies the symptoms of ADHD which are categorized into two types: inattentiveness (difficulty concentrating and focusing) or hyperactivity and impulsiveness. Many individuals with ADHD have symptoms that fall into both categories, however, that is not always the case. Symptoms in children and teenagers are well defined and typically noticeable before the age of six years old. Children can have symptoms of both inattentiveness and hyperactivity or just one of the two types. The symptoms for children of both types are found below.

Inattentiveness 

• having a short attention span and being easily distracted
• making careless mistakes – for example in schoolwork
• appearing forgetful or losing things
• being unable to stick to tasks that are tedious or time consuming
• appearing to be unable to listen to or carry out instructions
• constantly changing activity or task
• having difficulty organizing tasks

Hyperactivity and impulsiveness

• being unable to sit still, especially in calm or quiet surroundings
• constantly fidgeting
• being unable to concentrate on tasks
• excessive physical movement
• excessive talking
• being unable to wait their turn
• acting without thinking
• interrupting conversations
• little or no sense of danger

It is believed that adults may have the following symptoms

• carelessness and lack of attention to detail
• continually starting new tasks before finishing old ones
• poor organizational skills
• inability to focus or prioritize
• continually losing or misplacing things
• forgetfulness
• restlessness and edginess
• difficulty keeping quiet or speaking out of turn
• blurting out responses and often interrupting others
• mood swings, irritability and a quick temper
• inability to deal with stress
• extreme impatience
• taking risks in activities, often with little or no regard for personal safety or the safety of others – for example, driving dangerously

Diagnosis of ADHD

ADHD is diagnosed by a healthcare professional utilizing the guidelines in the American Psychiatric Association’s Diagnostic and Statistical Manual, 5th Edition (DSM-5). Diagnosis criteria from the DSM-5 include:

Individuals with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development:

1. 1. Inattention: Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
      1. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
      2. Often has trouble holding attention on tasks or play activities.
      3. Often does not seem to listen when spoken to directly.
      4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
      5. Often has trouble organizing tasks and activities.
      6. Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
      7. Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
      8. Is often easily distracted
      9. Is often forgetful in daily activities.

• Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:

1. 1. Often fidgets with or taps hands or feet, or squirms in their seat.
   2. Often leaves the seat in situations when remaining seated is expected.
   3. Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
   4. Often unable to play or take part in leisure activities quietly.
   5. Is often “on the go” acting as if “driven by a motor”.
   6. Often talks excessively.
   7. Often blurts out an answer before a question has been completed.
   8. Often has trouble waiting their turn.
   9. Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:

• Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
• Several symptoms are present in two or more settings, (such as at home, school or work; with friends or relatives; in other activities).
• There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
• The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.

Based on the types of symptoms, three kinds (presentations) of ADHD can occur:

• Combined Presentation: if enough symptoms of both the criteria for inattention and hyperactivity-impulsivity were present for the past 6 months
• Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
• Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity, but not inattention, were present for the past six months.

Because symptoms can change over time, the presentation may change over time as well.

**The criteria above is presented in shortened form. Please note that they are presented for your information only. Only trained healthcare professionals can diagnose or treat ADHD**

Types of ADHD

WebMD identified three types of ADHD:

• ADHD predominantly inattentive presentation (what used to be called ADD): Children diagnosed with this type are not hyperactive; there are no high energy levels as seen in individuals with ADHD. In this form, children may seem shy or in their own world. Symptoms include: trouble paying attention (easily sidetracked); doesn’t like or avoids long mental tasks (such as homework); trouble staying on task during school, at home, or even at play; disorganized and seems forgetful; doesn’t appear to listen when being directly spoken to; doesn’t pay close attention to details; loses things often; makes careless mistakes; or struggles to follow through with instructions. Children with this type of ADHD may go undiagnosed as the symptoms may be associated with daydreaming. 

• ADHD predominantly hyperactive-impulsive presentation: Children diagnosed with this type have tons of energy and are constantly moving in ways that cause problems. This type is more noticeable than the inattentive type. Symptoms include: blurting out answers before a question is finished; constantly interrupting others; trouble waiting for their turn; talking too much; gets up when it’s not appropriate (such as when the teacher is talking or in the middle of dinner); running or climbing in inappropriate situations; unable to play quietly; or always on the go.
• ADHD combined presentation (both inattentive and hyperactive-impulsive symptoms): A child with this type has symptoms from both the inattentive type and hyperactive-impulsive type. 

Statistics on ADD/ADHD

The CDC released the following statistics on ADHD:

• The estimated number of children aged 3–17 years ever diagnosed with ADHD, according to a national survey of parents, is 6 million (9.8%) using data from 2016-2019. This number includes
  • 3–5 years: 265,000 (2%)
  • 6–11 years 2.4 million (10%)
  • 12–17 years: 3.3 million (13%).
• Boys (13%) are more likely to be diagnosed with ADHD than girls (6%).
• Black, non-Hispanic children and White, non-Hispanic children are more often diagnosed with ADHD (12% and 10%, respectively), than Hispanic children (8%) or Asian, non-Hispanic children (3%).
• Estimates for ADHD vary by state:
  • ADHD diagnosis among children aged 3–17 years: State estimates vary from 6% to 16%.
  • Any ADHD treatment among children with current ADHD: State estimates vary from 58% to 92%
    • ADHD medication: State estimates vary from 38% to 81%
    • ADHD behavior treatment: State estimates vary from 39% to 62%

Related Conditions with Individuals with ADHD

NHS has identified that it is not always the case, however, children/teenagers and adults with ADHD can have the potential following conditions:

Children/Teenagers

• Anxiety Disorder – which causes your child to worry and be nervous much of the time; it may also cause physical symptoms, such as a rapid heartbeat, sweating and dizziness
• Oppositional Defiant Disorder (ODD) – this is defined by negative and disruptive behavior, particularly towards authority figures, such as parents and teachers
• Conduct Disorder – this often involves a tendency towards highly antisocial behavior, such as stealing, fighting, vandalism and harming people or animals
• Depression
• Sleep problems – finding it difficult to get to sleep at night, and having irregular sleeping patterns
• Autistic Spectrum Disorder (ASD) – this affects social interaction, communication, interests and behavior
• Dyspraxia – a condition that affects physical coordination
• Epilepsy – a condition that affects the brain and causes repeated fits or seizures
• Tourette’s Syndrome – a condition of the nervous system, characterized by a combination of involuntary noises and movements (tics)
• Learning difficulties such as dyslexia

Adults

• Personality Disorders – conditions in which an individual differs significantly from the average person in terms of how they think, perceive, feel, or relate to others
• Bipolar Disorder – a condition affecting your mood, which can swing from one extreme to the other
• Obsessive Compulsive Disorder (OCD) – a condition that causes obsessive thoughts and compulsive behavior

Behavioral issues associated with ADHD can also cause problems such as difficulties with relationships and social interaction.

Treatments to Address ADD/ADHD

The CDC recommends the following treatments for ADHD:

For children with ADHD younger than 6 years of age, the American Academy of Pediatrics (AAP) recommends parent training in behavior management as the first line of treatment, before medication is tried. For children 6 years of age and older, the recommendations include medication and behavior therapy together — parent training in behavior management for children up to age 12 and other types of behavior therapy and training for adolescents.  Schools can be part of the treatment as well. AAP recommendations also include adding behavioral classroom intervention and school support.

ADHD affects not only a child’s ability to pay attention or sit still at school, it also affects relationships with family and other children.  Children with ADHD often show behaviors that can be very disruptive to others. Behavior therapy is a treatment option that can help reduce these behaviors; it is often helpful to start behavior therapy as soon as a diagnosis is made.

The goals of behavior therapy are to learn or strengthen positive behaviors and eliminate unwanted or problem behaviors. Behavior therapy for ADHD can include

• Parent training in behavior management;
• Behavior therapy with children; and
• Behavioral interventions in the classroom

These approaches can also be used together. For children who attend early childhood programs, it is usually most effective if parents and educators work together to help the child.

Children younger than 6 years of age

For young children with ADHD, behavior therapy is an important first step before trying medication because:

• Parent training in behavior management gives parents the skills and strategies to help their child.
• Parent training in behavior management has been shown to work as well as medication for ADHD in young children.
• Young children have more side effects from ADHD medications than older children.
• The long-term effects of ADHD medications on young children have not been well-studied.

School-age children and adolescents

For children ages 6 years and older, AAP recommends combining medication treatment with behavior therapy. Several types of behavior therapies are effective, including:

• Parent training in behavior management;
• Behavioral interventions in the classroom;
• Peer interventions that focus on behavior; and
• Organizational skills training.

These approaches are often most effective if they are used together, depending on the needs of the individual child and the family.

Benefits of Treatment for ADD/ADHD

Medical News Today discussed that research has shown that psychotherapy and medication may reduce symptoms of ADHD. While there is no cure for ADHD, therapy can help individuals manage their symptoms. Benefits can include: 

• fewer side effects than ADHD medication, which can include sleep problems, changes in appetite, and headaches
• the potential for a greater effect on symptoms than ADHD medication alone
• tailored support and advice
• opportunity to develop coping skills for stress and situations that will occur in daily life
• improved communication skills

We all have difficulty concentrating at times. When our difficulty concentrating occurs too often, that is when we need to seek professional help. This is just a few tips/resources to assist in a diagnosis of ADHD. 

If you are looking to address your ADHD, don’t hesitate to reach out for help. Engaging in therapy can lead to decreasing mental health symptoms of ADHD. A licensed professional can assist you in overcoming these challenges. 

When Jessica is not providing therapy, she enjoys spending time with her family and friends, listening to country music, cooking, baking, and going to the beach.

Check out Jessica’s professional bio here

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