What Is ADHD?
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and/or impulsivity that interfere with daily life and development. These symptoms are typically present from childhood but can continue into adulthood.
There are also a number of myths around ADHD. Let's bust them.
What Are The Myths?
ADHD Is Not Real
ADHD has been in psychiatric manuals for over 50 years now.
Dr George Still was a paediatrician in the early 20th century. He had cases in his clinic that would now likely meet criteria for a diagnosis.
Brain imaging studies have often found a marked difference in the brains of people with ADHD.
It is strongly heritable which supports the idea it is genetic.
People With ADHD Are Lazy
ADHD affects the brain's executive functions, making it difficult to regulate attention, focus, and impulsivity.
Individuals with ADHD may try hard to focus but struggle due to these underlying challenges.
Only Children Have ADHD
While ADHD is often diagnosed in childhood, it can persist into adulthood.
Many adults with ADHD were either not diagnosed as children or experienced their symptoms differently.
Everybody Has ADHD These Days
Demand for ADHD clinics has gone through the roof in recent years.
Despite this, the best available evidence indicates that, in the UK and globally, ADHD is still massively underdiagnosed in both adults and children.
If everybody who met the criteria for an ADHD assessment were seen this year, it would cost more than the NHS's annual budget. The UK has a supply problem for ADHD treatment, not a demand problem.
People With ADHD Can't Be Successful
Many individuals with ADHD have successful careers and fulfilling lives. Olympic gymnast Simone Biles, actress Emma Watson, entrepreneur Richard Brandson, singers Nelly Furtado and Justin Timberlake are just a few examples.
While ADHD presents challenges, with appropriate support and strategies, individuals can thrive.
How is ADHD Diagnosed?
A medical doctor usually diagnoses ADHD. Research on incidence suggests most around 2.4 million people in the UK likely meet the criteria for diagnosis, according to ADHD UK. Available data suggests that ADHD is very under-diagnosed in women and girls. To reach diagnosis in children, they are assessed again inattention and hyperactivity criteria used parental interviews, standardised questionnaires (Conner's 3/4), computerised testing (QbTest) and clinical observations made by assessors. To reach a diagnosis, at least one of the following has to be proved:
Six inattentive symptoms (ADHD Inattentive Presentation)
Six hyperactive symptoms (ADHD Hyperactive Presentation)
Where a child has six of both, they have ADHD Combined Presentation, which is the most common type. For adults, they only need five rather than six symptoms as well as evidence they have similar difficulties in childhood.
Who Assesses For ADHD?
An ADHD assessment might be carried out by one or a number of the below as part of a Multi-Disciplinary Team (MDT):
One of the following Doctors:
Consultant Community Paediatrician
Consultant (Child and Adolescent) Psychiatrist.
An Associate Specialist / Specialty Doctor (a grade below a Consultant).
Clinical Psychologist or Practitioner Psychologist (non-medical doctors).
A Nurse Specialist in ADHD, Psychiatry, Mental Health or an Assistant Psychologist.
A Specialist Health Visitor or a Nursery Nurse for clinical observations.
A Clinical Support Assistant (QbTest or similar).
It is best practice for a child to be assessed by multiple professionals, but where this is more straightforward this doesn't always happen. Even when your children isn't assessed by multiple professionals, they will discuss your child in an MDT meeting to consider multiple expert perspectives.
Every area in England has a commissioned ADHD assessment service of some kind for under-18s provided by an NHS Trust or a community provider. Their waits are often long and so sometimes adults might choose to use NHS Right To Choose.
How Does ADHD Develop?
The exact cause of ADHD is not fully understood, but research suggests that it's a complex interplay of various factors:
Genetics: ADHD often runs in families, suggesting a strong genetic component. However, it's not a single gene but likely multiple genes that contribute to the development of ADHD.
Brain Structure and Function: Brain imaging studies have shown differences in the structure and function of certain brain regions in individuals with ADHD compared to those without. These differences may affect attention, impulse control, and executive functions.
Neurotransmitters: Imbalances in neurotransmitters, particularly dopamine and norepinephrine, which play crucial roles in attention and impulse control, are thought to contribute to ADHD.
How Is ADHD Managed?
Medication: Stimulant medications like methylphenidate (Concerta XL) or amphetamines (Elvanse) are often prescribed to improve focus and reduce impulsivity and hyperactivity. Non-stimulant medications (Strattera/Intuniv) may be used if stimulants are not suitable.
Parent Training and Education: In childhood, this helps parents understand ADHD and learn strategies to manage their child's behaviour at home.
Reasonable Adjustments: These can include extra time on tests, preferential seating, and other modifications to help children with ADHD succeed academically. For adults, this might mean working from home, being sat in a quiet part of the office or adaptive software depending on their role.
Cognitive-behavioral therapy (CBT): This can help adolescents and adults learn strategies to cope with distractions, improve time management, and address emotional difficulties.
Support Groups: Connecting with other adults with ADHD can provide valuable support and coping mechanisms. Similarly, as a parent of a child with ADHD, support groups are an invaluable way to 'build a village'; and learn from other parents.
Lifestyle Changes: Healthy habits like regular exercise, a balanced diet, and good sleep hygiene can help manage ADHD symptoms.
Advice for Adults Who Care for Young People with ADHD
Remember, your child can't control their ADHD. Especially at a younger age, a lot of the skills they would be developing at this point are slightly behind. They're not trying to annoy you. They need more guidance, and you will need new skills. Here are some tips for supporting your child:
Don't Punish Hyperactivity and Inattention: Your child can't help it. Find and negotiate ways of staying on task, including rewards, use of techniques such as the Pomodoro Technique and breaking work down into chunks.
Visual Timers and Planners: Both at home and school. Use these to help keep your ADHD child on task when it comes to getting ready, their self-care, and reducing their time-blindness.
Inform Teachers: Let them know about the ADHD so they can make changes within the classroom, as above. The school can also decide if they need to provide additional support above and beyond.
Advice for Young People with ADHD
Remember, you have ADHD. That's just a fact. That doesn't mean you're helpless, but it does mean that you will find some things harder, and that's okay. While there is no cure for ADHD, many management options can help. These may include:
Psychoeducation: Learning about ADHD, and understanding what is happening inside your brain can help reduce anxiety and stress when you release that what you thought were character flaws are biological differences. You may want to read this booklet from ADHD Foundation - The Neurodiversity Charity.
Coaching: An ADHD Coach can help you set targets, find strategies and techniques to use with managing your ADHD, and shift your mindset entirely on ADHD.
Medication: As part of the multimodal management of ADHD, medication is recommended as part of a comprehrensive management plan.
Relaxation Techniques: Practicing relaxation techniques like deep breathing and meditation can help manage stress and reduce hyperactivity and inattention. Being mindful of when your stress increases can make you mindful of how to avoid it, and reduce your ADHD symptoms.