What is Attention-Deficit/Hyperactivity Disorder (ADHD) and How is it Treated?
Can you (or your child) relate to any of the following?
I have difficulty focusing on activities I don’t enjoy, like chores or homework.
My friends and family would call me disorganized and messy.
I have trouble keeping track of important dates and deadlines.
I am restless, fidgety, talkative and loud.
These factors negatively affect my relationships, activities, and performance at work or school. I am frustrated by them, and they affect my self-esteem.
If so, it is possible that you have Attention-Deficit/Hyperactivity Disorder (ADHD).
What is ADHD?
ADHD is a neurodevelopmental disorder marked by significant levels of inattention, hyperactivity-impulsivity, or both. Symptoms of ADHD typically appear early in life and may persist into adulthood, although the primary concerns and difficulties may change over time. For instance, the primary concern with ADHD in preschool children is hyperactivity. As children age and advance in school, inattentive symptoms can become more noticeable. Hyperactivity also tends to decrease over time, though fidgeting or restlessness may continue. In any case, symptoms of ADHD are present across environments - at home, in school, at work, and/or during social interactions. Per the DSM-V, ADHD affects approximately 5% of children and 2.5% of adults across most cultures. ADHD generally occurs more frequently in males than females, at a rate of about 2:1. Of note, however, females are more likely to present with primarily inattentive symptoms, which may be less noticeable and take longer to detect.
There are three primary subtypes of ADHD. Two of these subtypes are the predominantly inattentive presentation subtype and the predominantly hyperactive/impulsive presentation subtype. If at least 6 symptoms in one of these domains are present for at least 6 months prior to the age of 12 years, the diagnosis is ADHD of that specific subtype (inattentive or hyperactive/impulsive). If diagnostic requirements for both subtypes are met, the diagnosis is the third subtype: ADHD combined presentation. An ADHD diagnosis can be classified as mild, moderate, or severe, depending on how significantly the symptoms impact one’s life.
Inattentive symptoms:
Failure to pay attention to detail; making careless mistakes
Difficulty sustaining attention to tasks or play activities
Difficulty listening when spoken to directly
Difficulty following instructions, and/or failure to complete tasks in full
Issues with organization (e.g., messy work, poor time management)
Avoidance and dislike of tasks that require sustained effort and attention
Often losing things
Being easily distracted
Forgetfulness
Hyperactive/impulsive symptoms:
Fidgeting or squirming
Leaving seat when expected to remain seated (e.g., in the classroom or workplace)
Often running about or climbing (or, in adults, a subjective feeling of restlessness)
Difficulty engaging in activities quietly
Being “on the go” or acting as if “driven by a motor”
Excessive talking
Blurting out answers before the entire question has been asked
Difficulty waiting one’s turn (e.g., in line)
Often interrupting or intruding on others
ADHD symptoms during childhood may interfere with speech, motor, and social development. Individuals with ADHD are likely to experience mood swings and irritability, and they may also have a low frustration tolerance. This can create many challenges, including self-regulation and behavioral difficulties in children. Symptoms can lead to poor performance at school or work, and individuals with ADHD may also experience social rejection when their difficulties are not understood. In treatment, we work to address these concerns along with the core ADHD symptoms.
Why do people develop ADHD?
Contrary to past theories, parenting factors and family interaction patterns in early childhood are not causes of ADHD. However, in children, these factors can influence certain challenges associated with ADHD, including behavioral issues, low self-esteem, and academic under-performance. Often, these challenges merit support for both parents and children during treatment. ADHD is significantly influenced by genetic factors and is strongly heritable in first-degree relatives of individuals with ADHD. Other identified risk factors are low birthweight, in utero alcohol or tobacco exposure, and exposure to neurotoxins (e.g., lead) and infections (e.g., encephalitis). A history of childhood abuse, neglect, or multiple foster placements may also affect the development of ADHD.
How is ADHD treated?
Stimulant and non-stimulant medications are widely used treatments to manage ADHD symptoms in children and adults. There is also significant evidence of behavioral therapy’s effectiveness in treating ADHD, either in addition to or prior to beginning a medication trial. In fact, the American Academy of Pediatrics recommends behavioral therapy as the first line treatment option for preschool-aged children (ages 4-5 years).
Behavior therapy refers to any intervention meant to modify physical and social environments in order to influence and change behavior. Behavior therapy, particularly for children younger than 10 years old, is often implemented through sessions with parents. During the course of treatment, providers coach parents to improve their ability to change and shape their child’s behavior. This generally involves introducing parents to a variety of effective techniques. For instance, they may learn how to use planned ignoring to reduce or halt minor misbehavior. They gain a deeper understanding in how to effectively reward appropriate behavior, and also become better able to determine appropriate consequences for more severe misbehavior. Finally, they learn how to better coach their children’s social, persistence, and emotional skills. In behavioral therapy, even when delivered primarily to parents, the ultimate goal is to improve the child’s ability to self-regulate.
There are several specific models of parent behavior management training used to address ADHD symptoms. BASE provider Dr. Chrissy Raines has extensive training in one of these programs, known as the Incredible Years. Other programs include the Positive Parenting Program (Triple P) and Parent-Child Interaction Therapy. Through BASE, Dr. Raines offers treatment based on the Incredible Years model to the greater Charlotte community. BASE offers parent behavior management training in both individual and group formats. Most individual sessions occur weekly or biweekly, and the length of treatment will be determined collaboratively with your provider.
Many children are able to successfully engage in and benefit from individual behavior therapy at approximately 8-10 years old. While parents should stay actively involved in treatment progress, one on one sessions with the child can provide many benefits. In these sessions, they develop skills to cope with frequent negative feedback and a low frustration tolerance. Concerns related to ADHD symptoms, such as organization and time management, are addressed. Children learn tools to deal with these concerns, as well as improve self-regulation. Again, it is important that parents stay actively involved in their child's treatment. This way, parents can also learn tools to support what their child has learned and provide encouragement.
For teens and adults, Cognitive Behavioral Therapy (CBT), Organizational Skills Training, and Coaching techniques are often effective in treating ADHD. In these approaches, individuals set specific goals for themselves. They learn to track progress toward these goals and reward themselves appropriately. They monitor their progress, and any concerns or challenges are addressed in treatment. A specific focus on problem-solving can also help those with ADHD better manage setbacks or frustrations.
Regardless of who is involved, or the specific type of treatment used, several common factors are important. Behavioral treatment of ADHD is most effective when one applies rewards and consequences consistently. Initial goals and expectations are likely to be short-term and relatively easy to achieve. As individuals master new tasks and goals, expectations may be gradually increased. Through this process, individuals with ADHD may experience an increase in confidence and self-esteem. This can be very valuable to those who have dealt with a great deal of negative feedback associated with their ADHD symptoms.
Are you ready to take on your, or your child’s, ADHD? Complete our New Client Information Form to get started.
For Further Reading
Barklay, R. A. (2013). Taking Charge of ADHD: The Complete, Authoritative Guide for Parents (3rd ed). New York: The Guilford Press.
Guare, R., Dawson, P., & Guare, C. (2012). Smart but Scattered Teens: The "Executive Skills" Program for Helping Teens Reach Their Potential. New York: The Guilford Press.