What is ADHD?
Attention deficit hyperactivity disorder (ADHD) is the official name used by the American Psychiatric Association, with or without hyperactivity.
ADHD is a neurological condition that is usually genetically transmitted. It is characterized by distractibility, impulsivity and restlessness or hyperactivity. These symptoms are present from childhood on, and with a much greater intensity than in the everyday person, so that they interfere with everyday functioning.
In my opinion, ADHD is a terrible term. As I see it, ADHD is neither a disorder, nor is there a deficit of attention. I see ADHD as a trait, not a disability. When it is managed properly, it can become a huge asset in one’s life. I have both ADHD and dyslexia myself and I wrote the book Positively ADD with Catherine Corman to profile a collection of fabulously successful adults with ADHD.
As I like to describe it, having ADHD is like having a powerful race car for a brain, but with bicycle brakes. Treating ADHD is like strengthening your brakes–so you start to win races in your life.
In my work as a psychiatrist who treats ADHD, I see myself not as a doctor who treats a disability, but rather as a doctor who helps people, adults and children alike, identify, develop, and celebrate their talents. That’s why I love my work!
Diagnosis is made primarily by reviewing one’s history; there is no foolproof “test” for ADHD (the preferred abbreviation for both disorders). In arriving at an accurate diagnosis it is important to look for other problems that may occur along with ADD, such as low self-esteem, depression, substance abuse or family turmoil. While the following lists may give you an idea if an evaluation for ADHD is appropriate, we strongly recommend getting diagnosed by a mental health professional if you suspect that you or your child may be ADHD.
ADHD in Children
- If your child exhibits at least eight of the following behaviors for at least a six-month period, consider an evaluation by a team of ADHD professionals.
- Often fidgets with hands or feet or squirms in seat (in adolescents or adults) and may be limited to subjective feelings of restlessness.
- Has difficulty remaining in seat when asked to do so.
- Is easily distracted by extraneous stimuli.
- Often blurts out answers to questions before they have been completed.
- Has difficulty following through on instructions from others.
- Often shifts from one uncompleted activity to another.
- Has difficulty playing quietly.
- Often talks excessively.
- Often interrupts or intrudes on others.
- Often does not seem to listen to what is being said to him or her.
- Often loses things necessary for tasks or activities at school or at home.
- Often engages in physically dangerous activities without considering possible consequences.
ADHD in Adults
If you have exhibited at least twelve of the following behaviors since childhood and if these symptoms are not associated with any other medical or psychiatric condition, consider an evaluation by a team of ADHD professionals:
- A sense of underachievement, of not meeting one’s goals (regardless of how much one has actually accomplished).
- Difficulty getting organized.
- Chronic procrastination or trouble getting started.
- Many projects going simultaneously; trouble with follow through.
- A tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark.
- A frequent search for high stimulation.
- An intolerance of boredom.
- Easy distractibility; trouble focusing attention, tendency to tune out or drift away in the middle of a page or conversation, often coupled with an inability to focus at times.
- Often creative, intuitive, highly intelligent
- Trouble in going through established channels and following “proper” procedure.
- Impatient; low tolerance of frustration.
- Impulsive, either verbally or in action, as an impulsive spending of money.
- Changing plans, enacting new schemes or career plans and the like; hot-tempered.
- A tendency to worry needlessly, endlessly; a tendency to scan the horizon looking for something to worry about, alternating with attention to or disregard for actual dangers.
- A sense of insecurity.
- Mood swings, especially when disengaged from a person or a project.
- Physical or cognitive restlessness.
- A tendency toward addictive behavior.
- Chronic problems with self-esteem.
- Inaccurate self-observation.
- Family history of AD/HD or manic depressive illness or depression or substance abuse or other disorders of impulse control or mood.
Clinical Definition of ADHD
The following are some of the criteria for diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders for ADHD, which is the standard reference among mental health professionals. While this definition is not perfect, I include it as it is the most commonly accepted definition.
DSM-IV Criteria for ADHD
I. Either A or B:
A) Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is inappropriate for developmental level:
- Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
- Often has trouble keeping attention on tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
- Often has trouble organizing activities.
- Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
- Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
- Is often easily distracted.
- Is often forgetful in daily activities.
B) Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:
- Often fidgets with hands or feet or squirms in seat when sitting still is expected.
- Often gets up from seat when remaining in seat is expected.
- Often excessively runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
- Often has trouble playing or doing leisure activities quietly.
- Is often “on the go” or often acts as if “driven by a motor”.
- Often talks excessively.
- Often blurts out answers before questions have been finished.
- Often has trouble waiting one’s turn.
- Often interrupts or intrudes on others (e.g., butts into conversations or games).
II. Some symptoms that cause impairment were present before age 7 years.
III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).
IV. There must be clear evidence of clinically significant impairment in social, school, or work functioning.
V. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000, via the CDC
Types of ADHD
There are three variations of ADHD, depending on which symptoms are strongest in an individual. These descriptions are taken from the CDC:
Predominantly Inattentive Type: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.
Predominantly Hyperactive-Impulsive Type:The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.
Combined Type: Symptoms of the above two types are equally present in the person.
1) Keep learning about ADHD! Some good places to start:
- Treatments for ADHD describes our recommended strategies for successfully adjusting to and coping with ADD/ADHD.
- Delivered From Distraction is one of the best introductions to ADD available
- The Top 10 questions about ADHD
- The Top 10 newest findings about ADHD
- Watch Dr. Hallowell discuss Kids and ADHD, or ADHD and education
- 8 Steps to Strength-Based Approach for Adults with ADHD
2) If you believe that you or your child or spouse may have ADHD, get a professional diagnosis:
- The Hallowell Centers specialize in the diagnosis and treatment of ADHD, for those in or near Massachusetts, New York, Seattle, and San Francisco.
- For those not near a Hallowell Center, we have a page to help you find a referral to someone qualified who can diagnose ADHD
- Ask your doctor about getting tested for ADHD
3) Remember that you are not alone! There is a tremendous community to support and help you. A few places to look, depending on your needs:
- CH.A.D.D. (Children and Adults with Attention Deficit Disorder): an excellent organization dedicated to helping and connecting those with ADHD
- For those married to someone with ADHD, or are ADHD themselves, go to the Marriage Blog, which is also a community of people sharing their experiences
- National Attention Deficit Disorder Association: a non-profit organization that focuses on the needs of adults and young adults with ADHD. They sponsor an annual national conference on ADHD.
“Those of us with ADHD need your support! We are not “lazy,” “stubborn,” “willful,” “disruptive,” “impossible,” “tyrannical,” “a space shot,” “brain damaged,” or “stupid.”
– Dr. Hallowell