The Diagnosis and Treatment of ADHD
Attention/Deficit-Hyperactivity Disorder, often referred to as ADHD, is often discussed in the context of children and academic functioning. However, this diagnosis is often misunderstood and stigmatized in our society. Too often, I have my adult patients tell me that they were labeled as “stupid” or “lazy” as the result of undiagnosed and untreated ADHD symptoms throughout their childhood and adolescence. Recently, social media content creators have become more vocal in discussing their own symptoms of ADHD and their impact on day-to-day functioning. This has resulted in an influx of individuals seeking evaluation, diagnosis, and treatment of ADHD symptoms. Oftentimes, this has also resulted in self-diagnosis without seeking professional support.
According to the National Resource Center on ADHD (2023), ADHD was first documented in 1902. ADHD affects approximately 11% of school-aged children (National Resource Center on ADHD, 2023). Furthermore, approximately 75% of these children will continue to experience symptoms as adults (National Resource Center on ADHD, 2023). Levrini (2023) notes that approximately 2.8% of adults worldwide are diagnosed with ADHD. It is also notable that boys/men are more likely to be diagnosed girls/women as boys are more likely to present with impulsivity and behavior difficulties (Fairbank, 2023).
In the past, ADHD was often known and diagnosed as Attention Deficit Disorder (ADD). However, the current DSM-IV lists only ADHD and provides the option for 3 separate subtypes:
- Predominantly Inattentive Presentation
- Predominantly Hyperactive/Impulsive Presentation
- Combined Presentation
Symptoms and Diagnosis
The symptoms of ADHD can be broad in nature. However, there are specific symptoms and themes that clinicians look for when making this diagnosis. Symptoms need to begin in childhood (before the age of 12), even if you are an adult being diagnosed for the first time. Oftentimes, individuals present with increased motor activity, impulsivity, poor attention span, failure to pay close attention to details, difficulty following through or completing tasks, forgetfulness, distractibility, poor organizational skills, fidgeting/restlessness, excessive talking, frequent interruption in conversations, and low frustration tolerance (National Resource Center on ADHD, 2023). It is also common to experience difficulties regulating emotion, chronic frustration, guilt/shame, and difficulties within relationships (Levrini, 2023).
Levrini (2023) notes that individuals with ADHD experience deficits in executive functioning (i.e. the part of our brain responsible for task completion, organization, etc.). Specifically, deficits in one’s inhibition or ability to control motor, verbal, cognitive, and emotional activities by suppressing impulses (Levrini, 2023). Additionally, deficits in metacognition (i.e. working memory, problem-solving, and emotional regulation) are often observed in individuals diagnosed with ADHD (Levrini, 2023).
The American Psychological Association (2019) states that ADHD is commonly missed in childhood, meaning that many adults don’t realize that they have ADHD. Further, the lack of a diagnosis in childhood does not mean that adults cannot be diagnosed with ADHD. In terms of diagnosis, Fairbank (2023) states that test scores, especially on their own, are not the best indicator of the presence of ADHD symptoms. Rather, a thorough clinical interview investigating the individual’s social, emotional, and academic history is required for an accurate diagnosis. Additionally, it is vitally important to note that a collection of symptoms is required for a diagnosis of ADHD. Experiencing 1-2 symptoms of ADHD is likely normal whereas experiencing 6 or more symptoms likely indicates a diagnosis (Fairbank, 2023).
Accurate diagnosis of ADHD is incredibly important as the lack of early treatment often leads to the development of other mood disorders, such as anxiety and depression (Fairbank, 2023). Furthermore, the lack of adequate treatment of ADHD symptoms often renders the treatment of other diagnoses ineffective. In my personal practice, I have often found that anxiety and depressive symptoms reduce significantly once ADHD is accurately diagnosed and adequately treated.
Late diagnosis of ADHD often results in mixed emotions for patients. On the one hand, it is often a relief for individuals to finally have an understanding of their symptoms and the fact that they could have done little to independently control their symptoms. Conversely, it is not uncommon for patients to experience a sense of grief regarding the losses they have experienced over their lifetime as a result of untreated symptoms (Fairbank, 2023).
More often than not, stimulant medication is offered as the first line of treatment for ADHD. However, given the ongoing Adderall nationwide shortage, it is often difficult for individuals to fill their prescriptions. Further, there are many who would prefer to avoid the use of stimulant medication if at all possible.
Individuals often experience the best results when combining stimulant medication with behavioral interventions. However, it is possible to reduce symptoms with the use of behavioral interventions alone. When working with my own patients, I often recommend implementing the use of times, checklists, and structured routines (i.e. always putting your keys in a basket by the door, putting medications by your toothbrush, etc.) to assist in reducing the impact of symptoms on day-to-day functioning. Additionally, seeing a therapist can help individuals to identify their symptoms and develop strategies to manage these symptoms independently.
Additionally, it is often helpful to seek accommodations in academic and employment settings. ADHD is viewed as a disability under ADA-this means that schools and employers are required to provide reasonable accommodations. For the school setting, this can include extra time for tests and assignments, testing in a quiet room, increased breaks, and allowances to move around the classroom. Older students often benefit from audio-recording lectures to review at a later time. In the workplace, these accommodations can include a private office, a standing desk, allowing employees to wear headphones and listen to music, and increased time to complete projects.
Regardless of chosen treatment path, it is vitally important to pursue adequate treatment of ADHD. Fairbank (2023) noted that individuals who had been accurately diagnosed with ADHD and received treatment endorsed experiencing increased self-esteem, functional performance, and quality of life. Conversely, untreated ADHD is often associated with poor performance at work/school, legal problems, alcohol and drug problems, poor physical and mental health, unstable relationships, unemployment, financial instability, and frequent automobile and other accidents.
ADHD is a complex and nuanced diagnosis. It has long been heavily stigmatized. In fact, many people were called “lazy” or “dumb” in their childhood as a result of ADHD and associated symptoms. Recently, social media platforms have increased awareness and understanding of the diagnosis and its impact on individuals’ functioning. However, this increased awareness has also resulted in increased self-diagnoses and misdiagnoses. It is vitally important for individuals who suspect that they may have ADHD to seek out evaluation and treatment from psychologists who are well-trained in this area of psychology. Importantly, with proper diagnosis and treatment, the prognosis for those with ADHD is optimistic.
About the Author
Dr. Montes is a licensed clinical psychologist and co-owner of Cognitive Behavior Therapy Center in Chesapeake, VA.
Elmaghraby, R., & Garayalde, S. (Eds.). (2022, June). What is ADHD?. Psychiatry.org - What is ADHD? https://www.psychiatry.org/patients-families/adhd/what-is-adhd
Fairbank, R. (2023, March 1). An ADHD diagnosis in adulthood comes with challenges and benefits. Monitor on Psychology. https://www.apa.org/monitor/2023/03/adult-adhd-diagnosis
Levrini, A. (2023). Succeeding with adult ADHD: Daily strategies to help you achieve your goals and manage your life. American Psychological Association.
Mayo Foundation for Medical Education and Research. (2023, January 25). Adult attention-deficit/hyperactivity disorder (ADHD). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/adult-adhd/symptoms-causes/syc-20350878
National Resource Center on ADHD. (2019, June 13). About ADHD - symptoms, causes and treatment. CHADD. https://chadd.org/about-adhd/overview/