Attention-deficit hyperactivity disorder (ADHD) is characterized by symptoms of impulsivity, emotional outbursts, hyperactivity, inattention, loss of focus, forgetfulness, and disorganization. These symptoms may be present all at once or may only appear occasionally, depending on the situation.
The diagnosis of ADHD has become increasingly controversial because it is commonly diagnosed in children, with greater frequency than in years past, and stimulant medications are often prescribed to control symptoms. However, the condition is real, and it affects both children and adults. It can become serious if left untreated, and while medication can be helpful, especially on a short-term basis, therapy is often effective at treating ADHD, particularly when used in conjunction with short-term medication. Those who believe they or someone in their family is experiencing symptoms of ADHD might find it helpful to speak to a therapist.
Controversy Over ADHD Diagnosis
Diagnoses of ADHD, in adults as well as children, have increased dramatically in the past years and received a great deal of public attention. In particular, the medications commonly used to treat ADHD-like behaviors are prescribed so frequently that at least one or two students will be taking such a medication in nearly every classroom in America. Add to this the ambiguous nature of the behaviors listed as symptoms for an ADHD diagnosis, and it is understandable ADHD and the associated treatments may be quite controversial.
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How do we know if the difficulties faced by some are the result of a mental condition or just normal reactions to difficulty following a strict routine? Society generally expects regimentation and routine, especially in a public school or a workplace; for some people, this expectation may be irritating but manageable, and for others it may feel natural. There are those, though, who might find it virtually impossible to follow strict routines, focus on tasks that are not entirely enjoyable or stimulating, or avoid giving in to impulses that might seem more natural, such as running, playing, talking when one feels like talking, and allowing one’s attention to go where it goes.
Common questions people facing an ADHD diagnosis for themselves or their children might ask include:
- Is my child’s hyperactivity really a problem, or is the hyperactivity simply due to youthful energy?
- Is medication necessary to help my child behave in the classroom, or might relaxation skills, a smaller classroom, or a change in diet to accomplish the same thing?
- Does my child really have ADHD, or have the symptoms developed as a result of boredom with a classroom curriculum that is not challenging enough?
- How do I know if my trouble focusing is a big enough problem to warrant treatment?
Causes and Symptoms of ADHD
ADHD runs in families and is therefore likely to be at least partially genetic. However, the condition also has an environmental component. Research evaluating the theories that sugar and food additives cause ADHD has shown neither to be a likely cause of the condition, but studies have shown cigarette smoking and alcohol use in pregnancymay contribute to the risk of a child developing ADHD. Lead exposure in young children can also influence the development of the condition. Some theorists have argued ADHD is a product of an increasingly stressful society and that the academic demands children must meet can result in hyper, distracted behavior.
There are three subtypes of ADHD:
- Predominantly inattentive presentation. This subtype indicates more inattention and less hyperactivity. Children may sit quietly in class and appear to be working because they do not act out or have trouble getting along with others. Symptoms, which mostly come from the inattention category, may be overlooked. Few symptoms of hyperactivity-impulsivity may be present.
- Predominantly hyperactive-impulsive. Most symptoms come from the hyperactivity-impulsivity category. Inattention may still be present, but not to such an extent as hyperactivity-impulsivity.
- Combined hyperactive-impulsive and inattentive. Six or more symptoms are present from each category (inattention and hyperactivity-impulsivity). This subtype is the most common.
Those with ADHD may have/exhibit:
- Trouble listening.
- Difficulty sitting still for long periods of time.
- A tendency to be easily distracted.
- Extremely hyper behavior.
- A tendency to make careless mistakes.
- A tendency to procrastinate.
- Difficulty establishing healthy study skills or work habits.
- Trouble with time management.
- A tendency to become easily bored and a need for constant stimulation.
Though these issues may be experienced by anyone, ADHD can make these difficulties more severe. Most people can concentrate on tasks that challenge them by resolving to do so, but people with ADHD often truly cannot concentrate.
ADD and ADHD
Attention-deficit disorder (ADD) and ADHD describe the same condition, although for a brief time they were classified separately. The term ADD is no longer in general use by medical professionals, and the diagnostic criteria for ADHD in the Diagnostic and Statistical Manual were revised in 2013 to include three subtypes of the condition where previously only two were included. Predominantly inattentive presentation of the condition generally describes what was once thought of as ADD.
Distinguishing High Energy from ADHD
One way to distinguish between a person who displays overly energetic or distractible behaviors in school or the workplace and a person with diagnosable ADHD is to discover whether the attention problems and impulsivity occur only in isolation or in every context of life. If a child cannot sit through math class but can carry on an intelligent conversation with an adult, has no trouble watching a two-hour movie in one sitting, and enjoys playing chess, ADHD is probably not an appropriate diagnosis. On the other hand, if impulsive, frantic behavior is present at school, at play, out shopping, talking on the phone, and at the dinner table, ADHD may be indicated.
How Therapy Can Help ADHD
Psychotherapy is effective for the treatment of the symptoms related to ADHD because it addresses behavior modification. Children and adults with ADHD can have a difficult time regulating their emotional and behavioral response to situations. Learning effective coping strategies is one way to gain control over symptoms. Therapists can also help with the development of a plan for organization and prioritization, key areas of difficulty for those with ADHD. Goal setting, reward and consequence, and emotional regulation are other areas that are addressed during psychotherapy for ADHD.
Even if ADHD is not diagnosed, difficulties concentrating at school or at work can be troublesome. Therapy, with or without the addition of medication, can help children and adults learn to stay more focused, manage impulses, and discover which learning and working environments and aids can help increase attention. A therapist, especially one with a specialization in attention issues or school concerns, can work with parents, teachers, and the child in question to help modify the learning environment to better suit the child’s learning style and needs. A therapist can also help discover whether attention issues are really the root of the problem: In many cases, learning disabilities, anxiety, anger, problems at home, or other emotional or cognitive issues can be masked by a child’s misbehavior. Therapy can help uncover the true nature of the child’s inappropriate or troubling behavior.
Although medication is often also prescribed as part of a treatment plan for ADHD, it is considered to be most effective when combined with therapy, which can teach coping skills. Common therapeutic treatments for ADHD include:
- Skills-based therapy: This type of therapy is particularly effective with young children. Therapists specializing in the treatment of attention problems can focus on helping children develop specific skills and time management strategies.
- Cognitive behavioral therapy (CBT): CBT can be helpful at changing unhealthy habits and thinking patterns. Adults with ADHD may find it particularly helpful because CBT helps patients reframe and retrain their thought processes. CBT is typically a short-term intervention, with changes often apparent after only a few sessions.
- Traditional psychotherapy: Traditional psychotherapy, which may include discussions of anxiety, analysis of family relationships, and a variety of other topics, may be helpful at alleviating some of the symptoms of ADHD, especially in those who are experiencing other issues, such as depression and anxiety, along with ADHD. Talk therapy can help alleviate some of these concerns, bringing one’s ADHD back into focus.
- Family therapy: ADHD doesn’t just affect those who have the condition. Parents are often exasperated by children with ADHD, and when an adult has the illness, spouses and children may be affected. In family therapy, the family can learn ways to help and support each other and establish healthy coping skills that may help minimize stress and power struggles.
Medication and ADHD
In many cases a person diagnosed with ADHD will be prescribed medications by a doctor or psychiatrist to control and manage their symptoms. These medications generally include stimulants such as methylphenidate or amphetamines. These medicines work to activate the circuits in the brain that support focused behavior, which often has the effect of reducing hyperactivity. The medications tend to demonstrate greater effectiveness when combined with therapy.
The American Academy of Pediatrics (AAP) recommends using only behavioral therapy with children 5 years of age and younger. They advised a combination of therapy and medication for children between 6 and 17 years old. However, exceptions can be made for individual needs.
ADHD in Adults
ADHD continues into adulthood in about two thirds of American children with ADHD. Nearly half of these adults have never been diagnosed or received treatment for their symptoms, and only about 25% of them end up seeking help. Generally, hyperactivity symptoms are less prevalent in adulthood, but symptoms of inattention and impulsivity often persist. About half of adults who have ADHD also have some form of anxiety, and these adults often experience difficulty in their daily lives, as the combination of ADHD and anxiety symptoms can often lead to impaired function. Overlapping symptoms might also make it less likely for an adult who seeks treatment to receive a correct diagnosis.
ADHD symptoms in adulthood may manifest in different ways than they did in childhood. ADHD can have a negative effect on relationships and success in the workplace, as mood swings and a short temper are often characteristic of the condition, as is difficulty coping with stress. It may also be difficult for those with ADHD to focus on tasks or prioritize activities, and this may lead to missed deadlines and forgotten social engagements.
Treatment of ADHD in adults is generally the same as it is in children. Medication might be prescribed along with therapy, but often the condition can be treated without medication. Family or marital counseling may also be helpful when one’s ADHD has an effect on loved ones and family members.
- Play therapy for hyperactive 12-year-old: Brian, 12, is brought to therapy by his parents who are frustrated by Brian’s recent behavior. He cannot finish his homework, he ignores directions often, he is loud, careless, and barely sits still. They tell the therapist they want to try therapy before putting him on medication. Through play therapy, the therapist begins to uncover some deep anxiety in Brian. The therapist discovers that in class, Brian is actually quite well behaved. The therapist also discovers that Brian’s father is angry quite often and tends to yell at Brian over even the smallest infractions. The therapist raises the issue with Brian’s parents, and as Brian’s father begins to acknowledge his anger problem and learn new ways to deal with his son, Brian’s anxiety, and the misbehavior that results from it, subsides.
- Learning disability misdiagnosed as ADHD: Erica, 6, is seen in school by a counselor because she cannot seem to stay focused. While she is very compliant with school rules, she fails to complete any assignments unless closely assisted by an adult for the duration of the work. The school counselor refers her to a psychiatristwho prescribes a medicine for ADHD, but Erica’s work does not improve. Finally, she is brought to a therapist, who decides to rule out a learning disability. A specialist is brought in and discovers that Erica is dyslexic, which makes schoolwork very difficult for her. She is taken off her medication, and, instead, a specialized learning plan is created in a collaborative effort between her family, teachers, and school counselor.
- Adult male who has difficulty concentrating for long periods: Dave, 27, has always had difficulty in school, finding it hard to pay attention for long periods and often feeling restless. As a professional, he experiences the same troubles at work, and they are threatening to cost him his job. The therapist teaches Dave some relaxation skills and engages Dave in some techniques for expanding his attention span; they help, but are inadequate. A referral to a psychiatrist results in a prescription that helps Dave increase his ability to focus significantly. Dave does not want to stay on the medication forever, though, and so he continues to work with his therapist to increase his attention span through mental skills training.