ADHD Part 1 – Medical Definition

ADHD (Attention Deficit Hyperactivity Disorder) is the most commonly diagnosed “disorder” applied to children. It affects children, teens and adults. It has high prevalence (5 to 8 of 100) and is a condition that is poorly understood. It can be difficult to manage, especially if the condition is misunderstood and mistreated.

Part 2 – Experiencing ADHD [Link]

Part 3 – Managing ADHD [Link]

Luis from the Marvel movie Ant-Man shows many classic examples of ADHD – odd conversation style, low ability to stay focused, easily distractible

Defining ADHD

ADHD describes a condition of low attentiveness (thus the Attention Deficit part of the name) caused by hyperactive brain activity that sometimes also affects the motor section. Common side issues of ADHD is doing behaviours with low regard to consequences and emotional dysregulation (mood varies chaotically and can be hard to control).

People diagnosed with ADHD often describe it as trying to work out what is the important thing to do, when that thing over there is more shiny, and now that, oh and look over there… Prioritising, concentrating and sticking to a chosen task is hard, while being distracted and becoming engrossed (hyper-focused) on an unimportant task is common.

The average adult has a 20 minute window of concentration, the average university student has evolved a 40 minute window of concentration. The average adult diagnosed with ADHD is about 5 and can train up to 10 minutes. If you can’t fit a task that isn’t shiny into 5 minutes, it won’t get done. Shiny is a personal definition – what is shiny for me won’t necessarily be shiny for you.

Working with someone with ADHD can be frustrating as they don’t stick to a task for as long as you want them to, get easily distracted by something else and seem to have a very different idea about what is important. Often we take out our frustration on the other, forgetting this this is frustrating for them too. Imagine knowing you need to do a thing, it is vitally important, but your brain just won’t let you. It’s like “I need to do this thing – I roll my two 6 sided dice to see if I do it, if I roll twin 6’s, I get to do it… and I guess I’m doing some other random thing instead”.

Steve Irwin – amazingly full of energy

Richard Giles [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0/)]

ADHD vs ADD

Originally there were two conditions – ADD was used to describe people who seemed to fade out, or would easily get distracted, while ADHD was used to describe people who fidgeted, couldn’t sit still and were full of energy. While both of these were noted for attention deficit, it was considered to be two separate conditions.

In modern times it is recognised that these both have the same root cause (mostly) with different presentations. As such, ADHD has three subtypes – inattentive (classic ADD, now called ADHDi), hyperactive-impulsive (classic ADHD, now called ADHDh or ADHDhi or ADHDk) and combined (ADHDc). Many practitioners still use the old terminology to distinguish the subtypes – with hyperactive (ADHD) or without (ADD).

Prevalence and causes

In children under 18 years of age, 7.2% of people fit the criteria for ADHD. This will vary a little based on country and screening tools. This statistic is pulled from a meta analysis of 175 reliable studies.

Unfortunately adults with ADHD have not been as well studied. Studies in Europe, the Middle East and the United States of America indicate a likely 3.4% of people
fit the criteria for ADHD.

(General Prevalence of ADHD – CHADD [Link])

Some of this variance from childhood may be the end of puberty defiance, or it may be that the adults have learned how to temper themselves better and camouflage their experience. More study into this is needed.

Another confounding factor is that children are often screened by asking the parents questions. Parents who come from a stricter background are likely to over-report difficult behaviour, not necessarily because the child has a disorder, but because the parent’s definition of reasonable is variable.

While a specific gene has not been located for ADHD, it is well known that ADHD tends to run in families. It can also spontaneously appear, especially in the presence of certain pollutants, premature or underweight birth and brain damage. While ADHD is unlikely to be a learned behaviour, some environments promote ADHD symptoms over others.

(About ADHD – Symptoms, Causes, and Treatments – CHADD [Link])

What this amounts to is that in any group of 20 people, you are likely to have between 1 and 2 people who are likely to fit the criteria for ADHD. For most classrooms of 30 kids, you are statistically likely to have have two people who fit the criteria. Many schools will note these youth and put them into a specialty class that doesn’t actually address the ADHD issues well, but mostly aim to contain the disruption these youth bring to from the rest of the class. This does not help people with ADHD symptoms to learn to manage themselves, it promotes self blame and lowered self esteem.

Co-occurring conditions

As many as 65% of people who fit the criteria for ADHD also have a co-occuring (comorbid) presentation with at least one other condition, around 25% of people have two, and some have three or more. It can be difficult to determine if these other conditions are parallel (happen to be in the same person at the same time) or secondary (one promotes diagnosis of another).

Most common co-occuring conditions in children:

  • Oppositional Defiant Disorder (ODD) and Conduct Disorders (CD)
  • Specific learning disorders (language, learning and motor skills)
  • Autism Spectrum Disorder (ASD)
  • Intellectual disorder

Most common co-occurring conditions in adults:

  • Anxiety (General Anxiety Disorder, Social Anxiety, specific phobia)
  • Depression
  • Substance Abuse
  • Intermittent Explosive disorder(impulsive anger)

( Psychiatric Comorbidities in Patients with ADHD|ADHD Institute [Link] and ADHD And Co-occurring Conditions – CHADD [Link])

What this amounts to is the fact that people trying to manage ADHD symptoms are often also trying to manage other things as well, each of which often requires specific methods to manage, some of which contradict.