Define: Attention-Deficit/Hyperactivity Disorder (ADHD)

 

Attention-Deficit/Hyperactivity Disorder (ADHD)

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by persistent patterns of inattention, impulsivity, and hyperactivity that interfere with daily functioning or development. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is commonly used to diagnose ADHD.

The primary diagnostic criteria for ADHD according to the DSM-5 are:

Inattention

Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents aged 17 years and older and adults; symptoms must be present for at least 6 months:

1. Fails to give close attention to details or makes careless mistakes.
2. Has difficulty sustaining attention in tasks or play.
3. Does not seem to listen when spoken to directly.
4. Does not follow through on instructions and fails to finish tasks.
5. Has difficulty organizing tasks and activities.
6. Avoids, dislikes, or is reluctant to engage in tasks requiring sustained mental effort.
7. Loses things necessary for tasks and activities.
8. Is easily distracted by extraneous stimuli.
9. Is forgetful in daily activities.

Hyperactivity-Impulsivity

Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents aged 17 years and older and adults; symptoms must be present for at least 6 months:

1. Fidgets with or taps hands or feet or squirms in seat.
2. Leaves seat in situations where remaining seated is expected.
3. Runs about or climbs in situations where it’s inappropriate.
4. Unable to play or engage in activities quietly.
5. Is "on the go," acts as if "driven by a motor."
6. Talks excessively.
7. Blurts out an answer before a question has been completed.
8. Has difficulty waiting his or her turn.
9. Interrupts or intrudes on others.

Additional Criteria

• Several symptoms must be present before age 12.
• Symptoms must be present in at least two settings (e.g., home, school, work).
• There must be clear evidence that the symptoms interfere with social, academic, or occupational functioning.

Reasons for Late Diagnosis:

1. Coping Mechanisms: Some adults develop coping strategies that help them manage ADHD symptoms, thereby masking the disorder's more obvious indicators.
2. Subtle Symptoms: In adults, symptoms might be less overt and could manifest as issues like chronic disorganization, poor time management, or emotional dysregulation, rather than hyperactivity.
3. Awareness: Earlier generations were raised with less awareness and understanding of ADHD, which could have contributed to a missed diagnosis in childhood.
4. High Functioning: Individuals who are intellectually gifted or have strong compensatory skills may perform adequately in academic or work environments, obscuring the need for a diagnosis.
5. Stigma: Societal stigma about ADHD and mental health conditions can deter people from seeking a diagnosis.
6. Comorbid Conditions: ADHD often occurs alongside other psychiatric conditions like depression or anxiety, which could be diagnosed first, overshadowing the ADHD.
7. Gender Bias: ADHD has historically been diagnosed more frequently in males, especially those who display hyperactivity. As a result, females or individuals who display primarily inattentive symptoms are often overlooked.

Implications:

1. Emotional Impact: A late diagnosis can be both a relief and a source of anxiety or confusion, as adults grapple with reinterpreting their life experiences through the lens of ADHD.
2. Treatment: Medication and behavioral therapies effective in children are generally effective in adults as well, although adult-focused resources may be less plentiful.
3. Personal and Professional Life: Understanding one has ADHD can be a pivotal moment for personal development, potentially leading to more effective coping strategies and better outcomes in work and relationships.

Weight of Evidence:

Research increasingly supports the idea that ADHD is not just a childhood disorder but a lifelong condition. Late-diagnosed adults are gaining more attention in clinical and academic circles, emphasizing the importance of diagnosis and treatment options suitable for this age group.