Types of ADHD
ADHD in adults
Treatment in ADHD
ADD/ADHD Self Test
David is an eleven year old, sixth grade student who has reading and math skills
one to two years below grade level. He is failing every subject and seems destined
to repeat the sixth grade. His teachers describe him as disruptive and oppositional
in class and state that he has difficulty paying attention during structured and
unstructured activities. The school administrators have contacted his parents and
have suggested that he is likely to be suffering from an Attention-Deficit Hyperactivity
Disorder (ADHD). They recommend that he be taken to his pediatrician for a confirmed
diagnosis. Even at home David is rebellious. He refuses to obey his curfews, goes
to bed late at night and fails to rise for school in the morning. Intermittently
he wets his bed.
Susan, a 20 year old executive in a multi national company exhibits many relationship
problems when in the presence of other people. She is constantly aware of others
and how they are seeing her, trying to get some kind of attention from them. She
seems to be worried about what impression is being made by her on others. She is
constantly “on stage,’ trying to get a person to like her, and if this doesn’t work,
to get them angry at her she pushes the limits to see just how angry the person
will get. She is often “well-behaved” in the presence of an authority figure (her
boss), but rude and annoying to her peer group the next moment—almost as a release
of the strain of pretending to be perfect for the boss. She is known for her lies,
is annoying on purpose, interrupts during conversations and is void of good manners.
Mina a 7 year old girl was having problems following instructions and was facing
difficulties organizing tasks and activities. She would often avoid to engage in
tasks that required sustained concentration, made careless mistakes in homework
and other activities, often had difficulties sustaining attention in tasks and play
activities and did not seem to listen when spoken to directly. She would often lose
things necessary for tasks or activities (e.g. toys, school assignments, pencils,
books) and would be easily distracted by extraneous stimuli
Ali aged 18 often fidgets with his hands or feet or squirms in his seat during his
classes in college. He often leaves his seat in the middle of a lecture and in other
situations in which remaining seated is expected. Outside the classroom, he walks
about and complains of many thoughts ’going on in his head’ making it impossible
for him to focus on anything in particular.
Ravi, a 14 year old was described as always being "on the go" or often acting as
if "driven by a motor". He would talk excessively and he would find it impossible
to finish a task that he had started. He would blurt out answers before questions
had been completed. He had difficulty waiting for his turn and would often interrupt
or intrude on others (e.g. butt into conversations or games)
(All above names have been changed for purpose of confidentiality)
You may have already identified someone you know who could probably fit one of the
above descriptions. Most of the behavior mentioned above is present in most of us
so what is the criteria that one follows to make a diagnosis of ADHD
The year 2000 Diagnostic & Statistical Manual for Mental Disorders (DSM-IV-TR) provides
criteria for diagnosing ADHD.
1. Often does not give close attention to details or makes careless mistakes in
schoolwork, work, or other activities.
2. Often has trouble keeping attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow instructions and fails to finish schoolwork, chores, or
duties in the workplace (not due to oppositional behavior or failure to understand
5. Often has trouble organizing activity.
6. 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).
7. Often loses things needed for tasks and activities (e.g. toys, school assignments,
pencils, books, or tools).
8. Is often easily distracted.
9. Is often forgetful in daily activities.
1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from seat when remaining in seat is expected.
3. Often runs about or climbs when and where it is not appropriate (adolescents
or adults may feel very restless).
4. Often has trouble playing or enjoying leisure activities quietly.
5. Is often "on the go"
6. Often talks excessively.
1. Often blurts out answers before questions have been finished.
2. Often has trouble waiting one's turn.
3. Often interrupts or intrudes on others (e.g., butts into conversations or games).
• Six or more of the following symptoms of inattention/hyperactivity/impulsivity
have to be present for at least 6 months to a point that is disruptive and inappropriate
for developmental level
• Some symptoms that cause impairment would be present before the age of 7 years.
• Some impairment from the symptoms is present in two or more settings (e.g. at
school/work and at home).
• There must be clear evidence of significant impairment in social, school, or work
Based on these criteria,
three types of ADHD have been identified:
1. ADHD, Predominantly Inattentive Type (previously known as ADD – Attention
Deficit Disorder which is marked by impaired attention and concentration )
2. ADHD, Predominantly Hyperactive-Impulsive Type (which is marked by hyperactivity
3. ADHD, Combined Type (the most common type, involves all the symptoms)
An Overview of ADHD in
Attention deficit hyperactivity disorder (ADHD) is well recognized in children and
is increasingly recognized in adult populations With ADHD in adults, there may be
some variation in symptoms. For instance, an adult may experience restlessness instead
of hyperactivity. In addition, adults with ADHD consistently have problems with
interpersonal relationships and employment.
The exact characteristics or symptoms defining this set of problems continue to
be defined. ADHD is not considered just a problem with poor attention but is additionally
a problem with moderating emotions and effective self-regulation. Dealing with the
demands of everyday life requires self-regulation to develop successful life skills.
For people with ADHD, problems with self-regulation cause difficulty managing emotions,
so they might respond to small events with excessive behavior and emotion while
not noticing more important events. Also, problems with self-regulation make it
difficult to develop good habits. Compared with other people, those with ADHD require
more practice over longer periods of time to develop effective behavior that is
self-regulated or habitual.
Again, the root problem in ADHD is not a simple problem of not paying attention.
When people with ADHD are involved in an area that naturally holds their interest,
they can pay attention as well as, or nearly as well as, others. However, when tasks
are repetitive or hold no interest for that person, these individuals experience
greater difficulty staying focused and remaining on task.
ADHD is a well-recognized diagnosis in children that has been formally identified
in adults for about the past 20 years. As children with ADHD grow up, their hyperactive-impulsive
qualities often diminish, while the inattentive and disorganized patterns of behavior
remain constant. Adults with ADHD fit this pattern: inattention and disorganization,
combined with the childhood history of inattention, hyperactivity, and impulsivity.
The level of impulsiveness in childhood seems to be the best predictor of symptoms
later in life. High levels of childhood impulsivity predict more serious adult dysfunction
Recognizing that ADHD can continue from childhood into adulthood has taken a significant
time. Current estimates are that one third of children receiving diagnoses of ADHD
may outgrow many symptoms; however, not all symptoms are outgrown. The remaining
two thirds of children with ADHD continue to have most symptoms but also experience
significant co-occurring psychiatric and life problems, such as borderline and impulse
personality problems, substance abuse and a significant risk for depression and
Biologically, ADHD is a neuro-hormonal and neuro-anatomical disorder. People with
ADHD have several chemicals (still to be determined) in the brain that are not present
in the right quantities in the right places at the right times. These chemicals
may work sometimes, but not always, and they are not under the individual's control.
This is why people with ADHD have variable performance. Also, some nerve groups
seem to be a bit out of position in the brain, causing delays or accelerations of
Heredity as a Cause of ADHD Heredity is the most common cause of ADHD. Most of our
information about the heritability of ADHD comes from family studies, adoption studies,
twin studies and molecular genetic research.
Exposure to Toxic Substances as a Cause of ADHD Researchers have found an association
between mothers who used tobacco products or used alcohol during their pregnancy
and the development of behavior and learning problems in their children. A similar
association between lead exposure and hyperactivity has been found, especially when
the lead exposure occurs in the first three years. Nicotine, alcohol, and lead can
be toxic to developing brain tissue and may have sustained effects on the behavior
of the children exposed to these substances at early ages. However, it is unlikely
that such exposure accounts for differences in brain development in the vast majority
of children and adolescents with ADHD.
Injury to the Brain from Trauma, Brain Tumors, Strokes or Disease Injury to the
brain can be the result of trauma (serious blow to the head), brain tumor, stroke
or disease. These factors can cause problems with inattention and poor regulation
of motor activity and impulses. While such circumstances can result in a diagnosis
of ADHD, the occurrence of such is atypical.
Treatment in ADHD
• Medical Treatment
• Cognitive Behavior Therapy
• Life Coaching
When medication is used appropriately for attention deficit hyperactivity disorder
(ADHD), patients notice a significant improvement in control. Objective observers,
such as acquaintances or coworkers, should notice more focus, better concentration,
and improved task completion.
Remembering what medicine does and does not do is very important. Medicine, when
used appropriately, simply makes a person with ADHD function more like a person
without ADHD. As a comparison, using medication is like putting on glasses. It makes
the system function more appropriately, just like glasses help a person achieve
20/20 vision. Medication alone will not make a person with ADHD sit down and write
a paper any more than glasses alone will. Medication allows the nervous system to
send its chemical messages more efficiently, but it does not provide skills or motivation
Medication is designed to help a person with ADHD be less forgetful and distracted,
so that he or she can stick to a plan and achieve daily goals. People with ADHD
who are on effective medication can have improved attention span, concentration,
memory, coordination, mood, and task completion. At the same time, daydreaming,
hyperactivity, anger, and immature or oppositional behavior may decrease. Medical
treatment allows a person's intellectual capabilities that were already present
to function more appropriately.
The medications available for attention deficit hyperactivity disorder (ADHD) can
have slightly different effects from individual to individual, and currently no
way exists to tell which will work best. Medications indicated for ADHD are thought
to work by improving the imbalance of neurochemicals that are thought to contribute
to ADHD. Some commonly prescribed medications include the following:
Stimulants include different formulations of methylphenidate:
• short acting, such as Ritalin ( Methyphenidate )and Focalin ( dexmethylphenidate
), with a duration of 3-5 hours
• intermediate acting, such as Ritalin SR, Metadate ER (Methylphenidate hydrochloride
extended release ), and Methylin ER (methylphenidate ), with a duration of 3-8 hours
• long acting, such as Concerta ( methylphenidate ), Rilatin LA and Metadate CD,
with a duration of 8-12 hours and which can be used just once a day
The other type of stimulant includes different formulations of amphetamine:
• short acting, such as Dexedrine ( d-Amphetamine ) and Dextrostat (d-amphetamine),
with a duration of 4-6 hours intermediate acting, such as Adderall ( mixture of
amphetamine and d-amphetamine ) and Dexedrine spansule, with a duration of 6-8 hours
• long acting, such as Adderall-XR
Medication should help in the following areas:
• Academic underachieving and inattentiveness
• Hyperactivity or fidgeting
• Verbal and/or behavioral impulsivity (for example, blurting out, interrupting
others, acting before thinking)
• Difficulty falling asleep at night
• Trouble waking up (not getting out of bed in the morning)
• Excessive irritability without cause and/or easy frustration
• Episodic explosiveness, emotional outbursts, or temper tantrums
• Unexplained and persistent emotional negativity
COGNITIVE BEHAVIOUR THERAPY
Cognitive behavioral therapy is a form of treatment which helps people make concrete,
observable changes in their lives. There is a focus on the ways a person's thoughts
and attitudes affect his feelings and behavior. The premise is that some people
develop negative and distorted beliefs about themselves which interfere with their
functioning. This can lead to depression and anxiety, as well as the procrastination
that affects so many adults with Attention Deficit Hyperactivity Disorder. Cognitive
behavior therapy helps people examine the beliefs that are holding them back and
learn strategies to counteract those beliefs.
Cognitive behavioral therapy is also a practical method of treatment that helps
clients deal with the day to day issues that impede their success. Many adults with
ADHD have difficulty with organization, prioritizing, and follow-through. Some adults
with attentional difficulties tend to ramble, have trouble remaining on topic, and
often forget what they've committed to do.
ADHD Coaching-This specialized branch of coaching is designed specifically to help
individuals create strategies for ADHD management. Using a coach is especially helpful
in areas of procrastination, follow-through, task management, attention and concentration.
One of the biggest challenges in managing ADHD is getting past the overwhelming
task of completing daily seemingly simple things. The consistent accountability,
education and support that an ADHD coach offers is vital to creating long lasting
strategies and habits.
Emerging evidence suggests that the combination of medication, cognitive therapy
and life coaching appears to significantly benefit adults with ADHD.
ADD/ADHD Self Test
Take this self ADD/ADHD test with an open mind if you suspect problems with hyperactivity
or distractibility. The test is purely subjective
Some parents find it helpful to have several people, including the child, fill out
the self ADHD /ADD test. By having more than one person complete the test you can
compare the results and discuss discrepancies.
More than 20 checked items on the test indicates a strong tendency toward Attention
Deficit Disorder or Attention Deficit Hyperactivity Disorder.
__ Does not work to potential in school, receives "not working to potential" teacher
__ Has short attention span unless very interested in a particular subject.
__ Has a family history of Attention Deficit Disorder, Attention Deficit Hyperactivity
Disorder, learning problems or substance abuse.
__ Is easily distracted.
__ Lacks attention to detail.
__ Has sloppy handwriting.
__ Has difficulty putting thoughts on paper.
__ Has trouble listening carefully to directions.
__ Frequently forgets or misplaces things.
__ Skips around while reading.
__ Has difficulty learning new games and new skills.
__ Has poor listening skills.
__ Transposes numbers, letters or words.
__ Is restless or in constant motion, is always "on the go."
__ Concentrates better when moving or fidgeting.
__ Has trouble sitting still or sitting in one place too long.
__ Has increased anxiety or nervousness.
__ Has a history of bed wetting beyond the age 5.
__ Has poor communication skills.
__ Lacks tact, often spurting out the first thing that comes to mind.
__ Acts impulsively or dangerously without considering the consequences.
__ Is easily bored.
__ Says things without thinking and later regrets having said them.
__ Starts to answer questions before the questions are fully asked.
__ Is impatient.
__ Has trouble following verbal directions.
__ Makes careless mistakes in schoolwork.
__ Has tendency to embarrass others.
__ Lies or steals on impulse.
__ Has trouble maintaining an organized work or living area.
__ Is often late.
__ Procrastinates, especially with multi-faceted tasks.
__ Is easily overwhelmed by everyday tasks.
Most children will display every character statement in this ADHD test and Attention
Deficit Disorder test at least once in their childhood. It is only when hyperactivity
and attentional characteristics occur on a frequent and regular basis and it disrupts
their regular functioning at school/work and at home that they are identified as
Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder.
This test can be used as a basis to go in for a formal diagnosis with a clinical
psychologist who can then advise you on how to start treatment (cognitive therapy
and life coaching) and refer you to a doctor ( for medication if required) qualified
to do the same