Did you know that nearly 5% of the world’s population currently struggles with ADHD?
There are many reasons for the rise in ADHD diagnoses over the past few years, and those affected face a number of challenges. Acknowledging the complexities of this behavioral disorder can help reduce the stigma and misconceptions.
Attention Deficit Hyperactivity Disorder (ADHD) affects an estimated 5-7% of children and 2.5-6.7% of adults worldwide. [1] ADHD in children is highest in the US, where prevalence is around 8.7%. [2]
The recent rise in cases of ADHD in adults has raised concerns about overdiagnosis and overprescription of stimulant medications. While diagnosis criteria have broadened over the years, so too has awareness of the condition in previously underrepresented groups such as women.
This article will discuss the characteristics of ADHD and its associated conditions. We will also cover the options for management and treatment.
What is ADHD?
ADHD is a neurodevelopmental disorder that affects an individual’s ability to function. ADHD characteristics include inattentiveness, hyperactivity, and/or impulsivity. Although Attention Deficit Hyperactivity Disorder was originally distinct from Attention Deficit Disorder, the DSM IV (Diagnostic and Statistical Manual of Mental Disorders) has now combined this into one disorder with three subtypes: primarily hyperactive and impulsive, primarily inattentive, and combined.
People with ADHD show a persistent pattern of inattention and/or hyperactivity–impulsivity. The ADHD diagnosis criteria for a youth (aged up to 17) includes having at least six of the nine symptoms mentioned in DSM 5, while an adult must show five or more symptoms. These symptoms must have been present for at least 6 months on a regular basis.
Inattentive ADHD symptoms include: [3]
• Lack of attention to detail; making careless mistakes in schoolwork, work, or other activities.
• Inability to listen or follow instructions; failing to finish tasks (i.e. losing focus or being distracted).
• Avoiding or being reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
• Losing items such as keys, paperwork, phone.
Hyperactive ADHD symptoms include:
• Lack of attention to detail; making careless mistakes in schoolwork, work, or other activities.
• Inability to listen or follow instructions; failing to finish tasks (i.e. losing focus or being distracted).
• Avoiding or being reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
• Losing items such as keys, paperwork, phone.
Hyperactive ADHD symptoms include:
• Fidgeting, squirming when seated; leaving their seat; highly restless
• Being unable to play or take part in leisure activities quietly
• Behaving as if “driven by an internal motor”
• Talking excessively or interrupting others who are speaking
• Unable to wait their turn
Individuals must also have displayed several inattentive or hyperactive-impulsive symptoms before age 12, and these symptoms must have been present in at least two settings (e.g., home, school, work; with friends or relatives). These symptoms must have interfered with their quality of life in some way, and are not related to another mental disorder (such as a mood disorder or personality disorder).
The importance of ADHD awareness
While ADHD has certainly become more commonplace in recent years, there are still many misunderstandings about the disorder. Increasing ADHD awareness can help reduce the stigma directed at those who have been diagnosed, and improve their access to support.
Common misconceptions include:
• ADHD is not a real condition
Over 10,000 scientific studies have been published on ADHD. It impairs normal life for millions of people. It also has genetic links, which indicate it is indeed a ‘real’ disorder.
• Only boys have ADHD
The male-female ratio of diagnosis of ADHD in childhood is 4:1. In adults, the ratio is now around 1:1. [4] This suggests that ADHD in girls does exist but is often overlooked and therefore underdiagnosed.
• You can outgrow ADHD
Research suggests that ADHD is a lifetime disorder. Up to 90% of children diagnosed will continue to experience symptoms into adulthood. One study suggests that around 75% of adults currently with ADHD were not previously diagnosed in childhood. [5]
• ADHD is just poor parenting
Many studies indicate that ADHD most often involves genetic and neurological factors. These may include pregnancy complications, brain damage, toxins, and infections rather than social factors. [6]
Co-existing conditions: an overview
It’s estimated that around 60-100% of children with ADHD also have at least one other condition that persists into adulthood. [7] These typically include learning disorders, depression, and behavior problems. Up to 80% of adults with ADHD have at least one coexisting psychiatric disorder, such as a mood and anxiety disorder, substance use disorder, and/or personality disorder. [8]
• Social phobias may be the most common coexisting condition, at 29.3%. Adults with ADHD also may have bipolar disorder (19.4%), major depressive disorder (18.6%), and generalized anxiety disorder (8.0%). [9]
• Learning disorders
Studies suggest that up to 92% of children diagnosed with ADHD also have a learning disorder. [10] Learning disorders in writing are twice as common (65%) than in reading, math, or spelling. [11]
• Depressive disorders
Childhood ADHD is associated with an increased risk of recurrent depression in young adults. [12] One study suggests that depression in youth with ADHD is around 12-50%, which is more than five times higher than in youth without ADHD. [13]
• Anxiety disorders
The risk for anxiety disorders is higher in people with ADHD than in the general population, with rates estimated at around 50%. [14]
One study reported that 28% of individuals referred to a tertiary clinic for mood and anxiety assessment were found to have undetected ADHD. [15]
Coexisting conditions can mask ADHD symptoms, which make it difficult to detect or manage ADHD. The nonspecific nature of ADHD symptoms can overlap with other psychiatric disorders, complicating diagnosis. Clinicians need to understand the patient’s range of symptoms and behavioral history.
Managing ADHD
The availability of effective ADHD treatments has improved significantly in recent years. Treatments are designed to target and alleviate the core symptoms of ADHD and functional impairment and can be either pharmacological or non-pharmacological. [16]
Pharmacological methods (medications) [17]
• Stimulant drugs: Norepinephrine and dopamine reuptake inhibitors
• Non-stimulant drugs:
- Alpha2 adrenergic receptor agonists (guanfacine, clonidine)
- Selective noradrenaline reuptake inhibitor (atomoxetine)
ADHD medication is one of the most commonly prescribed medication classes in child and adolescent psychiatry. A qualitative systematic review of studies regarding the benefits of ADHD medication has suggested there may be some short-term improvements in educational outcomes and in behavior, including fewer injuries and accidents. [18]
Non-pharmacological methods
Psychosocial interventions for ADHD include behavioral parent training (BPT), behavioral classroom interventions, and skills training. Studies suggest that these have benefits for children with ADHD, particularly for improving overall functioning.
BPT is the most well-studied and supported method. It involves teaching parents effective ways of coping with their child’s behavior, such as building a positive parent-child relationship, encouraging good behavior with incentive systems, and implementing appropriate consequences for bad behavior. [19]
Nutritive support: ADHD and diet or supplements
Folate (vitamin B9)
Folate is crucial for numerous biochemical pathways including neural stem cell development and neurotransmitter synthesis. [20] Lack of folate has often been linked to cognitive deficit, and studies have suggested that genetic variants affecting folate metabolism may be linked to ADHD.
Supporting folate levels with methylfolate, the most bioavailable form of folate, may be an option for those with ADHD.
Nootropics
Preliminary evidence also suggests that nootropics such as phosphatidylserine may be effective for reducing symptoms of inattention in children with ADHD. [21] Another important nootropic, citicoline, has also been found to improve attention and psychomotor speed and reduce impulsivity. [22]
ADHD management and support
If you’re a parent of a child with ADHD, some strategies for managing behavior may include:
• Establish a structured daily schedule that includes regular meal times, homework, play, and sleep.
• Break tasks into simple steps and provide clear instructions.
• Keep them active by encouraging daily physical exercise. This can boost endorphin release which then improves focus and reduces impulsivity.
• Minimize distractions in study and play areas to improve focus and concentration, supporting their ability to complete tasks and engage in social interactions.
• Work with teachers, counselors, and ADHD support groups to develop an individualized plan that supports your child’s specific needs.
• Seek help from health professionals regarding medication, ADHD therapy, and/or nutritional needs.
Managing your own ADHD symptoms
• Establish a daily routine into a schedule that covers all of your activities and tasks.
• Break tasks down into smaller, more manageable steps. Use a detailed checklist to create a step-by-step roadmap.
• Minimize distractions by decluttering and simplifying your surroundings at home or in the workplace. This can help improve focus.
• Be aware of your limits and recognize when you need to remove tasks from your plate.
• Seek help from health professionals regarding medication, behavioral therapies, and/or nutritional needs.
The takeaway
As research into ADHD continues, it’s important to keep an open mind about the disorder and those affected by it. Greater understanding of how it can impact someone’s life - and the lives of others - can help reduce the stigma.
If you or someone you love has been diagnosed with ADHD, take the time to think about what changes you can make to help minimize symptoms. Living with ADHD can be managed with the right medications, behavioral therapies, nutritional interventions, and simply organizing your daily life and surroundings. And be sure to check out Methyl-Life® for more ADHD resources and information.
References
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9616454
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9616454/
3. https://www.cdc.gov/ncbddd/adhd/diagnosis.html
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9616454
5. https://pubmed.ncbi.nlm.nih.gov/15197048/
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3927422/
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6745333/
8. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1463-3
9. https://pubmed.ncbi.nlm.nih.gov/16585449/
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6745333/
11. https://pubmed.ncbi.nlm.nih.gov/15495544/
12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8381237/
13. https://pubmed.ncbi.nlm.nih.gov/10102726/
14. https://pubmed.ncbi.nlm.nih.gov/16585449/
15. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1463-3
16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9713849/
17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9713849/
18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697582/
19. https://link.springer.com/article/10.1007/s40474-014-0034-2
20. https://pubmed.ncbi.nlm.nih.gov/29407547/
21. https://pubmed.ncbi.nlm.nih.gov/33539192/
22. https://pubmed.ncbi.nlm.nih.gov/26179181
Updated On: June 27, 2024
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