Introduction
ADHD is a common, neurological disorder that typically begins in childhood and is likely associated with decreased “dopaminergic functioning” in the brain (Wender et al, 2006). It is a topic of growing importance due to its increasing prevalence, impact on academic and social functioning, and the need for early diagnosis and effective management. The purpose of this blog is to inform patients, parents, and caregivers about ADHD from a clinical perspective, providing evidence-based insights and guidance.
Clinical Definition of ADHD
Attention-Deficit/Hyperactivity Disorder (ADHD) is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. This pattern is characterized by one or both of the following symptom domains:
Inattention:
Inattention may present as difficulty maintaining focus, staying organized, or following through on tasks. Individuals often appear forgetful, easily distracted, or may frequently lose important items (American Psychiatric Association, n.d.).
Hyperactivity and Impulsivity
Hyperactivity is typically characterized by constant movement, such as fidgeting, an inability to remain seated, or excessive talking. This restlessness can be especially noticeable in settings where calm behavior is expected (American Psychiatric Association, n.d.).
Impulsivity involves acting without thinking through the consequences. This can include interrupting others, difficulty waiting one’s turn, or making hasty decisions that may lead to problems in social, academic, or occupational settings (American Psychiatric Association, n.d.).
ADHD is classified into three distinct presentations based on the predominant symptom pattern observed over the past six months:
- Predominantly Inattentive Presentation (F90.0): Diagnosed when the criteria for inattention (Criterion 1) are met, but the criteria for hyperactivity-impulsivity (Criterion 2) are not met (American Psychiatric Association, 2013).
- Predominantly Hyperactive/Impulsive Presentation (F90.1): Diagnosed when the criteria for hyperactivity-impulsivity (Criterion 2) are met, but the criteria for inattention (Criterion 1) are not met (American Psychiatric Association, 2013).
- Combined Presentation (F90.2): Diagnosed when both inattention and hyperactivity-impulsivity criteria (Criteria 1 and 2) are met over the past six months (American Psychiatric Association, 2013).
According to the Centers for Disease Control and Prevention (CDC), the number of symptoms required for an ADHD diagnosis varies by age:
- Children up to 16 years old: Six or more symptoms of inattention and/or hyperactivity-impulsivity are required.
- Adolescents aged 17 and older and adults: Five or more symptoms in either domain are required.
Common Symptoms & Signs
Often, individuals diagnosed with ADHD will experience a combination of the following symptoms:
Often, individuals diagnosed with ADHD will experience a combination of the following symptoms: difficulty sustaining attention, impulsivity, hyperactivity, frequent forgetfulness, disorganization, trouble following through on tasks, fidgeting or restlessness, interrupting others during conversations, and difficulty managing time or prioritizing activities. These symptoms can vary in intensity and presentation depending on the individual and may change over time or in different environments.
ADHD Diagnosis Process
A comprehensive evaluation is essential for an accurate diagnosis of ADHD. It’s important to note that there is no single test that can definitively diagnose ADHD (Centers for Disease Control and Prevention, n.d.). Instead, the process typically involves multiple components and is most often conducted by a licensed psychologist or other trained mental health professional.
This evaluation includes structured clinical interviews and the use of standardized scales to measure the presence and severity of symptoms. Gathering collateral information from teachers, caregivers, or other key individuals in the patient’s life is also a critical part of the diagnostic process, as it helps provide a full picture of functioning across different environments.
Additionally, it is crucial to rule out other conditions—such as anxiety, trauma-related disorders, or sleep disturbances—that can mimic or contribute to ADHD-like symptoms (Centers for Disease Control and Prevention, n.d.).
At our practice, we do not conduct ADHD evaluations; however, once a formal diagnosis has been made, we are able to offer evidence-based treatment and ongoing care. If you or your child need an evaluation, we can help connect you with a trusted provider who specializes in ADHD assessment.
Causes and Contributing Factors
Currently, the exact cause of ADHD is not known (American Psychiatric Association, n.d.). Ongoing research continues to explore this, and there is evidence suggesting a strong genetic component, but the specific genetic factors involved have yet to be clearly identified (American Psychiatric Association, n.d.).
Studies have shown anatomical differences in the brains of individuals with ADHD. For example, children with ADHD often show reduced gray and white matter volume, as well as different patterns of brain activation compared to neurotypical children (Pliszka, 2007).
In addition to genetic influences, several non-genetic (environmental) factors may increase the risk of developing ADHD (American Psychiatric Association, n.d.). These include:
- Low birth weight
- Premature birth
- Prenatal exposure to toxins such as alcohol, nicotine, or lead
- High levels of stress during pregnancy
How to Manage ADHD
Managing ADHD is most effective when treatment involves a combination of medication and therapy (American Psychiatric Association, n.d.). In recent years, there has been a notable rise in the number of approved treatment options and clinical trials, signaling increased attention and advancements in ADHD care (Nazarova et al, 2022).
Non-Pharmacological Treatment
Psychotherapy and behavioral interventions are essential components of comprehensive care. Evidence-based approaches include social skills training, sleep and exercise interventions, meditation, hypnotherapy, and cognitive behavioral therapy (CBT) specifically adapted for ADHD. Of all non-medication treatments, behavioral therapy has shown the most consistent and statistically significant benefits (Nazarova et al, 2022). Parental education and collaboration with educators further strengthen support systems for children with ADHD.
Lifestyle strategies can contribute greatly to symptom management. Maintaining healthy sleep patterns, ensuring proper nutrition, engaging in regular physical activity, and following structured daily routines are all beneficial in promoting overall functioning and well-being.
Pharmacological Treatment
Pharmacological treatment options for ADHD commonly include:
Central Nervous System (CNS) Stimulants:
- Adderall
- Vyvanse
- Ritalin
- Focalin
- Other formulations such as Azstarys and Concerta
Non-Stimulant Medications:
- Selective noradrenaline reuptake inhibitors: atomoxetine and viloxazine
- Alpha-2 adrenergic receptor agonists: guanfacine hydrochloride and clonidine hydrochloride
Although some studies have explored the use of antidepressants (e.g., bupropion hydrochloride, vortioxetine) and atypical antipsychotics (e.g., quetiapine, aripiprazole) in managing ADHD symptoms, these medications are not currently approved by the FDA for ADHD treatment (Nazarova et al., 2022). All pharmacological treatments require careful dose titration and ongoing monitoring for potential side effects (Nazarova et al., 2022).
ADHD in Adults
While ADHD was identified in children as early as the 19th century, it was not recognized in literature as a condition affecting adults until 1976 (Adler & Chua, 2002). There are unique aspects of ADHD in adulthood that differentiate it from its childhood presentation and complicate both diagnosis and management.
Symptoms of adult ADHD resemble those seen in childhood, but certain features—particularly hyperactivity—often diminish over time (Adler & Chua, 2002). ADHD can significantly impact day-to-day life. Adulthood comes with its own set of demands, and navigating these responsibilities with ADHD can be overwhelming (Adler & Chua, 2002). “Normal” tasks, such as arriving to work on time, planning and preparing meals, and making space for self-care, may become daunting and are often neglected.
Additionally, there are common challenges in the diagnostic process. Many individuals with ADHD also suffer from comorbid psychiatric disorders, which can obscure or mimic ADHD symptoms (Adler & Chua, 2002). Ruling out overlapping symptoms and navigating a potentially complex clinical picture can make accurate diagnosis difficult.
ADHD is not typically considered a disorder with adult onset; therefore, individuals who receive a diagnosis later in life have likely been experiencing symptoms since childhood. In many of these cases, it is believed that their ADHD went unrecognized or undiagnosed because certain traits were masked or compensated for—either by a supportive family environment or by the individual’s high intelligence, which helped them develop coping strategies (Asherson & Agnew-Blais, 2019)
Another complicating factor is the phenomenon of masking. Masking—commonly associated with autism spectrum disorder but also observed in ADHD—involves adjusting one’s behavior in social settings to appear more neurotypical (Adler & Chua, 2002). While this may help individuals blend in or meet external expectations, it often leads to emotional exhaustion, misdiagnosis, and an underestimation of the severity of their symptoms.
When to Seek Help
Recognizing the signs of ADHD in adulthood can be challenging, but there are key red flags to watch for. Struggles in relationships—such as frequently forgetting promises or neglecting responsibilities like chores—can strain personal connections (6 signs to seek help for ADHD, 2023). A history of “underachievement,” including academic difficulties or consistently falling short of potential, may also be an indicator (6 signs to seek help for ADHD, 2023).
Many adults with ADHD experience chronic stress, often accompanied by feelings of guilt, frustration, or blame, especially when they feel unable to keep up with everyday demands (6 signs to seek help for ADHD, 2023). Difficulty managing daily responsibilities—such as staying focused on tasks, completing chores, or organizing time—can further disrupt life and well-being (6 signs to seek help for ADHD, 2023).
It’s also important to note that certain groups, particularly women, are often underdiagnosed due to less obvious symptom presentations (6 signs to seek help for ADHD, 2023). Early diagnosis and intervention can be life-changing, offering access to treatment and support that significantly improves long-term outcomes.
If any of these challenges sound familiar, seeking professional help may be an important next step.
How ONE Health Can Help
At ONE Health, we are committed to delivering patient-centered, evidence-based mental health care. While we do not perform formal ADHD evaluations, our experienced providers are equipped to offer treatment and support for individuals with an existing ADHD diagnosis. We also assist patients in finding trusted resources and specialists for proper assessment when needed.
Our team takes a collaborative approach, working closely with other medical providers and mental health professionals to ensure comprehensive, coordinated care. With compassion and empathy, we provide ongoing support and medication management tailored to each patient’s unique mental health needs.
If you’re looking for ADHD treatment in Columbus, Ohio or need help managing anxiety, depression, or other psychiatric concerns, ONE Health is here to help.
Concerned about your mental health? Contact us today to schedule with a licensed psychiatric nurse practitioner in Columbus, Ohio. Schedule now.
Adler, L. & Chua, H. (2002). Management of ADHD in Adults. J Clin Psychiatry. 63(12), 29-35
American Psychiatric Association. What is ADHD? (n.d.). https://www.psychiatry.org/patients-families/adhd/what-is-adhd
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Asherson, P. & Agnew-Blais, J. (2019). Annual Research Review: Does late-onset attention-deficit/hyperactivity disorder exist? Journal of Child Psychology and Psychiatry. 60(4), 333-352.
Centers for Disease Control and Prevention. (n.d.). Diagnosing ADHD. Centers for Disease Control and Prevention. https://www.cdc.gov/adhd/diagnosis/index.html
Nazarova VA, Sokolov AV, Chubarev VN, Tarasov VV, Schiöth HB. Treatment of ADHD: Drugs, psychological therapies, devices, complementary and alternative methods as well as the trends in clinical trials. Front Pharmacol. 2022 Nov 17;13:1066988. doi: 10.3389/fphar.2022.1066988. PMID: 36467081; PMCID: PMC9713849.
(Pliszka, 2007
Teeter Ellison, P. A. (2003, June). About ad/hd: myths and misunderstandings . Attention!
Wender, P., Wolf, L., & Wasserstein, J. (2006). Adults with ADHD, An Overview. New York Academy of Sciences. 931(1), 1-16. https://doi.org/10.1111/j.1749-6632.2001.tb05770.x
6 signs to seek help for ADHD. Community Health Partners. (2023, June 21).
https://chphealthmt.org/news/6-signs-you-should-seek-help-for-adhd
