Despite the fact that ADHD has been well-documented in the medical literature for many decades, it still seems to be one of the areas in educational psychology that is not always well-understood by parents, educators, and others who may be impacted by the disorder. I’d like to take this opportunity to provide information from reliable, efficacy-based sources which may help demystify what ADHD is, and what it is not.
First of all, does ADHD exist?
There is well-documented evidence which supports the existence of ADHD through genetic and imaging studies, as well as clinical treatment trials and follow-up studies. Despite this, skepticism about ADHD, in both childhood and adulthood, is still evident. I think it is important to trust the source of information you read about ADHD, and to be a critical consumer of information. Interestingly, through various longitudinal studies, there is evidence that suggests that approximately two-thirds of children diagnosed with ADHD continue to have significant impairment into adulthood.
So if ADHD does exist, what is it?
According to the Diagnostic and Statistical Manual, 5th Edition (DSM-V), there are three core symptoms of ADHD:
- the inability to regulate attention (or inattentiveness);
- the inability to regulate activity (or hyperactivity); and
- difficulty with inhibitory behavior (or impulsivity).
In addition, difficulty with “emotional regulation”, or managing emotions on a day to day basis, is often problematic. What is important to note here, is that while many children, teens or adults may exhibit these symptoms, it is the degree of functional impairment in many different domains of an individual’s life (e.g., school, family life, community), that results in a diagnosis.
For parents, I like to have them complete the WEISS Functional Impairment form (Parent version).
For adults who suspect they may have ADHD, I ask them typically to complete the WEISS Functional Impairment form (Self-Report).
When making a diagnosis, it is very important to have input about an individual’s behavior and functioning from many different sources including family members, teachers/coaches/instructors, friends, or colleagues. As part of the comprehensive diagnostic process, I use a variety of information-gathering tools and screeners, as well as clinical observation when determining if an individual meets diagnostic criteria (or not) for ADHD.
There are three different presentations of ADHD based upon clustering of the three core symptoms of inattentiveness, hyperactivity and/or impulsivity (the least common). Children, teens and adults who only have hyperactive and impulsive symptoms are diagnosed as ADHD, predominantly hyperactive-impulsive presentation. Those individuals who display only significant impairment in inattention are referred to as ADHD, predominantly inattentive presentation, and those who display all three symptom clusters are referred to as, combined presentation – inattentive and hyperactive-impulsive (the most common).
A comprehensive checklist for current and/or retrospective symptoms of ADHD is provided by The Canadian ADHD Resource Alliance (CADDRA) here.
For parents who suspect their child may have ADHD, and are wondering what’s involved in a thorough assessment, a great resource to check out can be found at the CADDRA site here.
What is the origin of ADHD?
Understanding the etiology of ADHD is very important. It is considered to be a “neuro-biological disorder” that is often due to genetic or biological factors. In fact, according to CADDAC:
“Family, twin and adoption studies have found that heredity is the most common cause of ADHD. Medical research has shown that some dopamine genes have been found to be associated with ADHD. If a child has ADHD there is five times more likelihood that another family member will also have the disorder. While ADHD symptoms may be caused by injury to the brain, or exposure to alcohol, nicotine or lead in the developing brain, this is not the cause in the vast majority of children with ADHD.”
Reference: What is Attention Deficit Hyperactivity Disorder?
How often does ADHD occur?
ADHD is definitely not a new disorder. After reviewing the literature, it seems that the rate of incidence varies depending upon the source cited. According to CADDAC:
“ADHD is the most common mental health disorder of childhood. Studies throughout the world have reported the occurrence of ADHD in school age children as being between 5% and 12%. This means that on average there are at least one to three children in every class with ADHD. More boys than girls are diagnosed at a rate of 3 to 1. However, since girls are less likely to display outward hyperactivity and impulsivity, and as many women as men are diagnosed in adulthood, we know that we miss diagnosing many girls with ADHD in childhood. Females with ADHD are equally impaired in the areas of attention and social and academic problems as males. Eighty percent of adolescents who were diagnosed as children continue to meet the criteria for diagnosis, and of those children, over sixty percent report continued impairing symptoms into adulthood…….It has been described in literature and medically documented for more than two centuries. ADHD is a chronic condition that can present at all levels of severity and rarely occurs by itself.”
Other conditions, such as learning disabilities or mood disorders, may also co-occur with ADHD – please refer to section of website on Learning Disabilities and/or Mood Disorders.