Attention Deficit Hyperactivity Disorder
- What is it?
- Facts to Know
- Questions to Ask
- Key Q&A
- Organizations and Support
What is it?
What Is It?
ADHD interferes with your ability to regulate activity (hyperactivity), control some behaviors (impulsivity) and focus on tasks (inattention).
Experts suggest that attention deficit hyperactivity disorder (ADHD) affects an estimated 8 percent of school-aged children, and about two-thirds of children diagnosed with ADHD continue to show signs of the disorder into adulthood.
ADHD interferes with your ability to regulate motor activity (hyperactivity), control key behaviors (impulsivity) and focus on tasks (inattention). When the hyperactivity is not present, the condition is sometimes called attention deficit disorder (ADD), although the more accurate term is ADHD-inattentive type.
By current estimates, more than two times as many boys as girls are affected by ADHD, but the ratio appears to become more even by adulthood.
Overall, women and girls may exhibit fewer of the typical symptoms associated with ADHD in boys. For example, girls with ADHD are more likely to be reserved than hyperactive. They tend to be less defiant and more compliant than boys and men with the condition. Like boys and men with ADHD, however, women with the condition may have difficulty completing tasks and remaining organized. Instead of being tested for ADHD, they're often dismissed as flighty or spacey.
Thus, because girls are less likely to disrupt class—the kind of behavior that often brings boys with the condition to medical professionals' attention—girls are less likely to get diagnosed with ADHD. Consequently, many girls and women do not get the help they need. Often, girls' self-esteem suffers as they encounter academic problems in school. They may have difficulty with interpersonal relationships as well as social challenges.
These secondary difficulties may result in depression, anxiety disorders, problems sleeping, self-harmful (cutting) behaviors and/or abuse of alcohol or other substances. Furthermore, girls with ADHD are at greater risk for early pregnancy, promiscuity and sexually transmitted diseases. A recent study following girls for 10 years showed significantly higher risk for suicide attempts and self-injury compared to a comparison group.
Once diagnosed, many women recall painful or difficult childhood experiences in school that were likely to have been linked to ADHD but attributed at the time to other causes, such as laziness or lack of ability. This misattribution can itself lead to significant damage to self-esteem and self-confidence, resulting in demoralization.
Causes of ADHD
Although no one knows for sure what causes ADHD, the condition does run in families, suggesting a strong genetic component. Children who have a parent with ADHD are at an increased risk for ADHD themselves. And twin and adoption studies confirm a high degree of genetic connection with this condition. For identical twins, there is a strong chance the other twin has it. Again, this "family resemblance" appears strongly related to genes rather than social factors. Many researchers around the world are now investigating various genes that may contribute to the development of ADHD in families. It is unlikely a single gene is responsible, but undoubtedly many genes, operating interactively with one another and with environmental risks.
A smaller percentage of cases of ADHD are due to environmental or nongenetic biological risk factors, including premature birth, low birth weight; prenatal use of alcohol, tobacco and/or cocaine; and exposure to lead, which can alter brain development in the fetus. Infections and complications during pregnancy can also increase the chances that a baby will eventually develop ADHD in childhood. Additionally, some postnatal problems, such as chronic low levels of lead, recurrent ear infections or severe head trauma, can result in ADHD.
For years, ADHD was thought to be a disruptive behavior disorder that most experts intuitively believed involved some brain abnormality. With the development of more sophisticated brain scanning techniques, it is now known that people with ADHD do have anatomical differences in their brains, as well as differences in the biochemical balance that controls everything from mood to impulses.
Brain imaging studies show differences in ADHD brains in several areas:
- differences in dopamine receptors in specific areas of the brain
- differences in total brain volume and brain volume of specific areas of the brain
- differences in the brain networks that are used to solve specific tasks
- differences in the rate of maturation of frontal/prefrontal areas of the brain
Children with ADHD show a pattern of delayed maturation of certain regions of the brain compared to their peers without the disorder. These regions of delayed development are involved with controlling motor behavior, impulse control and attention levels. The conclusion is that slower brain development is a characteristic of ADHD brains and may explain the delay in development of emotion/impulse control and organizational skills.
Another biological component of ADHD has to do with levels of certain neurotransmitters in the brain. Adults with ADHD who have never received any medication have lower amounts of receptors for the neurotransmitter dopamine in key subcortical regions linked to motivation and reward than do adults without the disorder. In fact, stimulant medications used in the treatment of ADHD help balance levels of dopamine, improving symptoms of inattention, hyperactivity and impulsivity.
ADHD is not caused by many environmental triggers commonly believed to be associated with the disorder, such as too much TV, food allergies, eating too much sugar, problematic home life, poor teaching or schools or permissive parenting. Still, it is essential to realize that the home environment and the school setting are extremely important in managing ADHD—and that ineffective parenting and educational settings can exacerbate the symptoms and lead to additional impairments.
Attention deficit hyperactivity disorder (ADHD) is the most prevalent chronic neurobiological disorder in children. Once thought to affect only children, it is now recognized as a disorder that most often continues into adulthood and presents unique issues for girls and women.
Common symptoms of ADHD can include:
- failing to give close attention to details or making careless mistakes
- difficulty sustaining attention to tasks
- appearing not to listen when spoken to directly
- failing to follow instructions carefully and completely
- losing or forgetting important things
- feeling restless or fidgeting
- talking excessively or blurting out answers before hearing the whole question
ADHD is a serious diagnosis that can have a tremendous negative impact on your life, work and family. It may require long-term treatment with counseling and medication, so it's important that a health care professional carefully evaluate all symptoms to rule out other conditions that could cause similar symptoms or behaviors.
For instance, stress can cause symptoms similar to those seen in ADHD, such as forgetfulness or feeling overwhelmed and disorganized. However, reactions to stress are usually temporary, subside when the stressful events pass, and are not present in a chronic fashion since childhood. Symptoms caused by ADHD are persistent, chronic and unchanging since childhood or early adolescence.
The diagnosis itself, however, must be approached very carefully and shouldn't be done during a time-limited office visit with a pediatrician or other medical doctor. Improper treatment from misdiagnosis or failure to obtain treatment because of a missed ADHD diagnosis can both have significant, long-term consequences.
To reach an ADHD diagnosis in children, health care professionals use diagnostic criteria published by the American Psychiatric Association (APA) in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV-TR) and consider information from other sources. For example, interviews with the patient, the patient's family and, in the case of children, information provided by caregivers and teachers who see the child regularly can provide a picture of the patient's behavior and learning styles.
Diagnosing and treating adults is challenging. The diagnostic criteria, with their emphasis on school behavior and performance, are designed to make the diagnosis in children, not adults. Hyperactivity, for instance, tends to diminish by adulthood, although other symptoms, such as inattention, may appear worse because of mounting adult responsibilities.
The following informal checklist further describes behaviors in adults that may be the result of ADHD. An individual having chronic problems since childhood with many of these symptoms may require further evaluation:
I am constantly trying to get organized, but can never seem to get or stay there.
I often feel that I talk too much or impulsively blurt things out.
I often feel overwhelmed.
I make impulsive purchases and decisions.
I frequently misplace personal items.
I start one thing but never finish it because I am distracted by something else.
I am frequently late.
I am a procrastinator.
I often make careless errors and oversights during the day.
I often pay bills late and have difficulty managing my money.
There are three primary subtypes of ADHD: predominantly hyperactive-impulsive, predominantly inattentive and combined hyperactive-impulsive and inattentive. The DSM-IV lists these other signs of ADHD, many of which apply to children in the classroom:
Those who are inattentive find it difficult to keep their minds on any one thing and may get bored with a task after only a few minutes. They may, however, give effortless, automatic attention to activities and things that are highly engaging, like video games. But they may have difficulty with deliberate focus, conscious attention on organizing and completing tasks, responses to repetitive materials or mastery of challenging information.
Hyperactivity: Those who are hyperactive always seem to be in motion and have trouble sitting still. They squirm in their seats or roam around the room. Or they might wiggle their feet, touch everything or noisily tap their pencils. They may be fidgety or try to do several things at once, bouncing around from one activity to the next. They report an internal sense of restlessness and the need to continually move around.
Impulsivity: Those who are overly impulsive seem unable to curb or weigh their immediate reactions, thoughts and behaviors before acting. As a result, they may blurt out inappropriate comments or physically attempt something without thinking it through. This could apply to taking tests in school as well as participating in potentially dangerous behaviors. Their impulsivity also makes it hard for them to wait for things they want. This leads to poor frustration tolerance and temper outbursts.
Not everyone who is overly hyperactive, inattentive or impulsive has an attention disorder. Nor does everyone with ADHD exhibit all behaviors associated with the disorder. It's important to realize that during certain stages of development, it may be normal for children to be inattentive, hyperactive or impulsive, and that these behaviors at these stages don't fit an ADHD profile.
For example, preschoolers typically have lots of energy and run everywhere they go, but that doesn't mean they are hyperactive. And many teenagers go through a phase when they are messy, disorganized and reject authority. This phase doesn't necessarily persist as a lifelong problem with attention, organization and/or impulse control.
Because everyone exhibits some of these behaviors at times, the DSM-IV contains very specific guidelines for determining when the behaviors indicate ADHD. Specific symptoms must appear early in life, before age seven, and continue for at least six months. In children, they must be much more frequent or severe than in others the same age. Above all, the behaviors must create a real handicap in at least two areas of a person's life, such as school, home, work or social settings. However, it's important to know that the inattentive type of ADHD may not be diagnosed until age nine or 10, the age when symptoms of inattention become noticeable and problematic because school demands have increased.
So if your behavior or your child's doesn't impair work, friendships or other relationships, you probably won't be diagnosed with ADHD. Nor would a child who seems overly active at school but who functions well elsewhere.
Health care professionals also consider the following questions during an assessment for ADHD:
Are these behaviors excessive, long-term and pervasive? That is, do they occur more often in you or your child than in others the same age?
Are they a continuous problem rather than a response to a temporary situation?
Do the behaviors occur in several settings or only in one specific place?
The health care professional pieces together a profile of behaviors, based on all available information, and then considers:
Which ADHD-like behavior patterns listed in the DSM-IV are apparent?
How often and in what situations?
How long have they been going on?
How old was the child/adult when the problem(s) started?
Are the behaviors seriously interfering with school, friendships, activities or home life?
Are there any other related problems?
- Is there a parent with ADHD symptoms?
The answers to these questions help identify whether the hyperactivity, impulsivity and inattention are significant and long-standing. If so, a diagnosis of ADHD may be made.
Other conditions may occur with ADHD, making it more difficult to arrive at a clear diagnosis. Women and girls with ADHD, for example, are more prone to depression than men and boys with ADHD. A serious but treatable mental disorder, depression can disrupt all areas of your life, including mood, sleep, appetite, relationships, and the ability to think clearly. If you think you're suffering from depression, it's critical that you get a diagnosis and proper treatment. Left untreated, depression can be life-threatening, given the risk of suicide that accompanies the disorder.
Anxiety is another common condition seen in those with ADHD. Some children with ADHD, for example, feel tremendous worry, tension or uneasiness, even when there's nothing to fear. Because the feelings are scarier, stronger and more frequent than normal fears, they can affect the child's thinking and behavior.
Children with ADHD are also more likely to have achievement problems than children without the disorder, even if they don't have a full-blown learning disability. ADHD is not in itself a learning disability but learning disabilities commonly occur with ADHD. But because it can interfere with concentration and attention, it can make it doubly hard for a child to do well in school, creating lifelong frustrations.
A very small number of people with ADHD have a rare disorder called Tourette syndrome. People with Tourette syndrome have tics and other involuntary movements like eye blinks or facial twitches they can't control. Some may grimace, shrug, sniff or bark out words. Fortunately, these behaviors can be controlled with medication.
The effects of ADHD extend far beyond the classroom, often wreaking havoc on everything from educational budgets to sibling relationships. In 2005, the CDC reported that the educational cost of ADHD was about $36 billion to $52 billion annually. Children with ADHD use more mental health services, have more frequent emergency department visits and have higher rates of pedestrian, bicycle and driving accidents than children without ADHD. All of which places extreme stress on their parents.
It doesn't matter if the child with ADHD is male or female; parenting either is equally stressful. Overall, mothers of children with ADHD report significantly higher levels of parenting stress than mothers of children with other chronic disorders, and they're more likely to become depressed.
Parents of children with ADHD are also more likely to experience increased absenteeism and decline in productivity in the workforce than parents of children without the disorder. The annual cost to the economy in terms of lack of productivity, unemployment and related issues linked to ADHD is measurable in many billions of dollars. Of course, ADHD also places tremendous strain on relationships and places marriages at higher risk for divorce. Learning how to manage children with ADHD effectively and consistently is a major component of most treatment plans.
Some research looks at the concept of executive function (EF). This involves the ability to organize, sequence a task, shift from task to task, prioritize, plan and anticipate, and hold information in your memory as you consider multiple factors when making a decision. Some researchers consider executive dysfunction inherent to ADHD, while others consider it a separate category as defined by neuropsychological test results. Children and adults with ADHD plus EF deficits show more academic and life impairments that those with ADHD without EF dysfunction. ADHD medication, although helpful for ADHD symptoms, has much less beneficial effect on EF symptoms. Skills-based therapies are more useful in these cases.
Getting a Diagnosis
Several types of health care professionals are qualified to diagnose and treat ADHD.
Child psychiatrists are physicians who specialize in diagnosing and treating childhood mental and behavioral disorders. A psychiatrist can provide therapy and prescribe any necessary medications.
Child psychologists are also qualified to diagnose and treat ADHD. They can provide therapy for the child and help the family develop ways to deal with the disorder. But psychologists are not medical doctors and must rely on physicians for medical exams and prescriptions.
Neurologists, physicians who work with disorders of the brain and nervous system, can also diagnose ADHD and prescribe medicines. They will likely be involved with any brain imaging tests. But unlike psychiatrists and psychologists, neurologists usually do not provide therapy for the emotional/organizational aspects of the disorder.
Family physicians receive training to provide continuing and comprehensive medical care, health maintenance and preventive services to patients of all ages. When it comes to ADHD, they can diagnose the condition, prescribe medications and, in some cases, provide counseling.
Pediatricians are physicians who have specialized training in treating children's illnesses. Like family practitioners, pediatricians may or may not have specialty training in or experience with ADHD. Because ADHD is most prevalent in children, it is likely that a pediatrician will have experience in the ADHD screening process and can help rule out (or identify) medical conditions similar to behavior or learning patterns of ADHD. Pediatricians can also provide referrals to local ADHD specialists.
Developmental and behavioral pediatricians specialize in behavior and development in children. Serving as a liaison with primary care physicians and other medical specialists, developmental and behavioral pediatricians serve as key members of a multidisciplinary team. They provide comprehensive developmental, medical and behavioral assessments; education for parents and professionals regarding various medical/developmental diagnoses; and medical management of ADHD and other neurobehavioral disorders.
Psychologists, psychiatrists, neurologists and primary care physicians may also diagnose and treat ADHD in adults. But not all health care professionals are trained and skilled in identifying or treating ADHD in adults.
Within each specialty, individual health care professionals and mental health professionals differ in their knowledge of and experience with ADHD. So when selecting a health care professional, it's important to find someone with specific training and experience in diagnosing and treating the disorder and distinguishing coexisting psychiatric disorders.
An effective treatment plan will help you cope with ADHD, whether you or your child is the one with the diagnosis. For adults, the treatment plan may include medication along with practical and emotional support. For children and adolescents, it may include providing an appropriate classroom setting and accommodations, as well as medication and helping parents understand and manage the child's behavior.
Treatment for ADHD may involve medication, behavioral/psychological counseling, educational/workplace interventions or a combination.
Three medications in the class of medications known as psychostimulants, or stimulants, seem to be the most effective in treating ADHD in both children and adults. These are:
Methylphenidate (e.g., Ritalin, Concerta, Metadate, Methylin, Daytrana). Methylphenidate is available in brand name and generic tablets,capsules and liquid. Daytrana is a methylphenidate transdermal patch approved for treating ADHD in children aged six to 12.
Dexmethylphenidate (Focalin, Focalin XR)
Dextroamphetamine-amphetamine mix (Adderall, Adderall XR).
Dextroamphetamine(Dexedrine, Dextrostat, Concentra).
Stimulant medications, when used with medical supervision, are usually considered safe. Stimulants seldom make children with ADHD "high" when taken as prescribed. Because these medications are stimulants, there is no sedating effect. However, restlessness and fidgetiness may decline leaving the person feeling "calmer." Ultimately, the stimulants help children control their hyperactivity, inattention and other ADHD-related behaviors.
Stimulant drugs are available in both short-, medium- and long-acting forms. The short-acting forms last for about four hours, medium-acting forms for about 6 hours and long-acting forms last 8 to 14 hours.
Stimulants do carry the risk of abuse and addiction. However, abuse and dependence with ADHD stimulant medication are more likely with short-acting forms. To reduce chances of substance abuse, make sure you or your child is getting the right dose of stimulant medication at the needed time of the day. Do not put your child or adolescent in charge of his or her own medication. Keep medication locked in a childproof container at home. If a school time dose is needed, don't send supplies of medication to school with your child; instead, deliver medication to the school nurse or health office yourself.
Although sudden deaths have occurred in children on stimulant medications, a recent extensive review of sudden death in children and adolescents on stimulant medication concluded that stimulant medication poses no increased risk for sudden death, cardiac arrest or stroke compared to children and adolescents not on these medication. Always review medication packaging information, and talk to your health care professional about this potential risk. Heart screening questions to assess any risk should be asked before starting any ADHD medication.
Additionally, stimulant medications have been associated with a slightly reduced growth rate in some children, although the extent of this appears to be a half inch on average.
Other potential side effects, such as weight loss, problems sleeping and tics, should be carefully weighed against the benefits before prescribing the medications. Preexisting tics may or may not worsen with stimulant medication. Most side effects can often be handled by reducing the dosage.
Atomoxetine (Strattera). The first non-stimulant medication approved to treat ADHD, Strattera is classified as a selective norepinephrine reuptake inhibitor. It works by blocking norepinephrine in the brain, thus leading to greater amounts in the synapse when the medication is used. Overall, Strattera has been shown to lead to significant improvements in individuals with ADHD, but the benefit may be less substantial than stimulants.
Strattera has been linked to rare side effects that include liver problems as well as the increased risk of suicide, according to the FDA. Call your health care professional right away if you or your child experiences yellowing of the skin or eyes (jaundice), unexplained flu-like symptoms or dark-colored urine, or if you or your child has thoughts of suicide or a sudden change in mood or behavior, especially at the beginning of treatment or after a change in dose.
Strattera is not classified as a controlled substance like the other ADHD medications (i.e., the stimulants), although it is a prescription drug. Unlike stimulants, refills can be provided on prescriptions. Side effects include: decreased appetite, upset stomach, nausea or vomiting, and fatigue. In addition, some of the most common side effects in adults are problems sleeping, dry mouth, dizziness, problems urinating (more so in males) and sexual side effects.
Other additional medications are sometimes used to treat the condition if stimulants don't work completely or if the ADHD occurs with another disorder. These medications are not approved for the treatment of ADHD, yet many have been shown effective in at least some studies.
For example, clonidine (Catapres) and guanfacine (Tenex), medications normally used to treat hypertension, may be helpful in people with ADHD who have tics and/or insomnia as a result of ADHD medications or who experience aggression as part of their condition. Clonidine can be administered either by pill or skin patch and has different side effects than stimulants, including rash (from the patch), constipation,nervousness and sedation.
Other medications not FDA-approved for ADHD but that may be prescribed include the antidepressants nortriptyline (Pamelor, Aventyl) and bupropion (Wellbutrin).
Antidepressants may temporarily increase risk of suicidal thoughts and behavior in people up to age 24, according to the FDA. Short-term studies in children and adolescents with major depressive disorder and other psychiatric disorders showed an increased risk of suicidal thoughts in those taking antidepressants, during the initial weeks of treatment. Although this effect is rare, anyone considering the use of an antidepressant in a child or adolescent must balance this risk with the need for the drug.
Also, health care professionals should observe their patients closely for any increased risk of suicide or unusual changes in behavior. Families and caregivers should also closely watch patients.
Medication won't cure ADHD; it will just control the symptoms while you're taking the medication. For instance, stimulants have only immediate benefits, so once a dose wears off that day, the symptoms return.
Also, although the medications may help you pay better attention to and complete your work, they can't increase your knowledge or improve your (or your child's) academic skills. As the expression goes, "Pills don't teach skills." The medications alone can't make you feel better about yourself or cope with problems. These issues require other kinds of treatment and support.
Although ADHD primarily affects a person's behavior and cognition, the disorder has broad emotional repercussions. Scolding is the only attention some people with ADHD ever get while growing up. They may have few positive experiences to build their sense of worth and competence. Facing the daily frustrations that can come with having ADHD can make people fear that they are strange, abnormal, lazy or stupid.
Often the cycle of frustration, blame and anger has gone on so long it becomes incorporated into one's self-concept. In such cases, mental health professionals can help adolescents and adults with ADHD develop new skills, attitudes and ways of relating to other people. Often successful treatment will help a person separate the disorder (ADHD) and its symptoms/impairments from the individual and their innate strengths and potential.
In group counseling, people learn that they are not alone; other people with ADHD have similar experiences, and there are people who want to help. Support from group therapy can be complimented with individual therapy to address specific life issues. Very often, ADHD symptoms and inconsistent performance adversely affects personal relationships. Family and marital therapy with a professional aware of ADHD can be helpful in changing the communication pattern.
Several types of therapy are available, with different therapists preferring different approaches. Knowing something about the various types of interventions makes it easier to choose a therapist.
- Psychotherapy works to help people with ADHD like and accept themselves despite their disorder. In psychotherapy, patients talk with the therapist about upsetting thoughts and feelings, explore self-defeating patterns of behavior and learn alternative ways to handle their emotions. As they talk, the therapist tries to help them understand how they can change. However, people dealing with ADHD usually want to gain control of their symptomatic behaviors more directly. The following interventions can provide that kind of help.
- Behavior therapy, used with children and adolescents, involves providing parents with education about ADHD, teaching them to use regular and consistent rewards and punishments with their children and coordinating efforts with teachers at school. Indeed, for children and adolescents, behavior therapy and medication are the only two evidence-based interventions that consistently lead to improvement in symptoms and impairments.
- Cognitive-behavioral therapy helps you work on immediate issues. Rather than helping you understand your feelings and actions, it supports you directly in changing your thoughts and behavior. The support might be practical assistance, like learning to think through tasks and organize work or changing a repetitive negative thought pattern. Cognitive therapies have not been found to be very helpful for children and adolescents, but for adults, results are promising.
- Social skills training helps children and adults learn new behaviors, specifically social behaviors. Impulsive behavior can be intrusive and abrasive in interactions. In social skills training, the therapist discusses and models appropriate behaviors and helps the patient practice the new behavior. It is essential that clear limits are set in the social skills groups; otherwise, children may model maladaptive behaviors from one another.
- Support groups connect people who have common concerns. Many adults with ADHD and parents of children with ADHD find it useful to join a local or national support group. Many groups deal with issues of children's disorders, and even ADHD specifically.
Ineffective or unproven alternative treatments
The following treatments have NOT been scientifically shown to be effective in treating people with ADHD:
restricted diets (although recent studies from the United Kingdom do show small effects of certain food additives on hyperactive behavior)
medicines to correct problems in the inner ear
chiropractic adjustment and bone realignment
treatment for yeast infection
special colored glasses
essential fatty acids
yoga and meditation
Neurofeedback, also known as biofeedback, is a promising intervention, not completely supported by definitive studies but with some recent investigations yielding support for improvements in attention and behavior.
Be cautious about pursuing complementary and alternative treatments that are not supported by scientific research and/or the U.S. Food and Drug Administration. Although single positive studies often receive media attention, it is important that such findings be replicated. Until sound, scientific testing shows a treatment to be effective, families risk spending time, money and hope on fads and false promises.
Managing Your Life as an Adult with ADHD
Here are some practical steps you can take to manage your life with ADHD from ADHD expert Kathleen Nadeau, PhD.
Give yourself a break. High expectations are deeply ingrained in many women. Identify your strengths and perform those tasks. Identify your weakness and either find a compensatory skill or ask someone else to perform these tasks. Psychotherapy can help capitalize on strengths while limiting the impairments in areas of weakness.
Educate your partner about ADHD and how it affects you. Your partner may be angry or resentful about a less-than-organized lifestyle. If your partner understands this as a disorder, he or she may be more understanding and accommodating. Reassign household responsibilities based on skill strength. Strategize how to make your life at home and work more accommodating.
Try to create an "ADHD-friendly" environment in your home and work. If you can approach your ADHD with acceptance and good humor, tensions will decrease and you'll save more energy for the positive side of things.
Simplify your life. Look for ways to reduce commitments so you're not always pressed for time. Learn how to better prioritize tasks to avoid overcommitment.
Choose supportive friends. Many women describe friends or neighbors whose houses are immaculate, whose children are always clean, neat and well-behaved and who make them feel terrible by comparison. Try to avoid situations that lead you to impossible expectations and negative comparisons.
Build a support group for yourself. For example, ask a friend who understands your condition to keep you company while completing a task that is always difficult for you.
Build in daily breaks. This is essential when you have ADHD, especially if you're raising children. Make them routine so that you don't have to keep planning and juggling. For example, arrange for a regular babysitter several times a week.
Eliminate and delegate. Look at things that you require of yourself at home or on the job. Can you eliminate some of these things? Can you hire someone to do some of them?
Get help for premenstrual or menopausal symptoms. They may be severe in women with ADHD. Managing the destabilizing effects of your hormonal fluctuations is a critical part of managing your ADHD.
Make lists and encourage other family members to list and record activities, responsibilities and events. Try to create a central family calendar with all activities for everyone to check. Online calendars may facilitate this. Avoid scattering information on multiple pieces of paper that can get lost.
Create filing systems or organizational systems that work for you. Color coding folders is a fast visual way to identify what's in them. Set up autopay for bills, provided you have money and won't overdraw accounts. Don't let yourself be overwhelmed at home or at the office by mountains of paperwork: sort, file or discard.
According to current medical research, there is no known way to prevent most ADHD. There are some pre and post-natal risk factors that can be addressed: avoid alcohol and tobacco when pregnant, avoid a premature birth if possible and avoid lead exposure to the child.
Facts to Know
Facts to Know
It is estimated that attention deficit hyperactivity disorder (ADHD), also known as attention deficit disorder (ADD) when present without hyperactivity, affects 8 percent of U.S. school-aged children, according to the Centers for Disease Control.
Follow-up studies of children with ADHD find that the vast majority will continue to suffer impairments through adolescence, and 60 percent through adulthood. Many girls and women suffer the effects of ADHD and do not get the help they need.
Once diagnosed, many women recall painful or difficult childhood experiences in school that were likely caused by ADHD, but at the time were attributed to laziness or lack of ability. Low self-esteem is the outcome of chronic criticism and is common among women with ADHD.
ADHD, once called hyperkinesis or minimal brain dysfunction, is the most common psychiatric condition among children. More than two times as many boys as girls are affected in childhood; however, in adults it's almost equal proportions.
ADHD can be mild, moderate or severe. An ADHD diagnosis is more difficult to identify in women and girls because they tend to be less hyperactive, less defiant and more compliant than boys (though this is not always the case). The absence of disruptive behavior can delay identification.
ADHD has a very strong genetic component. Children who have a parent with ADHD or another mood or behavioral disorder are at an increased risk. Still, as with other conditions with a strong genetic liability, the quality of life and the provision of strong parenting and quality schooling can greatly influence any long-term outcomes.
Like all chronic medical conditions, there are no cures for ADHD. Treatment for ADHD may involve medication, behavioral/psychological counseling, educational interventions or a combination.
Medication can help to control the core symptoms: hyperactivity, impulsivity and inattention. But more often, there are other aspects of the problem that medication won't alleviate. Even though ADHD primarily affects a person's behavior and cognition, having the disorder has broad emotional repercussions.
Currently, ADHD is a diagnosis made in people who demonstrate chronic and persistent symptoms across a number of settings. Although people identify with some of these symptoms at different times in their lives, ADHD is a disorder starting in childhood that usually persists into adulthood. Childhood onset (or early adolescence, in the case of the inattentive type) is the cornerstone of the diagnosis. There is no such disorder as "adult-onset ADHD," although some adults with this condition may not have been diagnosed as children.
Questions to Ask
Questions to Ask
Review the following Questions to Ask about attention deficit hyperactivity disorder (ADHD) so you're prepared to discuss this important health issue with your health care professional.
Do you have experience in diagnosing/treating ADHD? How long have you been treating patients with ADHD?
Do you have experience treating girls with ADHD?
Do I or does my child have ADHD? How can you tell? Could something else be causing this behavior?
What can I do about my child's behavior at home and school? How can I help my child?
What can I do to function better at home and work? What tools can I use to organize my responsibilities and activities?
Should I or my child be medicated for ADHD? What are the risks of medication for ADHD? What can I expect the benefits will be with medication?
Do you offer counseling or behavior therapy as well as medication? Do you know of others in the community who can offer such treatment?
When should I or my child be medicated, and when is it not necessary to take the medication?
How should I approach the subject of ADHD with the people in my life, such as relatives, colleagues, other parents or teachers?
Are there support groups for people with ADHD and their families?
Can I expect my child to grow out of ADHD?
Do you have experience working with adults and/or women with ADHD?
As an adult with ADHD, should I tell my employer, boyfriend, husband, partner?
What accommodations can I get at school or work in regards to my ADHD?
As an adult on other medications, what concerns should I have when adding ADHD medication?
I have trouble focusing on tasks and often feel overwhelmed during times of extreme stress. Does this mean I have attention deficit hyperactivity disorder (ADHD)?
Not necessarily. Stress can cause symptoms similar to ADHD, such as forgetfulness or feeling overwhelmed and disorganized. Reactions to stress are usually temporary and subside when stress subsides. These symptoms should not be confused with ADHD symptoms or behaviors, which are long lasting and persistent.
Are bad parenting skills to blame for ADHD?
No. ADHD is a complex neurobiological disorder that affects learning and behavior. Too much TV, poor home life, poor schools or teachers, food allergies or excess sugar do not cause ADHD. International research demonstrates the presence of ADHD in children regardless of culture and parenting. Still, how a family responds to their child's ADHD may go a long way in shaping the child's ultimate outcome. Biology is not destiny.
Does ADHD only affect children? I think I recognize some symptoms in myself.
No. Until recent years, adults were not thought to have ADHD, so many adults with ongoing symptoms have never been diagnosed. There has been a recent increased awareness of adult ADHD, however. About half of children with ADHD continue to have impairments through adulthood. The recent awareness of adult ADHD means that many people can finally be correctly diagnosed and treated.
What causes ADHD?
Scientists are not sure what causes ADHD, although genetic and neurobiological factors are clearly involved. Health care professionals stress that because there is no known cause, it is far more important for a woman and her family to move forward with treatment and identify ways to manage her lifestyle in areas affected by ADHD than to search for a cause.
Can stimulant medications be abused?
Although stimulant medications are recognized as a safe and effective treatment for ADHD when taken as prescribed, these medications, like many others, nonetheless do have the potential for abuse. Stimulant medication has been misused by people without ADHD. They take these medications to increase alertness and focus but also to gain a "high." Substance abuse and dependence does not develop in people who take their medications as prescribed. You should discuss the risks and benefits of stimulant medication with your health care professional. If you have a history of substance or alcohol abuse, this should be discussed with your physician to choose the right course of treatment and medication.
My relationship with my husband has suffered because of my ADHD. Is there anything I can do?
Yes. Because adult women often suffer for many years without help for their ADHD, their personal relationships can become strained. Health care professionals usually recommend counseling for women and their families, along with medication treatments. A therapist can assist you and your family in finding better ways to deal with your ADHD and reduce the frustration of the non-ADHD spouse/family member.
Is ADHD a learning disorder?
No. ADHD is a specific psychiatric disorder that can occur with a coexisting learning disorder. Learning disorders do not, in general, improve with medication. Intelligence and ADHD are separate entities. People with ADHD can have a broad range of IQs. Regardless of IQ, most ADHD individuals feel frustrated at not living up to their potential because of the impairments.
Organizations and Support
Organizations and Support
Attention Deficit Information Network (ADIN)
Address: 475 Hillside Avenue
Needham, MA 02194
CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder)
Web Site: http://www.chadd.org
Address: 8181 Professional Place, Suite 150
Landover, MD 20785
Learning Disabilities Association of America
Web Site: http://www.ldaamerica.org
Address: 4156 Library Road
Pittsburgh, PA 15234
National Institute of Neurological Disorders and Stroke
Web Site: http://www.ninds.nih.gov
Address: NIH Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
A.D.D. & Romance: Finding Fulfillment in Love, Sex, & Relationships
by Jonathan Halverstadt
ADHD: A Path to Success: A Revolutionary Theory and New Innovation in Drug-Free Therapy
by Lawrence Weathers
ADHD Handbook for Families: A Guide to Communicating with Professionals
by Paul Weingartner
The Attention Deficit Answer Book: The Best Medications and Parenting Strategies for Your Child
by Michael Boyett
Put Yourself in Their Shoes: Understanding Teenagers with Attention Deficit Disorder
by Harvey C. Parker
Kids Health from Nemours Foundation
Email: [email protected]
Centers for Disease Control and Prevention
Address: Centros para el Control y la Prevención de Enfermedades,
1600 Clifton Road
Atlanta, GA 30333
Email: [email protected]
"Attention deficit hyperactivity disorder." The National Institutes of Health. April 2011. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002518/. Accessed March 2012.
"Attention deficit hyperactivity disorder faststats." Centers for Disease Control and Prevention. November 2011. http://www.cdc.gov/nchs/fastats/adhd.htm. Accessed March 2012.
"Attention deficit/hyperactivity disorder; data & statistics." Centers for Disease Control and Prevention. December 2011. http://www.cdc.gov/ncbddd/adhd/data.html. Accessed March 2012.
"Attention deficit/hyperactivity disorder in children." The Mayo Clinic. February 2011. http://www.mayoclinic.com/health/adhd/DS00275/DSECTION=alternative-medicine. Accessed March 2012.
Biederman J, Petty C, Fried R, et al. "Impact of psychometrically defined deficits of executive functioning in adults with attention deficit hyperactivity disorder." Am J Psychiatry. 2006;163(10):1730.
Swanson J, Baler RD, Volkow ND. "Understanding the effects of stimulant medications on cognition in individuals with attention-deficit hyperactivity disorder: a decade of progress." Neuropsychopharmacology. 2011;36(1):20726.
Goodman DW. "The consequences of attention-deficit/hyperactivity disorder in adults." J of Psychiatric Practice. 2007;13:318-27.
Goodman DW, Thase ME. "Recognizing ADHD in adults with comorbid mood disorders: Implications for identification and management." Postgraduate Medicine. 2009. 121;5:1-11.
Heinonen K, et al. "Trajectories of growth and symptoms of attention deficit/hyperactivity disorder in children: A longitudinal study." BMC Pediatrics. 2011.11;84:1-32.
Hinshaw SP, Owens EB, Zalecki C, et al. "Prospective follow-up of girls with attention-deficit/hyperactivity disorder and continuing impairments includes elevated risk of suicide attempts and self-injury." J Consult Clin Psychol. 2012. August 13 (Epub ahead of print).
Biederman J, Petty CR, Monuteauz MC, et al. "Adult psychiatric outcomes of girls with attention deficit hyperactivity disorder: 11-year follow-up in a longitudinal case-control study." Am J Psych. 2010; 167(4):409-17.
Castells X, Ramos-Quirage JA, Borch R, et al. "Amphetamines for attention deficit hyperactivity disorders in adults (Review)." The Cochrane Collaboration. 2011.online access at http://www.cochrane.org/cochrane-reviews.
Danckaerts M, Sonuga-Barke EJS, Banaschewski T, et al. "The quality of life of children with attention deficit/hyperactivity disorders: a systemic review." Eur Child Adolesc Psychiatry. 2010;19:83-105.
Lee SS, Hamphreys KL, Flory K, et al. "Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: A meta-analytic review." Clinical Psycholgy Review. 2011;31:328-41.
Lofthouse N, Arnold LE, Hersch S, et al. "A review of Neurofeedback Treatment of Pediatric ADHD." J of Attention Disorders. 2012 Jul;16(5)351-72.
Hodgson K, Hutchinson AD, Denson L. "Nonpharmacological treatments for ADHD: a meta-analytic review." J of Attention Disorders. 2012. Published online before print May 29, 2012, doi: 10.1177/1087054712444732.
Miller M, Ho J, Hinshaw SP. "Executive functions in girls with ADHD followed prospectively into young adulthood." Neuropsychology. 2012. 26;3:278-87.
Zuvekas SH, Vitiello B. "Stimulant medication use in children: a 12-year perspective." Am J Psychiatry. 2012.169;2:160-6.
Shaw P, et al. "Development of cortical surface area and gyrification in attention-deficit/hyperactivity disorder." Biol Psychiatry. 2012;72:191-7.
Turgay A, Goodman DW, Asherson P, et al. "Lifespan persistence of ADHD: the life transitions model and its application." J Clin Psych. Feb;73(2):192-201.
"Overview of the treatment and prognosis of attention deficit hyperactivity disorder in children and adolescents." Uptodate.com. May 2009. Subscription necessary to view text. Accessed October 2009.
"Attention Deficit Hyperactivity Disorder." The National Institute of Mental Health. 2008. http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml. Accessed October 2009.
"Attention-deficit/hyperactivity disorder in children." The Mayo Clinic. February 2009. http://www.mayoclinic.com/health/adhd/DS00275. Accessed October 2009.
"Attention deficit hyperactivity disorder in children and adolescents: Clinical features and evaluation." Uptodate.com. May 2009. Subscription necessary to view text. Accessed October 2009.
"Adult attention deficit hyperactivity disorder." Uptodate.com. May 2009. Subscription necessary to view text. Accessed October 2009.
"ADHD Data & Statistics." The Centers for Disease Control and Prevention. Last updated March 2009. http://www.cdc.gov/ncbddd/adhd/data.html. Accessed October 2009.
"About ADHD: Statistical Prevalence." The National Resource Center on ADHD. 2007. http://www.help4adhd.org/en/about/statistics. Accessed October 2009.
Volkow ND, Wang GJ, Kollins SH, et al. "Evaluating Dopamine Reward Pathway in ADHD." JAMA. 2009;302(10):1084-91.
Barkley, R.A. Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. (3rd ed). New York: Guilford Press, 2006.
Nigg, J.T. What Causes ADHD? New York: Guilford Press, 2006.
"Attention Deficit and Hyperactivity Disorder." The Mayo Clinic. September 2005. http://www.mayoclinic.com/health/adhd/DS00275/DSECTION=7. Accessed May 2006.
"Attention Deficit Disorder Articles." The Attention Deficit Disorder Association. 2006. http://www.add.org/articles/index.html#abc. Accessed May 2006.
"ADHD." The Centers for Disease Control and Prevention. September 2005. http://www.cdc.gov/ncbddd/adhd/dadburden.htm. Accessed May 2006.
Letter regarding Daytrana approval. The US Department of Health and Human Services. April 2006. http://www.fda.gov/cder/foi/appletter/2006/021514s000ltr.pdf. Accessed May 2006.
"US Food & Drug Administration (FDA) Approves Adderall XRr To Treat Adults." August 12, 2004. Shire Pharmaceuticals Group, LLC. http://www.shire.com. Accessed September 15, 2004.
Talen Jamie. "High-tech tools focus on ADHD; Non-drug approaches to diagnosis and treatment draw new research." Newsday. June 1, 2004, pg. B56.
Barbaresi WJ, et al. "How common is ADHD? Incidence in a population-based birth cohort in Rochester, Minn." Arch Pediatr Adolesc Med. 2002;156(3):217-24.
"The ABCs of ADD." National Attention Deficit Disorder Association. Modified April 2002. http://www.add.org. Accessed August 2003.
"Attention Deficit Hyperactivity Disorder (ADHD) - Questions and Answers." National Institute of Mental Health. Updated April 2003. http://www.nimh.nih.gov. Accessed August 2003.
"AD/HD in Adults - Fact Sheet #7." Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). Updated July 2001. http://www.chadd.org. Accessed August 2003.
"Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV-TR)." American Psychiatric Association. Published 2000. http://www.psychologynet.org. Accessed 2012.
Nadeau, K. & Quinn, P. (2002). Understanding Women with AD/HD. Silver Spring, MD: Advantage Books. 888-238-8588.
Nadeau, K., Littman, E., & Quinn, P. (1999). Understanding Girls with AD/HD. Silver Spring, MD: Advantage Books. 888-238-8588.
"ADDvance: A Resource for Women and Girls with ADHD." Copyright 2001. http://ADDvance.com. Accessed August 2003.
"FDA In USA Approves Non Stimulant Option For Treatment of ADHD." Adders.org. Nov. 2003. http://www.adders.org. Accessed August 2003.
"Strattera (Atomoxetine Hydrochloride) Capsules, Rx." CDER New and Generic Drug- Approvals: 1998-2002. http://www.fda.gov. Accessed December 2002.
McGuffin P, Riley B, Plomin R. "Toward behavioral genomics." Science. 2001; 291:1232-49.
Kovatchev B, Cox D, Hill R, Reeve R, Robeva R, Loboschefski T. "A psychophysiological marker of attention deficit/hyperactivity disorder (ADHD)—defining the EEG consistency index." Appl Psychophysiol Biofeedback. 2001 June;26(2):127-40.
Castellanos FX, Lee PP, Sharp W, et al. "Developmental trajectories of brain volume abnormalities in children and adolescents with attention-deficit/hyperactivity disorder." JAMA. October 9, 2002;288(14):1740-8.
Barkley RA, Fischer M, Smallish L, Fletcher K. "Does the treatment of attention-deficit/hyperactivity disorder with stimulants contribute to drug use/abuse? A 13-year prospective study." Pediatrics. January 2003;111(1):97-109.
Wilens TE, Faraone SV, Biederman J, Gunawardene S. "Does Stimulant Therapy of Attention-Deficit/Hyperactivity Disorder Beget Later Substance Abuse? A Meta-analytic Review of the Literature." Pediatrics. January 2003;111(1):179-85.
"Attention-deficit/hyperactivity disorder treatment with a once-daily formulation of methylphenidate: effect on growth and tics." European Neuropsychopharmacology. 2002;12(Suppl 3):S413 (abstract). Presented at the 15th Congress of the European College of Neuropsychopharmacology, 2002 (poster).
Tourette's Syndrome Study Group. "Treatment of ADHD in children with tics: a randomized controlled trial." Neurology. February 26, 2002;58(4):527-36.
National Institutes of Health Consensus Panel on ADHD. "National Institutes of Health consensus development conference statement: diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD)." J Am Acad Child Adolesc Psychiatry. 2000; 30:182-193.
Leibson CL, Katusic SK, Barbaresi WJ, Ransom J, O'Brien PC. "Use and costs of medical care for children and adolescents with and without attention-deficit/hyperactivity disorder." JAMA. January 3, 2001;285(1):60-6.
Hankin CS, et al. "The Burden of Attention-Deficit/Hyperactivity Disorder." Drug Benefit Trends. April 2001;12(4).
Jensen PS, Kettle L, et al. "Are stimulants overprescribed? Treatment of ADHD in four U.S. communities." J Am Acad Child Adolesc Psychiatry. July 1999;38(7):797-804.
"ADHD - Unproven Treatments." 2001 American Academy of Pediatrics. Medem Medical Library. http://www.medem.com. Accessed August 2003.
Last date updated: 2012-10-17