“No matter how much you want to pay attention, boredom allows curiosity to find the key and open the dungeon door, allowing attention to escape and find some interesting place to visit.”
-Edward M. Hallowell (MD)
What is ADHD?
ADHD is a neurodevelopmental disorder. It is one of the most common disorders to affect children and adults. Mostly, adult diagnoses happen when the symptoms were ignored or misunderstood at a younger age. The median age for diagnosis is 6 years. There are several controversies when it comes to ADHD diagnoses, however, recent studies have clearly shown the connection through neurochemistry.
ADHD symptoms often overlap with other comorbid conditions, which makes it hard to diagnose. However, ADHD evaluations can prove the neurodivergence common to the disorder or rule out other conditions that may be affecting the patient. The three main categorizations of the disorder are hyperactivity, inattention, and a combination of hyperactivity and inattention. The disorder impairs executive functions that affect daily tasks and may lower the overall quality of life. The symptoms and the severity varies between people, however, they are often overlooked or confused with symptoms of other ailments.
ADD vs ADHD
ADD or more commonly as it is known, ADHD inattentive type, is a form of the disorder, which results in some atypical symptoms. ADD is an outdated term that is no longer used. The characteristics of this form of ADHD are:
- Issues with following directions
- Easily loses focus/is distracted
- Interest-based hyper focus
- Struggles to await their turn
- Prematurely answers questions
- Intrudes upon others
These symptoms are further discussed below, in relation to ADHD hyperactive and ADHD combined types.
ADHD symptoms mimic symptoms of other conditions and disorders. There are several differential diagnoses for the disorder, the most common being Major Depressive Disorder amongst many others. A person can suffer from a combination of the symptoms listed below.
The table above highlights the symptoms of all three manifestations of the disorder. To qualify for evaluations, one must experience six or more symptoms of each type for the last six months or more. ADHD affects executive functions; impaired executive functions result in reduced cognitive abilities required to achieve goals. This can lead to a variety of outcomes, depending on the severity of the symptoms. While some people thrive with time and task organizers, trackers, and other management tools, others may require medication, management tools, and therapies to control their symptoms.
As there is no one test for ADHD, psychiatrists conduct a variety of tests that screen out other conditions. An in-person evaluations, alongside a variety of tests, are carried out for children, as well as adults. ADHD typically affects children between the ages of 3 to 17 years old. An adult diagnosis is not infrequent either; often ADHD symptoms are overlooked or written off at a younger age. The combination of assessments gives psychiatrists a clear picture of if the person is suffering from ADHD or not.
ADHD Symptoms in Kids
The symptoms experienced by children often differ from adult ADHD symptoms. This may primarily be due to the accommodations made during childhood, or another term for it is social scaffolding. In other words, scaffolding is referring to a stepping stone, a setup to assist the person suffering from ADHD, achieve something that may be out of their developmental zone. While the symptoms of ADHD in kids, as well as adults may be the same, the outcomes of those symptoms, rather the signs of those symptoms may be different.
Adult ADHD Symptoms
The way the symptoms show up in adults often differs from the symptoms that show up in children. For instance, children may be restless and running about, whereas, the adult manifestation of the same symptoms will be restlessness and fidgeting during meetings, seminars, or during other face-to-face interactions. Also, often a person suffering from ADHD learns to compensate for their challenges, which makes it harder to diagnose. The evaluations and correct treatment are crucial for an improved quality of life.
Signs of ADHD
The symptoms of ADHD are based on what the person is feeling, whereas, the signs of ADHD are what is being projected, or rather how it is perceived by others. The simple table below shows how a symptom is perceived by people for face-to-face interaction.
Dr. Gundu Reddy is a Board Certified Psychiatrist with more than ten years of experience practicing forensic psychiatry and fifteen years of experience practicing clinical psychiatry.
Dr. Gundu Reddy
The United Medical & Dental Schools of Guys Kings and St Thomas’s at King’s College London
Mount Sinai School of Medicine, New York
NYU Psychoanalytic Institute
American Board of Psychiatry Neurology
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Dr. Gundu Reddy is a board-certified urgent psychiatrist with fifteen years of experience practicing clinical psychiatry and ten years of experience practicing forensic psychiatry, including as a postpartum depression psychiatrist. She has trained in Medication Management, psychodynamic psychotherapy, and cognitive behavioral therapy, and has a special interest in integrative psychiatry, including as a postpartum depression psychiatrist.
Dr. Reddy believes that multiple factors should be considered when evaluating and treating a patient, including genetic and developmental factors, medical illness, nutrition, and hormones, as well as environmental and dynamic factors.
Many individuals receive substandard care due to incomplete evaluation, and an integrative approach, including the expertise of a postpartum depression psychiatrist, is needed to provide optimum clinical improvement.
Dr. Reddy emphasizes that the decision to take psychiatric medication, including postpartum depression medication, should not be taken lightly and should be prescribed with the utmost care. The goal of medication management, including postpartum depression medication management, is to achieve maximum efficacy with minimum side effects, and gentle titration.
Dr. Reddy believes that in most cases psychiatric illness is treatable, and most people can achieve significant improvement in symptoms, as well as social and occupational functioning, with high-quality and consistent care, including the expertise of a postpartum depression psychiatrist. Her goal is to provide the best possible treatment to patients in a telepsychiatry or online psychiatry setting, utilizing her expertise as a postpartum depression psychiatrist, and achieve the same standards of care as if seeing the patient in person.
Please schedule online or call +1(833)312-4222 if you wish to schedule an appointment with Dr. Reddy.
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ADHD in Women
This disorder is very frequently misdiagnosed or written off, leading to a late adult diagnosis. Girls are more prone to having symptoms of ADHD inattentive type. As the symptoms are not of the hyperactive/impulsive type, which is primarily seen in boys, the inattentive/impulsive symptoms in girls are overlooked and misdiagnosed. The gender bias is clear when the numbers are compared. Only 5.5% of girls between the ages of 3 to 17 are diagnosed with ADHD, in contrast to 11.9% of boys within the same age group.
ADHD Positive Traits
As per DSM-5, the criterias required to reach a diagnosis for insomnia disorder include:
- Dissatisfaction with the quality or quantity of sleep, and that includes difficulty in falling asleep, remaining asleep or waking up early and then inability to fall asleep again.
- This sleep deprivation causes a great amount of stress and impairs social, occupational, educational, academic, behavioral, or other important areas of functioning.
- Difficulty in sleeping occurs at least three nights per week and is present for at least 3 months.
- The sleep difficulty occurs despite several opportunities to fall asleep.
- Insomnia cannot be better explained by any other physical, mental or sleep-wake disorders such as narcolepsy, a breathing-related sleep disorder, or sleep-wake disorder.
- Mental disorders and medical conditions cannot adequately explain the insomnia experience.
- The sleep disability does not occur due to any substance use or medication.
In order to better diagnose insomnia, physicians use Sleep diary and the Epworth Sleepiness Scale. While a sleep diary helps your doctor to detect changes in your sleep patterns, the Epworth Sleepiness Scale identifies how tired or drowsy you feel when confronted with specific situations such as waiting in a long queue, reading or watching television.
The doctor might also recommend physical examination and blood tests to check for thyroid function and any other disorders.
Effects of ADHD in Personal Life
People suffering from this disorder often face issues in their personal life due to poor management skills, memory problems, and more because of executive dysfunction. The following are some of the challenging areas that ADHD sufferers find hard to navigate.
ADHD and Finance
“The majority (60%) of those surveyed who are living with ADHD said they believe it has a direct cost implication for them because of its impact on day-to-day money management.” a report in the Guardian.
ADHD can impact in some positive ways; however, for many, the struggles of daily life with ADHD are real. For instance, many struggle with financial management. Even for most people without ADHD, it can be a struggle. The disorder affects a person’s executive functions, organization, and planning skills. Tracking and management tools can help stay current on bills; while it is an uphill task, it is possible to stay ahead of the bills, and spending patterns.
ADHD and career
Many suffering from ADHD have challenging times with their careers. Although the global reports state that there is roughly 2.5% of the adult population suffering from the disorder, there are many that remain undiagnosed or worse still, misdiagnosed. This means that millions of adults struggle at their workplace or have difficulty excelling at their jobs. It is prudent to note, however, that yet others flourish at their jobs or careers. The hyperfocus on their careers can often lead to successful jobs and positions. Nevertheless, most people suffering from ADHD generally struggle with daily routine tasks, challenges in communication skills, and poor discipline.
ADHD and academic performance
ADHD children’s academic performance has two sides to it, similar to that of professional performance. Hyperfocus and perseverance are a few of the positive traits of the disorder. Children that have these skills and enjoy or hyperfocus on their academic progress can excel in class. However, others will be struggling with their schoolwork and require assistance from the teachers and their parents. Generally, with the right accommodations, such as trackers and management tools, alongside assistance from teachers and parents, children can slowly learn how to stay afloat without struggling. However, achieving and maintaining this balance can be challenging.
ADHD and relationships
The common symptoms of inattention, hyperactivity, and impulsivity can wreak havoc on relationships and spark misunderstandings Hyperfocus and distraction, can be equally damaging in a relationship and lead to feelings of being ignored or overlooked, or feelings of being trapped under the microscope. Either way, these aren’t ideal feelings for a successful relationship, whether it is a marriage or a live-in situation.
While it’s true that opposites attract, the question with ADHD partners is, if it will be a positive and a fruitful relationship, living together. People with ADHD have unique personalities. For a healthy and successful relationship, your partners must love your ADHD traits. They must support you at your weak points and admire your strengths. If a partner is irritated by the drawbacks and fails to notice the strengths, this can have a devastating impact on the partners with ADHD. It can drain the partners with ADHD, as they feel inadequate and seriously inhibit their overall success.
People suffering from ADHD can often be difficult around the house, as many find it hard to tackle basic chores and daily activities without getting overwhelmed. Memory problems can also be another challenge that couples with ADHD have to navigate. When that is coupled with anxiety where one or both partners are suffering from the disorder can find it hard to achieve and maintain that balance.
Loving your ADHD spouse ; lateness, messiness, job instability, interrupting, mood swings, poor credit , fighting , addictions , the hardest part is knowing when to support your other half, when to forgive, and when to hold them to account. ADHD focused relation ship therapy will help navigate theses issues , ease resentment and help you both function as a team.
Opposites attract , but can they live together in the long run ? people with ADHD have unique personalities, and the key to a successful relationship/ marriage is finding a partner who loves your ADHD personality, admires your strengths and supports or fills the gaps for your weaknesses. A partner who is irritated by you or tries to change you completely can destroy your soul drain your energy and inhibit your success. ADHD focused relationship therapy can save your marriage.
ADHD and anxiety
There is a very strong correlation between ADHD and anxiety. People suffering from ADHD often suffer from anxiety as well. In fact, anxiety disorders are a few of the most common differential diagnoses for ADHD, apart from depressive disorders. ADHD is challenging to navigate, as it affects executive functions. Couple that with anxiety and it can be an overwhelming situation for the person.
Oftentimes, the anxiety is because of ADHD, where the person may be worried about their performance and how it reflects in their daily lives. However, anxiety also brings on its own symptoms such as:
- sleep problems
- feeling on the edge most of the time
Sometimes, ADHD treatments offer respite from anxiety, as it was the result of ADHD. However, many have both the disorders together. In such cases, usually the disorders are treated separately. Some ADHD medications often exacerbate anxiety and have the opposite effect. Careful monitoring and titration is needed for the ideal balance.
ADHD and addictions
Addiction is a coping strategy that many suffering from ADHD use to get the dopamine hit that the brain craves. An ADHD brain produces less of the neurotransmitter and hormone; alcohol and drugs give them the much-needed hit to relax and fit in socially. Although, addiction can also be for food, shopping, gambling etc.Often the addiction and ADHD are treated as dual diagnoses. It may sometimes be important depending on the situation, to treat both disorders simultaneously; frustrations with ADHD can lead to alcohol and drug use as self-medication. This often becomes a vicious cycle that’s hard to break.Addiction counselling, therapy, and self-help groups are good ways to manage the conditions, besides medications, if required.
ADHD and obesity
Obesity is far more prevalent in people suffering from ADHD than not. Binge eating is one of the many manifestations of ADHD impulsion. Adults suffering from the disorder may have trouble planning for meals (breakfast/lunch/dinner) and thus either eat take-out or skip meals all together. It can swing from one extreme to another. Skipping meals, and binge eating and both lead to weight gain. The use of stimulants for ADHD is one factor that helps immensely with food habits. The person is able to plan better and maintains a more regular diet as compared to the bingeing. Another side effect of stimulants is that it suppresses hunger, which also works to the person’s advantage to some extent.
Ultimately, ADHD affects more than one areas of daily life and can be overwhelming without proper management.
CNS Vital Signs is a broad spectrum neurocognitive test. It is computerized and comprises nine tests.
- Verbal memory test
- Visual memory test
- Finger tapping test
- Symbol Digit Coding test
- Stroop test
- Shifting attention test
- Continuous performance test
- Perception of emotion test
- Non-verbal reasoning test
Psychiatrists use the evaluations to understand their cognitive abilities. This helps with the final diagnoses when used in tandem with other assessments.
The Conners CBRS test is a popular test for children between the ages of 6 and 18. This test is not just used to test for ADHD, but also a host of other conditions and disorders. The test results decide the following.
- If the child requires inclusion or exclusion in special education
- It ascertains if the treatments or the interventions are effective
- It monitors response times for the treatments are effective
- Explore other treatment plans that may work better
- Test for differential diagnoses for comorbid conditions
- Use Conner Clinical Index to easily screen and test treatment efficacy
Vanderbilt ADHD Diagnostic Rating Scale relies on teachers and parents to spot and highlight the problem areas. While the test may be used for children across all ages, it is predominantly used for children between 6 to 12 years old. The test is streamlined to specific areas that are exclusive to the parents and teachers. Teachers have a section on learning disabilities; parents judge for conduct disorder or antisocial behavior. It is a reliable and effective test to evaluate ADHD and other conditions.
SNAP-IV Rating Scale measures ADHD (Inattentive/Hyperactive/Combination) on nine parameters. It also measures 8 parameters for oppositional defiant disorder. If the test results are positive then further testing is required. For a negative screening, other tests should be conducted for symptoms.
The QbTest is used to measure symptoms of inattention, activity, and impulsivity for ADHD. It is also used to test for the efficacy of the set treatment plan with repeat assessments. This test, together with other tests can rule out the disorder.
The Hamilton Depression Rating Scale or the HAM-D or HDRS assesses the severity and progression of depression between the ages of 7 to 17. The parameters of the test are guilt, mood, suicide ideation, and insomnia.
T.O.V.A (Test Of Variable Attention) is used for children and adults. It allows psychiatrists to customize treatment plans, whether it is just therapy and management tools, or a combination of both with medication.
The ASRS-v1.1 is a test prescribed to adults, alongside TOVA, CNVS, and QbTest.. This test measures a person’s reaction times and responses to different situations and stimuli.
These are the main assessments for ADHD that psychiatrists use to screen out other disorders and conditions and prescribe adequate treatment plans.
Several differential diagnoses are made during ADHD evaluations. The assessments are used to screen out other comorbid conditions, and other disorders. Common differential diagnoses are:
- Anxiety disorders
- Depressive disorders
- Post-traumatic stress disorder
- Obsessive-compulsive disorder
- Learning disabilities
- Thyroid disease
- Substance abuse
- Nutritional deficiencies
The ADHD evaluations are used for differential diagnoses, as well as to check on the efficacy of the ongoing treatment plans.
ADHD treatment plans are often multimodal. If the treatment plan is for a child below the age of 6 years, then the American Academy of Pediatrics (AAP) recommends parent training in behavior management; if that fails, there may be medications involved in the treatment plan. However, this is still a very controversial subject, as many professionals believe that medication shouldn’t be used at that young age. Children below the age of 6 should try to manage their symptoms without the use of medication, with stringent management. Medication may be used to treat children above the age of six, along with parental guidance and management and with behavior therapy, depending on the severity of the symptoms.
The most common behavior therapies for children below the age of six are:
- Parent Training in Behaviour Management
- Behavioral Interventions in Classroom
- Behavioral Therapy for Children
For children above the age of 6 (medication and behavior therapy)
- Parent Training in Behaviour Management
- Behavioural Interventions in Classroom
- Peer Intervention focusing on behavior
- Organisational Skills Training
Adults often manage their symptoms with trackers, management apps, and therapy; in severe cases, medication will be added to that list. There is no cure for ADHD. Therefore, managing symptoms with the aid of trackers, prompts, therapy, and medication only works when consistently used. Many are irregular with their treatment plans, which may lead to a decreased quality of life.
Medications are used as a last resort in ADHD treatment. They are usually used in tandem with other treatment plans. There are a variety of medicines available in the market, however, what works for one, may not work for the next. Every person reacts differently to the medication and often needs to try a few with varying doses, before getting the right one for their symptoms.
The most commonly prescribed medication for ADHD is stimulants and non-stimulants. Stimulants have shown remarkable improvement in symptoms for nearly 70-80% of the children that take them. They work by increasing the dopamine production in the brain. It boosts focus and reduces impulsivity and hyperactivity. There are short-acting stimulants, which have to be taken a few times a day; they usually peak after a few hours. Long-lasting stimulants peak at around 8 to 12 hours; these types of stimulants are far more common and also preferable, as people suffering from ADHD can often forget to take their medications.
Non-stimulants also work, albeit not as fast as stimulants; however, their effects can last up to twenty-four hours. This kind of medication has a much lower risk of abuse or addiction. They are generally prescribed if stimulants haven’t or the person experiences severe side effects.