About Attention Deficit Hyperactivity Disorder (ADHD)
Attention-deficit/hyperactivity disorder (ADHD) is a disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development
Inattention
means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.
Impulsivity
means a person makes hasty actions that occur in the moment without first thinking about them and that may have a high potential for harm, or a desire for immediate rewards or inability to delay gratification.
An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.
Hyperactivity
means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks.
In adults, it may be extreme restlessness or wearing others out with constant activity. It can also relate to racing thoughts and inner feelings of hyperactivity and associated restlessness.
Signs and Symptoms of ADHD
Inattention and hyperactivity/impulsivity are the key behaviours of ADHD. Some people with ADHD only have problems with one of the behaviours, while others have both inattention and hyperactivity-impulsivity, which is referred to as combined ADHD
It is normal to have some inattention, unfocused motor activity, and impulsivity, but for people with ADHD, these behaviours:
- are more severe
- occur more often
- interfere with or reduce the quality of how they function socially, at school, or in a job
Inattention
People with symptoms of inattention may often:
- Overlook or miss details, make mistakes in schoolwork, at work, or during other activities
- Have problems sustaining attention in tasks, including conversations, lectures, or lengthy reading
- Not seem to listen when spoken to directly
- Not follow through on instructions and fail to finish schoolwork, chores, or duties in the workplace or start tasks but quickly lose focus and get easily sidetracked
- Have problems organizing tasks and activities, such as what to do in sequence, keeping materials and belongings in order, having messy work and poor time management, and failing to meet deadlines
- Avoid or dislike tasks that require sustained mental effort, such as preparing reports, completing forms, or reviewing lengthy papers
- Lose things necessary for tasks or activities, such as books, tools, wallets, keys, paperwork, eyeglasses, and mobile phones
- Be easily distracted by unrelated thoughts or stimuli
- Be forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments
Hyperactivity-Impulsivity
People with symptoms of hyperactivity-impulsivity may often:
- Fidget and squirm in their seats
- Leave their seats in situations when staying seated is expected, such as in the classroom or the office
- Run or dash around or climb in situations where it is inappropriate or, in teens and adults, often feel restless
- Be unable to engage in hobbies quietly
- Be constantly in motion or “on the go,” or act as if “driven by a motor”
- Talk nonstop
- Blurt out an answer before a question has been completed, finish other people’s sentences, or speak without waiting for a turn in a conversation
- Have trouble waiting for his or her turn
- Interrupt or intrude on others, for example in conversations, games, or activities
Risk factors
Researchers are not sure what causes ADHD. Like many other conditions, several factors can contribute to ADHD, such as:
- Genes
- Cigarette smoking, alcohol use, or drug use during pregnancy
- Exposure to environmental toxins during pregnancy
- Exposure to environmental toxins, such as high levels of lead, at a young age
- Low birth weight
- Brain injuries
ADHD is more common in males than females, and females with ADHD are more likely to have problems primarily with inattention. Other conditions, such as learning disabilities, anxiety disorder, conduct disorder, depression, and substance abuse, are more common in people with ADHD.
Diagnosis of ADHD
Diagnosis of ADHD requires a comprehensive evaluation by an appropriately skilled clinician, such as a psychologist, or psychiatrist with expertise in ADHD.
For a person to receive a diagnosis of ADHD, the symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting and impair the person’s functioning. The doctor will also ensure that any ADHD symptoms are not due to another medical or psychiatric condition. For an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present before age 12.
ADHD symptoms can appear as early as between the ages of 3 and 6 and can continue through adolescence and adulthood.
Symptoms of ADHD can be mistaken for emotional or disciplinary problems or missed entirely in quiet, well-behaved children, leading to a delay in diagnosis. Adults with undiagnosed ADHD may have a history of poor academic performance, problems at work, or difficult or failed relationships.
ADHD symptoms can change over time as a person ages.
In young children with ADHD, hyperactivity-impulsivity is the most predominant symptom. As a child reaches high school, the symptom of inattention may become more prominent and cause the child to struggle academically. In adolescence, hyperactivity seems to lessen and may show more often as feelings of restlessness or fidgeting, but inattention and impulsivity may remain. Many people with ADHD also struggle with relationships and antisocial behaviours. Inattention, restlessness, and impulsivity tend to persist into adulthood.
ADHD Treatment and Therapies
While there is no cure for ADHD, currently available treatments can help reduce symptoms and improve functioning.
Treatments include medication, psychotherapy, education or training, or a combination of treatments.
Medication
For many people, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medication also may improve physical coordination. Sometimes several different medications or dosages must be tried before finding the right one that works for a particular person. Anyone taking medications must be monitored closely and carefully by their prescribing doctor.
Stimulants
The most common type of medication used for treating ADHD is called a “stimulant.” Although it may seem unusual to treat ADHD with a medication that is considered a stimulant, it works by increasing the brain chemicals dopamine and norepinephrine, which play essential roles in thinking and attention.
Under medical supervision, stimulant medications are considered safe. However, there are risks and side effects, especially when misused or taken in excess of the prescribed dose. For example, stimulants can raise blood pressure and heart rate and increase anxiety. Therefore, a person with other health problems, including high blood pressure, seizures, heart disease, glaucoma, liver or kidney disease, or an anxiety disorder should tell their doctor before taking a stimulant.
Talk with a doctor if you see any of these or other side effects while taking stimulants:
- decreased appetite
- sleep problems
- tics (sudden, repetitive movements or sounds)
- personality changes
- increased anxiety and irritability
- stomach-aches
- headaches
Non-stimulants
A few other ADHD medications are non-stimulants. These medications take longer to start working than stimulants, but can also improve focus, attention, and impulsivity in a person with ADHD. Doctors may prescribe a non-stimulant: when a person has bothersome side effects from stimulants; when a stimulant was not effective; or in combination with a stimulant to increase effectiveness.
Antidepressants may help with the symptoms of ADHD and can be prescribed if a patient has bothersome side effects from stimulants. Antidepressants can be helpful in combination with stimulants if a patient also has another condition, such as an anxiety disorder, depression, or another mood disorder.
Doctors and patients can work together to find the best medication, dose, or medication combination. This is referred to as titration.
Psychotherapy and Psychosocial Interventions
Several specific psychosocial interventions have been shown to help patients and their families manage symptoms and improve everyday functioning.
In addition, children and adults with ADHD need guidance and understanding from their parents, families, colleagues and teachers to reach their full potential and to succeed.
For some frustration, blame, and anger may have built up within a family before a person is diagnosed. Families or individuals may need specialized help to overcome negative feelings. Mental health professionals can educate people about ADHD and how it affects a family. They also will help people develop new skills, attitudes, and ways of relating to each other.
Behavioural therapy
Behavioural therapy is a type of psychotherapy that aims to help a person change his or her behaviour. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events.
Behavioural therapy also teaches a person how to:
- monitor his or her own behaviour
- give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting
Depending on the age of the patient, parents, teachers, or family members also can give positive or negative feedback for certain behaviours and help establish clear rules, chore lists, and other structured routines to help a person control his or her behaviour.
Therapists may also teach social skills, such as how to wait turn, sharing, asking for help, or responding to teasing. Learning to read facial expressions and the tone of voice in others, and how to respond appropriately can also be part of social skills training.
Cognitive behavioural therapy
Cognitive behavioural therapy can also teach a person mindfulness techniques, or meditation. A person learns how to be aware and accepting of one’s own thoughts and feelings to improve focus and concentration.
The therapist also encourages the person with ADHD to adjust to the life changes that come with treatment, such as thinking before acting, or resisting the urge to take unnecessary risks.
Family and marital therapy
Family and marital therapycan help family members and spouses find better ways to handle disruptive behaviours, to encourage behaviour changes, and improve interactions with the patient.
Support groups
Support groups can help people connect with others who have similar challenges and concerns. Groups often meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts…
Skylight Psychiatry’s ADHD Diagnostic Process
We provide more details within our registration pack for all patients who are completing an ADHD assessment.
Below is a summary of the ADHD diagnostic pathway.
Step 1 We gather information about you
ADHD assessments are detailed, so we collect information in different ways to understand your experiences and needs. Please tell us if there is anything that would make the assessment easier for you. We will do our best to make reasonable adjustments.
Step 2 We follow national guidance
Your assessment follows NICE guidance and is carried out in line with recognised national standards.
Step 3 You complete questionnaires and meet with a clinician
We gather information through questionnaires and a clinical assessment. This may include talking about your mental health, past history, physical health, social life, and day-to-day experiences (usually 1 appointment completed virtually)
Step 4 We use recognised ADHD assessment tools
As part of the assessment, we use recognised diagnostic tools recommended in NICE guidance to support a thorough and accurate outcome.
Step 5 Experienced assessors review your information and provide you with an outcome
Your assessment is completed by a skilled and experienced clinician who regularly carries out ADHD diagnostic assessments. They will provide a diagnostic outcome at the end of your assessment in most cases. At times they may feel more information or further discussion is required within the clinical team. If this is the case, they will explain this to you. You will be contacted by email to confirm your diagnostic outcome once your assessment has been reviewed by a multi-disciplinary team.
Step 6 You receive your reports
In the weeks following your assessment you will receive a full report explaining the information gathered and how the diagnostic outcome was reached. We also provide a shorter version that will be shared with your referring GP and that you can choose to share with others.
Step 7 You access the post diagnostic support hub at your own time and pace.
A link will be sent to you, please keep this safe so you can access the resource and support hub at any time.
Step 8 We discuss treatment and next steps
Where appropriate, we can discuss treatment options, including medication. We may also work with your GP on shared care arrangements after treatment.