Attention Deficit Hyperactivity Disorder (ADHD)

What is attention deficit hyperactivity disorder (ADHD) (Dodson, 2022)?

​

• Attention deficit hyperactivity disorder (ADHD) is a neurological disorder that affects approximately 11% of children and 5% of adults

• ADHD is a result of a developmental impairment within the brain’s executive functioning

• Brain imaging, neuroscience, and research over the years has taught us that ADHD is NOT a behavioral issue, mental illness, or learning disability but instead, an impairment within the brain’s self-management system

 

 

What are the symptoms of ADHD (Dodson, 2022)?

​

• Symptoms vary depending on the type of ADHD. Common ADHD symptoms include:

  • Inattention

  • Inability to focus

  • Poor time management

  • Lack of impulse control

  • Heightened emotions

  • Hyperfocus

  • Hyperactivity

  • Executive dysfunction

​

• There are three types of ADHD:

  • Primarily hyperactive-impulsive ADHD

    • The individual feels “driven by a motor”

    • Minimal impulse control

    • Impatient

    • Often interrupts others

    • Excessive squirming, fidgeting, or talking

  • Primarily inattentive ADHD (formerly known as ADD)

    • Difficulty focusing or finishing tasks

    • Hard time following instructions

    • Easily distracted

    • Forgetful

    • “Daydreamers”

  • Primarily Combined Type ADHD

    • Symptoms include a mixture of hyperactive-impulsive and inattentive ADHD

    • Those diagnosed with Combined Type ADHD meet requirements for both types of ADHD

      • These individuals meet at least 6 of the 9 symptoms for each sub-type in the DSM-5

 

 

ADHD in Children vs. Adults (Hagan, n.d.)

​

• As people age, childhood ADHD symptoms may manifest into something else later in adulthood

  • Research has shown that 1 in 3 children will show remission in ADHD by the time they reach adulthood

    • Those who do not reach remission often find other ways to cope with their symptoms

    • Symptoms in adults are also felt internally rather than outwardly observed, like children

• There are three key components that make up ADHD:

  • Hyperactivity

  • Inattention

  • Impulsiveness

• Below is a chart that shows how symptoms may present for each component in both childhood and adulthood:

 

 

 

 

 

 

 

 

 

​

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADHD in Women (Littman, 2022)

​

• Although women experience the same ADHD symptoms as men, women experience many other burdens due to restrictive gender roles, hormone fluctuations, and an increased likelihood of self-doubt and self-harm

  • Research has shown us that though symptoms are identical between the two genders, the long-term outcomes for women are drastically different than those of men

​

• Restrictive gender roles

  • Women often feel that the conforming to gender roles leads to acceptance by society

  • Current societal demands require near perfect use of executive functioning

    • Woman often become overwhelmed and frantic feeling as though they are not entitled to a support system. Instead, they are the support system

    • Inability to execute tasks and functioning perfectly is perceived as a character flaw within women rather than a mental health concern within society

​

• Negative sense of self

  • Women with ADHD tend to blame themselves for their lack of motivation, disorganization, and lateness and even anticipate the criticism or rejection they may receive because of this

  • Women often censor themselves from emotional reactivity to diminish the risk of inappropriate responses

    • Due to being less guarded at home, women with ADHD often experience outbursts towards partners and children

      • Many individuals portray these outbursts as rejection sensitivity dysphoria (RSD) or Borderline Personality Disorder (BPD) rather than a symptom of ADHD

      • The feelings of shame and guilt from these outbursts create a sense of demoralization and regret

        • Without a neurobiological answer for their struggles, their functioning can be viewed as a character flaw rather than an interruption within the brain’s networking system

​

• Hormonal fluctuations

  • During puberty, women experience hormonal fluctuations that consist of high levels of estrogen and progesterone

    • Increased estrogen and progesterone impact the functioning of neurotransmitters. This can negatively impact cognitive functioning post-menstruation

  • In addition to typical premenstrual changes and symptoms, when premenstrual hormone levels drop, women often experience significant exacerbation in symptoms

    • Low estrogen levels are responsible for mood, sleep, and concentration disruptions

    • Women with ADHD are often misdiagnosed with premenstrual dysphoric disorder (PMDD) as a result of the onset of these symptoms

    • As estrogen levels continue to drop as women age, ADHD symptoms begin to intensify

​

• Perfectionism

  • Self-esteem is often acquired through early success in academics

    • As women age symptoms tend to increase. Women often start to question their capabilities as sustaining attention becomes more difficult

    • Previous “success” now requires extra time and energy that it did not require early in life

  • Women with ADHD often compare themselves to peers who seem to be functioning “normally” with little effort

  • Women with ADHD are often in a state of self-monitoring and obsessive preparations which can cause exhaustion and anxiety

    • When plans do not go as originally planned, the high standards women with ADHD have for themselves leaves them feeling demoralized and undeserving of sympathy or compassion

    • One’s façade is often considered successful if nobody is aware of the desperation that consumes the woman

  • The struggles in women with ADHD tend to be secret but no less damaging

​

• ADHD and Comorbid Conditions

  • Typically, by adulthood women with ADHD are struggling with multiple comorbid concerns. With the presence of these comorbid concerns, symptoms of ADHD become more noticeable

  • Women with ADHD are often misdiagnosed with anxiety and mood disorders leading to ineffective treatment approaches

    • E.g. Women are more likely to be misdiagnosed with a personality disorder when it is really ADHD

  • ADHD symptoms can manifest into anxiety-like symptoms such as nausea, nail-biting, cuticle-picking, etc.

  • Women with ADHD often report substance abuse, compulsive shopping or gambling, sensory overload, and hypersensitivity often leading to misdiagnosis

  • Women who have experienced early physical or sexual abuse are likely to be diagnosed with PTSD as ADHD symptoms are often overlooked in trauma survivors

 

​

ADHD in Men (Orlov, 2022)

​

• Certain ADHD symptoms present differently in men than women

​

• Shame in job-related problems

  • Research suggests that men with ADHD are more likely to have difficulty getting along with coworkers, quitting out of hostility or boredom, being disciplined, and being fired

    • Repeated rejection and guilt due to the inability to keep up with work duties brings up feeling of shame and guilt

      • This shame and guilt often begin to affect relationships with loved ones and home life

  • Men with ADHD also report spending longer work hours than coworkers to manage their workload – making stress even worse

​

• Emotional regulation challenges

  • Men with ADHD tend to respond to stimuli quickly and intensely leading to anger management issues

    • As society accepts anger in men more than women, many men with ADHD do not see their rage as an issue

  • Research has shown us that men have more difficulty recovering from an argument or conflict than women

    • This is due to the elevated blood pressure and physical uncomfortableness men with ADHD experience after an argument

      • Because of this, men often avoid arguments which can lead to “secretive” behaviors such as lying or being emotionally distant

​

• Difficulty expressing emotions

  • Society does not do a good job at teaching men how to properly express and be comfortable with their emotions

    • Instead, society teaches men to be tough, stoic, and silent

    • Because men with ADHD struggle with reading emotional cues of others, conforming to society’s “norm” becomes even more difficult in men with ADHD

  • Developing the ability to express one’s emotions takes both practice and courage in men with ADHD

​

• Stubbornness about the ADHD diagnosis

  • Women tend to accept their ADHD diagnosis more than men

    • Men tend to reject the idea of an “ADHD label”

      • It is difficult to take necessary steps to improve symptoms and functioning when one does not accept their diagnosis

    • Women tend to be more comfortable with self-reflection and self-criticism as a way to improve their symptoms and functioning unlike most men with ADHD

  • Due to the anger, frustration, and resentment that comes with the ADHD in men, relationships are often negatively affected

 

​

ADHD in Black, Indigenous, and People of Color (BIPOC) (Brown, 2022)

​

• The BIPOC population experiences ADHD differently than white individuals due to racial disparities in diagnosis and treatment

​

• Lack in diagnosis and treatment

  • Research shows us that white children are more likely to be diagnosed with ADHD than children of the BIPOC community

    • This leads to a significant number of underdiagnosed ADHD in BIPOC children

  • Under- or mis-diagnosed ADHD can have lifelong effects as many individuals go a lifetime not knowing that ADHD is the root cause of their struggles and hardships

    • Racial barriers and inequalities only amplify these struggles in the BIPOC population

  • Studies show that clinicians tend to overlook ADHD symptoms more in Black and Latino children

  • It is difficult to receive treatment without a diagnosis

    • Since individuals of the BIPOC population are underdiagnosed, many BIPOC individuals go a lifetime without proper treatment

​

• Stigma and mistrust

  • In many BIPOC cultures and communities, “mental toughness” is a positive quality to have

    • This often leads to the unwillingness and desire to seek help as it may be a sign of “weakness”

  • Some cultures also believe that symptoms of ADHD can be “fixed” through parenting styles, instead of professional support

  • Due to deep and pervasive roots, many individuals within the BIPOC community have mistrust in medical professionals

    • Throughout history, minorities have found themselves ignored or mistreated by medical professionals when they needed medical assistance the most

      • It is important that we all work together to ensure that all people receive the care that they need. If you feel that your concerns are not being taken seriously, it is always advisable to advocate for yourself. Clinicians must be aware of the systemic barriers to care which BIPOC patients face, and must create the space necessary for their voices to be heard. Equity in health outcomes requires cooperation within the healthcare community and the communities they serve.

 

​

Basics of the ADHD Brain (Silver, 2022)

​

• The “ADHD brain” differs from the brain of neurotypical individuals

• Those with ADHD have low levels of norepinephrine, a neurotransmitter within the brain

  • Norepinephrine plays a role in our dopamine response, which controls the brain’s reward and pleasure center

​

• The “ADHD brain” has impaired neurotransmitters activity in four regions of the brain:

  • Frontal cortex

    • Located in the frontal portion of the brain

    • Controls executive functioning such as:

      • Attention

      • Planning

      • Organization

      • Time management

      • Working memory

      • Self-control

      • Self-monitoring

      • Problem solving

    • Impairment of the frontal cortex neurotransmitters results in dysregulation of executive functioning

  • Limbic system

    • Located deep in the brain

    • Regulates emotions and attention

      • Impairment within the limbic system can cause emotional and attentiveness concerns

  • Basal ganglia

    • Intertwined with our cerebral cortex, thalamus, and brainstem

    • A deficiency here can cause a “short-circuit” within the inter-brain’s information and communication

      • This deficiency is responsible for inattention and impulsivity

  • Reticular activating system

    • This acts as a relay system for the various pathways that enter and leave the brain

    • Deficiencies within this system are responsible for inattention, impulsivity, and hyperactivity

 

 

Treatment

​

• There are few options in the treatment of ADHD

​

• Medications

  • Stimulants

    • These are medications that include methylphenidate or amphetamine

      • Vyvanse

      • Adderall

      • Ritalin

    • Stimulants boost and balance neurotransmitters, improving ADHD symptoms

    • Abuse of some stimulants can lead to addiction

  • Non-stimulants

    • Do NOT include methylphenidate or amphetamine

      • Atomoxetine

      • Qelbree

      • Some antidepressants like Bupropion can be used in the treatment of ADHD

    • Atomoxetine and some antidepressants relieve symptoms by balancing neurotransmitters

    • Non-stimulants do not pose the same risk of abuse or addiction as stimulants

​

• Psychological counseling

  • Cognitive behavioral therapy (CBT) is a common therapy option in ADHD

    • Structured counseling that assists in managing negative thinking and behavioral patterns

    • Addresses life challenges

    • Develop coping tools

  • Psychotherapy can help individuals with ADHD:

    • Improve time management and organizational skills

    • Learn how to reduce impulsivity

    • Develop problem-solving skills

    • Cope with past work, social, or academic failures

    • Improve self-esteem

    • Learn ways to improve relationships

    • Develop strategies to cope with anger and emotional outbursts

​

​

Personal Story: Born This Way: Personal Story of Life with ADHD

​

Curry was diagnosed with ADHD in 1978, when he was in seventh grade. He was prescribed Ritalin, but, after a year, his parents and doctors agreed to discontinue the medication. That was good news for Curry: He discovered that he could be successful without treating his ADHD.

After finishing school, Curry worked in automotive stores, increasing sales and profits at each one, before starting an auto repair shop. One shop led to 10, making him the owner of one of the largest independent auto-repair chains in the Washington, D.C., area. Wanting to share his experiences and success, Curry wrote the book The A.D.D. Entrepreneur, and works with other business owners to help them grow their businesses.

​

“ADHD is my superpower,” Curry says. “I’m successful because of it, not in spite of it.” There are strategies he uses in his everyday life to help him harness his creativity and energy. When a million ideas run through his mind, he captures them on a whiteboard and narrows them down to “three things I need to do.” He breaks down each of the three things into the vision, the game plan, and the message — what he wants to do, how he will do it, and why.

When his mind speeds like a race car, he slows himself down by taking a walk, going for a drive, or retreating into his office and meditating. There are times when brainstorming with others helps Curry sort out ideas and plans, and there are other times when quiet thinking is most productive.

Curry’s advice to others diagnosed with ADHD is to embrace it. “Put yourself in situations where you are going to be successful,” he says. “People with ADHD are good at sales. You might be good at social work or other jobs where you are helping people. Use your strengths to find your own path in life.”

​

Retrieved from: https://www.additudemag.com/adhd-personal-stories-real-life-people-living-with-adhd/#:~:text=Matt%20Curry&text=Matt%20Curry%20was%20diagnosed%20with,successful%20without%20treating%20his%20ADHD.

 

 

Resources to help manage ADHD symptoms:

​

• Professional Rehabilitation Consultants

  • 651-603-8774

  • https://www.PRCMN.com

• ADHD Re-Wired

  • https://www.adhdrewired.com/arc/  

 

​

​

Crisis Resources:

​

• NAMI HelpLine

  • 800-950-NAMI (6264)

  • info@nami.org

• NAMI Crisis Text Line

  • Text NAMI to 741-741

• COPE (Hennepin County)

  • Adult: 612-596-1223

  • Child: 612-348-2233

• Ramsey County

  • Adult: 651-266-7900

  • Child: 651-266-7878

• Text Connect (Crisis counseling via text)

  • Text “HOME” to 741741

• Suicide & Crisis Lifeline

  • Chat online at 988lifeline.org

  • Call OR text 988

 

​

​

References

 

Brown, D. (2022). Why ADHD is different for people of color. ADDitiude Magazine.

https://www.additudemag.com/health-disparities-people-of-color-untreated-adhd/

​

Dodson, W. (2022). What is ADHD? Attention deficit hyperactivity disorder in children and adults.

 

ADDitude Magazine. https://www.additudemag.com/what-is-adhd-symptoms-causes-treatments/

 

Hagan, S. (n.d.). The difference between child and adult attention-deficit/ hyperactivity disorder. The Psychology Couch. Accessed December 29, 2022, from https://sadag.org/images/pdf/MHM_Difference-between-Child-and-adult-ADHD.pdf 

 

Littman, E. (2022). Women with ADHD: No More Suffering in Silence. ADDitude Magazine.

https://www.additudemag.com/gender-differences-in-adhd-women-vs-men/

 

Mayo Clinic. (n.d.). Adult attention-deficit/hyperactivity disorder. https://www.mayoclinic.org/diseases-

conditions/adult-adhd/diagnosis-treatment/drc-20350883 

 

Orlov, M. (2022). For men with ADHD – and those who love them. ADDitude Magazine.

https://www.additudemag.com/adhd-men-relationship-anger-shame-communication/

 

Silver, L. (2022). The neuroscience of the ADHD brain. ADDitude Magazine.

https://www.additudemag.com/neuroscience-of-adhd-brain/