A Patient's Guide to ADHD

Attention deficit hyperactivity disorder, or ADHD, is, in many ways, just what it sounds like: a disorder involving an inability to pay attention and the tendency to make excess movements that don't suit the situation. The condition can also involve impulsivity – that is, taking hasty actions without thinking them through ahead of time.

ADHD is one of the most common mental disorders in children. An estimated 8% of kids have ADHD, according to the American Psychiatric Association. It mostly affects boys. Adolescents and adults can have ADHD, too; about 2.5% percent in the U.S. have it, according to the APA.

While the term ADD – attention deficit disorder – is sometimes used interchangeably with ADHD, the latter term is more commonly used today. Even those who don't experience hyperactivity can now be diagnosed with ADHD.

Types

These are the three different types of ADHD:

Diagnosis

ADHD is a common neurodevelopmental childhood disorder, according to the Centers for Disease Control and Prevention. There are no medical tests, like a blood screening, to diagnose ADHD, says Oksana Hagerty, an educational and developmental psychologist at Beacon College in Leesburg, Florida. She's also the assistant director of the Center for Student Success at Beacon College, which is the first accredited baccalaureate school to educate primarily students with learning disabilities, ADHD, dyslexia and other learning differences. "The clinical assessment of ADHD usually involves an interview (typically with a child's parents or caretaker and ideally also a teacher), which goes over the individual's developmental, social, educational and behavioral history," she says. To diagnose ADHD, health care professionals rely on the APA's Diagnostic and Statistical Manual, fifth edition (DSM-5). For children up to age 6, the criteria for ADHD would typically require six or more symptoms of inattention, and five or more symptoms for adolescents age 17 and older as well as adults. Health care professionals would look for a pattern of hyperactivity, impulsivity, inattention and lack of focus, often manifested through inappropriate social behavior, difficulty organizing and emotional outbursts. For an ADHD diagnosis, the behavior would have to occur in more than one environment, for example, at school and at home. For an adult, it would be at home and at work, Hagerty says.

Typically, ADHD is not diagnosed before a child is age 6, though some health care professionals do make such determinations, says Robert Melillo, a chiropractic neurologist with a degree in neuropsychology who is based in New York City. He's a co-founder of Brain Balance Centers, which has more than 100 facilities nationwide that help children with neurobehavioral deficits improve their academic, social and behavioral functions. Melillo has written four books about medication-free regimens to treat ADHD, learning disabilities and other neurological disorders. Most diagnoses are made when the patient is between ages 6 and 10, though adults can be diagnosed as well. Many more boys than girls are diagnosed with ADHD, he says, though some experts believe it may be underdiagnosed in girls. Girls tend to be diagnosed with the inattentive subtype of ADHD. It's not known why ADHD is apparently more prevalent in boys.

Diagnosing ADHD in Adults

When diagnosing adults, medical professionals look for a different set of symptoms than they do in children, says Dr. Salina Graves, medical director at Independence Blue Cross Blue Shield of Pennsylvania. These symptoms include:

What Kind of Doctor Can Diagnose ADHD?

ADHD can be diagnosed by a pediatrician, pediatric neurologist, psychiatrist, psychologist or neuropsychologist, Melillo says.

Genetics

While the exact cause of ADHD isn't known, the condition "tends to run in families," according to the United Kingdom's National Health Service. One study, for instance, found that among more than 1,000 kids with the condition, 22 percent had mutations in certain genes that affect brain cells.

That doesn't necessarily mean it's completely hereditary, Melillo says. "There are genetic predispositions for ADHD," he says. "There never has been a clear genetic mutation identified for ADHD." Behaviors associated with ADHD are on a spectrum, he says. "It's like people who might be a little obsessive-compulsive but aren't fully OCD," Melillo says. "You might have someone who's a little impulsive, but not to the point of having ADHD. In most of these disorders, we're looking at extreme versions of normal human traits, and not genetic mutations."

Symptoms

While ADHD's defining characteristics sound a lot like normal childhood (what kid is always a rational, thoughtful decision-maker who likes to sit still?), to be diagnosed with ADHD, symptoms can't be attributed to run-of-the-mill childhood development, or to a desire to rebel or misbehave.

Kids with the disorder don't perform as well as they could at school or in dealing with social events, while adults may find their work and social lives suffering, too. These problems can't be fleeting, either. As the APA book puts it, "ADHD occurs when there is a lasting and frequent pattern of inattention and/or hyperactivity or impulsivity that disrupts function or development."

Specifically, ADHD symptoms fall into two categories and can include:

Inattention

Hyperactivity and Impulsivity

Environment

Research suggests there are several environmental risk factors for ADHD. In this context, the environment could be that the child was not fully developed at birth, says Susan Courey, a professor of special education at the Touro Graduate School of Education in New York City. Studies suggest these could be risk factors for ADHD:

Child Development and ADHD

In terms of child development, according to Courey, risk factors for ADHD include:

Treatments

Good news: There are established treatments for ADHD, and more are being tested. Which treatment or, more likely, what combination of treatments, works best for any one person can take some trial and error to determine. Behavioral treatment, for instance, can help people manage symptoms and control behavior and can also help the people around those with ADHD – say, parents and teachers – respond in ways that encourage good behavior.

The Centers for Disease Control and Prevention doesn't recommend parents turn to drugs before trying therapy. After all, medications come with side effects, and the long-term consequences of many pharmaceutical treatments have yet to be seen.

Changing everyday habits can also help make ADHD more manageable. For example, keeping routines, minimizing distractions (turning off the TV while trying to work, for instance) and social support can help. Diet may play a role, too. One study, for example, suggests that a diet high in omega-3 fatty acids and other nutrients (think vegetables, nuts and fish) can lower ADHD risk. Common allergens like wheat, soy, dairy, peanuts and artificial dyes may also contribute to symptoms, so some doctors advise trying an elimination diet to pinpoint any particular foods that may be adding to distractibility or hyperactivity. And, since sugar in the form of cookies, candy and other processed foods can spike and drop blood sugar and therefore exacerbate ADHD symptoms, it's best for those with ADHD to limit their intake.

Health Care Providers That Treat ADHD

Medications

For some kids, adolescents and adults, medications can help manage symptoms like inattentiveness, says Dr. Segundo S. Robert-Ibarra, an assistant professor in the psychiatry and behavioral sciences department at McGovern Medical School, a part of the University of Texas Health Science Center at Houston. Commonly prescribed medications include: