What is ADHD/ADD?
ADHD stands for Attention-Deficit/Hyperactivity Disorder and is a chronic mental health condition that affects millions of children, teens, and adults. The diagnosis is also commonly referred to as ADD (Attention-Deficit Disorder). It is most often diagnosed before the age of 12 and is a lifelong condition. People with ADD present with a pattern of hyperactivity (excess of movement), inattention (distractible, disorganized and forgetful behavior), and/or impulsivity (action without reflection). Individuals may experience all or only some symptoms of ADD. There are some who experience only inattentive symptoms (distractibility, forgetfulness, inattention). Others experience only hyperactive symptoms (restlessness, running/climbing when inappropriate, talking excessively, intruding/interrupting others). There are also those who experience symptoms of both inattention and hyperactivity.
What Are the Symptoms of ADD?
It’s important to note that everyone struggles with inattentive, excitable, and impulsive behavior at times. ADD is only diagnosed when the individual experiences significant impairment in performing their major roles and responsibilities because of their symptoms.
The attentional difficulties associated with ADD include ongoing patterns of inattention (especially for boring tasks), distractibility, poor time management (chronic lateness, failure to meet deadlines, not being conscious of the passage of time), forgetfulness, frequently losing or misplacing needed items, avoidance of tasks that require sustained mental effort (procrastination is a hallmark of this diagnosis), and disorganization/messiness.
Hyperactivity symptoms are more common in children. Behavior seems “driven by a motor” and energy that is seemingly boundless. Play style may be overly enthusiastic and intrusive into the physical space of others. Butting into or taking over conversations, activities, or games without asking for permission is quite common. People with ADD- related hyperactivity may also be unable to play quietly, remain seated when they are expected to, or remain still without fidgeting. Those with ADD may run, climb, or jump when it is not appropriate. These folks may also talk excessively, blurt out answers to questions before it’s appropriate, and have difficulty waiting their turn. Impulsive behavior is also a hallmark of hyperactive ADD symptoms. Impulsive aggression, speaking or acting before thinking, and risky and reckless behavior are all indicators of impulses that are poorly managed or not filtered or inhibited by the brain.
Additionally, people with ADD may present with irritability and quick shifts in their emotions when provoked. People with ADD may also experience disproportionate emotional reactions to stressors or other stimuli. Those who experience ADD-related emotional dysregulation may present with tantrums that are not developmentally appropriate or proportionate to the offending event or person. People with ADD also sometimes present with patterns of poor sleep (which, in turn, worsens inattention), aggression toward others, and defiance toward authority. Though none of these are inherent to the ADD diagnosis and are not included as diagnostic criteria in the DSM-V (the diagnostic manual used by most mental health clinicians in the US), they are associated traits that can occur in those with ADD.
It is important to note that several of the symptoms of ADD overlap with other psychiatric diagnoses. Stress, trauma, anxiety disorders, mood disorders, and other physical conditions or illnesses can cause symptoms similar to ADD. That is why it is so important to see a psychiatric professional who can perform a thorough assessment to determine the locus of symptoms and how best to manage them.
Are ADD Symptoms the Same in Boys and Girls?
For various reasons (including the differing ways in which boys and girls are reared and socialized), boys and young men tend to present with more hyperactive, externalized behavior than their female counterparts. Boys who are disruptive in their classroom, during leisure activities, and at home tend to be diagnosed earlier because hyperactivity symptoms are hard to ignore or miss. Because females with ADD tend to be less disruptive, they can be overlooked and their symptoms misunderstood as lazy, unmotivated, disinterested, or failing to fulfill their potential.
What Causes ADD?
Like many psychiatric disorders, it is thought that our genes and our environment both influence the development of ADD.
Genetic influences are strongly implicated in ADD. Twin studies suggest a heritability rate of 80%. This means that ADD is very strongly influenced by genetic inheritance. Several DNA variants associated with ADD have been identified. However, gene studies have not established universal or consistent genetic patterns occurring across all individuals with ADD. There are also certain areas of the brain that appear to be smaller in those with ADD as compared to controls. These differences persist into adolescence and adulthood and can be more pronounced in those who have never received medication to treat their symptoms.
Environmental influences are numerous and varied. During pregnancy, maternal smoking, alcohol and/or cocaine consumption, significant maternal stress, use of certain anticonvulsants, and factors leading to low birth weight can increase the risk of a baby later developing ADD. Additionally, severe environmental adversity (war, abuse, natural disasters, chronic neglect) and exposure to lead are also risk factors. Severe head injury and brain disease are also associated with ADD.
There is some thought that diet may influence the development of ADD, though evidence for this is less robust than genetic and environmental factors. Several studies have examined the association between ADHD and certain foods containing gluten, dairy, or artificial colors and additives. Results suggest that these products may exacerbate ADD symptoms.
How Can I Figure Out If My Child Has ADD?
At The Midtown Practice, we offer psychiatric assessment for children and teenagers. This form of assessment can help to determine if your child meets diagnostic criteria for ADD. Usually, psychiatrists work with the child, their caregivers, and other professionals (teachers, tutors, babysitters) to obtain information about the child’s behavior and functioning. Information obtained from caregivers and other involved adults helps to determine if ADD is present. If ADD is diagnosed, you can work with your Midtown Practice psychiatric provider to discuss what interventions and resources will be most helpful for your child. Medications may only be one piece of the treatment plan that you and your psychiatric provider will formulate together to suit your preferences and needs.