Understanding ADHD [with PDF Printable, OFFICIAL Rating Scales]


ADHD (attention-deficit/hyperactivity disorder) is a neurodevelopmental condition that can affect a person's ability to control and regulate their behaviour and emotions. While a vocal minority of the population may doubt the existence of ADHD, (*Can you hear my eyes rolling?) There are hundreds of scientific studies to support and expand its definition.
At this point, we know that ADHD is a neurobiologically based syndrome involving the dysregulation of neurotransmitter (brain chemical) levels in the prefrontal cortex and other brain regions. Imaging studies provide some of the most compelling evidence, comparing the brain scans of children and adults with and without ADHD, and indicate there is a difference in the activity of certain parts of the brains of people with ADHD.


Symptoms of ADHD can include increased impulsivity, hyperactivity, and inattention. People with ADHD can find it difficult to regulate their emotions, becoming easily frustrated, overwhelmed, and angry. ADHD can also severely impact executive functioning skills, I.E. the mental processes we use to understand and manage things, like scheduling, organisation, and memory.

Left untreated, ADHD can impact relationships, performance at work or school, and overall quality of life. Studies have shown that the majority of those with ADHD had difficulty in school, 30 to 50% have repeated a grade, and 25 to 36% didn't finish high school. Untreated, ADHD can also have an increased risk of self-harm, depression, anxiety, substance abuse, and suicide. With proper medical and behavioural interventions, however, people living with ADHD can learn to manage their symptoms and the least successful, happy lives. 

The faces of ADHD

The diagnostic and statistical manual of mental disorders, fifth edition, (DSM-5) – The guidelines used by doctors, psychiatrists, and certified health care practitioners – breaks ADHD down into three presentation subtypes: predominantly hyperactive-impulsive, predominantly inattentive, and predominantly combined.

ADHD, also known as ADD

The more research there is, the more we can come to understand how the symptoms of ADHD manifest in people. For that reason, the name and acronym have changed over the years to be more reflective of the new research but, as with all language, it takes some time for the new terminology to work its way into the common usage. As you continue to research ADHD, you may come across the term ADD or attention deficit disorder. This is an old classification, and today would be correctly diagnosed as ADHD, predominantly inattentive presentation. ADHD is a broader term that encompasses the spectrum of the symptoms that make up this disorder. 


A lifetime with ADHD

ADHD is not a static disorder. People with ADHD can move between the different clinical presentations as they age. Generally speaking, the pattern as follows: a child initially diagnosed with predominantly hyperactive ADHD in grade 4, may slow down over time, as they learn to control their hyperactivity and impulsivity but, as the age, they may find it more challenging to stay focused and pay attention. Their ADHD diagnosis might change to the combined presentation during the middle to late childhood, and to a predominantly inattentive presentation by the time they are adults.
Too often, ADHD is thought of as a childhood issue, but nothing could be further from the truth. Studies show that most children with ADHD don’t outgrow it as they get older and their symptoms persist into adulthood, their symptoms may change and become more or less severe, but they always have ADHD.
Adults may still have the underlying ADHD neurobiological issues but may have developed coping mechanisms or have found jobs that work with, instead of against, their symptoms.

It may be disheartening to know that there's no cure for ADHD. 
ADHD is a chronic condition that will not disappear, importantly, ADHD symptoms can, when controlled, directed, and managed effectively, can be viewed as “a gift” by some. In fact, many of the world's most excessive people are using their ADHD to make the world a better place. However, the majority will find that the symptoms do negatively impact their quality of life.


ADHD signs and symptoms

When should you suspect ADHD? If you suspect that you or your child or student of yours may have ADHD, there is many signs and symptoms to look for, all of which are related to ADHD score symptoms – inattention, hyperactivity, and impulsivity.

Signs and symptoms associated with hyperactivity/impulsivity
based on the SNAP– IV and Canadian ADHD resource alliance guidelines, (PDF PRINTABLE ATTACHED) persons who often: 
- fidget with hands or feet or squirmed in seat
- leave the seat in classroom or in other situations for remaining seated is expected
– run around or climb excessively in conditions where it is inappropriate
– having difficulty playing or engaging in leisure activities quietly
- are on the go or often act as if driven by a motor
– talk excessively
– blurt out answers before questions have been completed
– have difficulty waiting for their turn
– interact or intrude on others, such as butting into conversations or games

Signs and symptoms associated with inattention
based on the SNAP-IV and Canadian ADHD resource alliance guidelines, persons who often:
– fail to give close attention to details, or make careless mistakes in schoolwork or tasks
– have difficulty sustaining attention in tasks or play activities
– do not seem to listen when spoken to directly
– don't follow through on instructions and fails to finish schoolwork, chores, or duties
– have difficulty organising tasks and activities
– avoid it, dislike, or reluctantly engage in tasks requiring sustained mental effort
– lose things necessary for activities, such as toys, school assignments, pencils, or books, and files, documents, or keys,
- are distracted by extraneous stimuli
– are forgetful in daily activities

Other signs and symptoms indicate indicators of adult ADHD
Based on the adult ADHD rating scale a.s. RS, persons who often:
– have trouble wrapping up the final details of the project, once the challenging parts are done
– have difficulty getting things for a task that requires organisation
– have problems remembering appointments or obligations
– avoid or delay getting started with functions that need much thought
– fidget or squirm with hands or feet when required to sit time
– feel overly active and compelled to do things as if driven by a motor

If ADHD is suspected, the first step is to contact a family doctor, who should ensure a medical or health issue is not contributing to their symptoms. The family doctor may use a screening questionnaire to get the idea if ADHD is likely.  THE PDF PRINTABLE ATTACHED  They will, in turn, refer you to a psychologist, paediatrician, or psychiatrist who specialises in ADHD.
The ADHD specialist will go through a diagnostic workup or protocols to confront and reject the ADHD diagnosis. 


How common is ADHD?

The American Pediatric Association reports that 5% of children have ADHD, but the Centres for Disease state that up to 11% – around 6.4 million – of American children between four and 17 years of age have ADHD. The first symptoms of ADHD typically start between three and six years of age, and most kids are diagnosed with ADHD by age 7.
It's estimated that about 1 in 20 children have ADHD worldwide, although it is possible that some of these children have been misdiagnosed. In Canada and the United States, 5 to 6% of children are being treated for ADHD with prescribed medication. The United States has seen a 42% increase in ADHD diagnoses over the past 8 years, and the rate of ADHD diagnoses in school-aged children in Canada has almost doubled as well.
Why this increase?
Improvements in ADHD diagnostic criteria, coupled with aggressive marketing of medications to treat ADHD, are believed to have led to increased acceptance of the diagnosis and treatment of ADHD by educators and parents. However, ADHD isn't just a disorder of childhood. The ADHD symptoms experienced in children persist into adulthood and up to two-thirds of individuals. It is estimated that about 4% of adults suffer symptoms of ADHD over their lifespan, about 13% of men and 5% of women will be diagnosed with ADHD. Some fear ADHD is being underdiagnosed, while others worry it's being overdiagnosed. This is why it's so important that health professionals take particular care when making a diagnosis one way or the other.

Gender differences in ADHD
ADHD symptoms differ in boys and girls. Boys symptoms tend to be more externalised and obvious, such as negative behaviours directed towards the external environment, while girl symptoms are more internalizing and less obvious, including negative behaviours directed towards themselves. Girls with ADHD are more likely to have inattentive ADHD subtypes compared to boys and present with less destructive behaviours. Most kids with ADHD are first identified at school, but it's been reported that even when boys and girls are at equal levels of impairment, teachers are more likely to refer boys rather than girls for an assessment. It would seem the destructive behaviour boys with ADHD teachers and parents to pursue evaluation and treatment. Because of gender differences in the expression of ADHD, girls who have ADHD are less likely to receive a diagnosis and treatment. Another factor that can contribute to a missed or late diagnosis in girls is that they are more frequently have other mental health issues, such as anxiety or depression, that can muddy the diagnostic process. On a positive note, unlike males, girls have been found to be more likely to admit their ADHD symptoms and seek treatment.

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ADHD and other mental disorders
ADHD is often accompanied by other psychiatric, like a learning disability, oppositional defiant disorder, and mood and anxiety disorders.
Children must be assessed for these related disorders, as they may contribute to a lower-level of functioning.

A study found the most common co-occurring conditions with ADHD to be:
– oppositional defiance disorder (most common, appearing 41% of the time)
– minor depression (was second, with a rate of 22%)
– generalised anxiety disorder (was third, with 15% of the time)
Other conditions found in patients with ADHD
– specific learning disabilities
– oppositional defiant disorder
– conduct disorder
– anxiety, OCD, and mood disorders
– tourettes syndrome
– substance use disorder
– sleep disorders

Treatment of ADHD

As mentioned previously, there is no cure for ADHD. That doesn't mean that ADHD cannot be managed. In fact, some of the symptoms of ADHD, such as increased energy levels, creativity, and the ability to think and no non-linear way – when controlled and directed – can be used to achieve great things. It is a treatment plan to help reduce symptoms that improve how well the person with ADHD can carry out daily tasks.

Treatment plans can include stimulant and non-stimulant medications, behavioural therapies, educational interventions and, most effectively, a combination of all three approaches.
Studies have indicated that an integrated, multi-modal, treatment approach can be highly effective. Usually, people try nonmedical interventions before the medical, pharmacological ones. No two people are the same, and medication that works successfully for one person with ADHD may have little or no effect on another. Also, your doctor will be able to monitor and regulate the dosage for the best outcome.

Medical intervention
Medical intervention can help children and adults with ADHD reduce the severity of their symptoms, including the constant on the go hyperactivity and knee-jerk reactions that go along with impulsivity. Medications can create a shared mental space that allows a person to focus, learn, and work. They can help regulate the behaviour issues that lead to trouble interacting with people at home, school, work, and the community.
Psychopharmacological treatments have also been shown to improve executive functions. Executive functions as an umbrella term for those mental processes that let us manage, control, and regulate things like memory, reasoning, mental agility, and problem-solving. Mainly these are the abilities that allowed us to analyse, plan, and execute tasks at home, work, and school.

Psychotherapy and educational interventions for ADHD
Psychotherapy and educational interventions are the only evidence-based nonmedical treatments for ADHD.  They deal with the challenges caused by the symptoms of ADHD, such as bad grades, poor performance, and inability to deal with authority figures, difficulty making and keeping friends, and a tendency to take risks. Psychosocial treatments help people with ADHD develop and refine techniques that support the skills they need to succeed.

Integrated intervention
Studies have shown that the efficiency of an integrated approach to ADHD therapy – a combined medical, behavioural, and educational approach. Significant research for United States National Institute for mental health reported that children with ADHD who received either medical or behavioural therapy improved over a 14 month period, while children who received a combination of medical and behavioural interventions showed much more improvement during that same period.

Alternative interventions
A large percentage of those diagnosed with ADHD turn to alternative therapies to treat and manage their symptoms. Alternative treatments typically don't have a solid base of scientific evidence to prove it very useful.
Alternative therapies may include:
dietary changes such as  
– omega-3 fatty acids
– supplements and herbal treatments
– decreasing intake of sugars and chemicals such as food additives, dyes, pesticides, and preservatives
– being alert for food sensitivities, such as gluten
– EEG biofeedback
– meditation and mindfulness therapies

While there hasn't been a substantial amount of scientific testing to date, a recent analysis of assisting studies have shown that some evidence to support the concept that decreasing artificial dyes and adding omega-3 fatty acids to a diet, may be helpful as a part of a program in treating ADHD. There is no increasing evidence that meditation and mindfulness therapies may also be beneficial.