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What is ADHD?

Updated: Apr 12, 2023

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by impairing levels of inattentive and/or hyperactive and impulsive behaviours. Whilst ADHD usually manifests itself in early childhood in recent years there has been increasing numbers of adolescents and adults receiving their diagnosis. Individuals with ADHD may have difficulties with maintaining attention, executive function and working memory. To be diagnosed with ADHD an individual must experience at least six symptoms from either (or both) the inattention ground of criteria and the hyperactivity and impulsivity criteria. These symptoms must have persisted for at least six months to a degree that negatively impacts directly on social educational and work settings.

The criteria of symptom for diagnosis can be seen below.


Inattentive Presentation


Hyperactive-Impulsive Presentation


· Fails to give close attention to details/ makes careless mistakes

· Difficulties in sustaining attention

· Doesn’t appear to listen

· Struggles to follow through on instructions

· Difficulty with organisation

· Avoids or dislikes tasks requiring sustained mental effort

· Loses things

· Easily distracted

· Forgetful in daily activities

· Fidgets with hands or feet or squirms in chair

· Difficulty remaining seated

· Runs about or climbs excessively in children, extreme restlessness in adults

· Difficulty engaging in activities quietly

· Acts as if driven by a motor; adults will often feel inside like they were driven by a motor

· Talks excessively

· Blurts out answers before questions have been completed

· Difficulty waiting or taking turns

· Interrupts or intrudes upon others

Causes of ADHD

Whilst there is agreement that ADHD is a neurodevelopmental disorder there is some level of disagreement surrounding whether ADHD occurs because of genetics or whether there is a role for environmental influences.


Genetic

Genetic explanations of ADHD focus upon considering structural, functional, and chemical differences within this brain. Structural differences refer to abnormalities in the formulation of the brain structure itself. Research has found that the right pre-frontal cortex is smaller in children with ADHD compared with their neurotypical controls. It has been found that typically a child with ADHD may experience developmental delays of on average about three years in areas of the executive functions, emotional control and working memory. Functional explanations look to brain activity when explaining ADHD. Children with ADHD have been shown to have reduced activation in the right prefrontal cortex and the anterior cingulate cortex. ADHD can affect neuron activity. Neurons may not release enough neurotransmitters; the receiving neuron may have trouble receiving the neurotransmitter of the neurotransmitter may get engulfed by the sending neuron before a good connection is made with the receiving neuron. There are also explanations of ADHD that evidence chemical differences. Research has shown that children with ADHD experience reduced levels of dopamine in the prefrontal cortex. The genetic evidence that has been presented provides a potential explanation for why it is estimated that there is a nine times chance of a first degree relative of someone who has ADHD also having ADHD themselves.


Environmental

Whilst there is a large genetic evidence base for ADHD, research has also shown that environmental factors can also impact the chance of a child receiving a diagnosis of ADHD. The environmental risk factors associated with ADHD include mental related prenatal risks (such as substance misuse or maternal stress) pregnancy and birth complications (including premature birth and complications in delivery) and a potential role for external agents such as infection and psychosocial adversities.

Treatments and Support

Due to the strong genetic basis for ADHD one of the most common treatments that can be offered is the use of medication. Stimulant medications such Ritalin are thought to be effective as they correct the dopamine levels in the prefrontal cortex which in turn produces a calming effect and reduces impulsive behaviours. Nonstimulant medications do not start working as stimulant medication but have the benefit of lasting up to twenty-four hours.

Not all young people who are diagnosed with ADHD are prescribed medication. Many will instead be supported through behaviour therapy of additional support at school.


Implications

Whilst it has been discussed what ADHD is, the causes and potential support or treatments that can be offered, it is important to consider the implications and potential difficulties a young person with ADHD may experience.


Executive Function

Individuals with ADHD often exhibit deficits in one or more area of executive functioning (higher-level cognitive skills and functions). Young people with ADHD may experience difficulties with their verbal working memory, emotional regulation, behavioural inhibition, motivation, planning, strategy generation and implementation and self-monitoring. It is important to recognise these difficulties in executive function that occur due to differences in the brain development of a young person with ADHD, as when assessing performance, it is likely that a child with ADHD will perform below average for the average compared to their age-related peers. Executive functions are not fixed, and with support young people can develop their skills in these areas, but it is likely that a child with ADHD will take longer than their neurotypical peers to fine tune these skills.


Education

Research has shown significant relationship between ADHD and various difference aspects of education. For example, it has been shown that the core symptoms of ADHD can negatively affect a child’s functioning in the educational environment in areas such as reading ability, writing and mathematics, which can result in lower attainment as well as general attitudes towards school. Research has also shown that children with ADHD show higher rates of disruptive and high-risk behaviours which can thus impact classroom behaviour, attendance and ultimately exclusions from school. Research such as these highlight the importance of young people with ADHD receiving early identification and intervention to help them not only manage the school environment but also to provide them with as many opportunities to thrive as their neurotypical peers.


Mental Health

It is important to highlight here that whilst some consider ADHD as a mental health difficulty, this section wishes to look at the potential comorbidities that a young person with ADHD may experience in relation to their mental health. Children with ADHD are more likely to develop poorer self-perception and poorer social and communication skills than their neurotypical peers. There is evidence to support that those with ADHD are more likely to experience anxiety, depression, conduct disorder, substance abuse and sleep problems. One recent study that looked at which symptoms were viewed as having the most significant impact on an individual experiences found that children tending to report more internalizing problems that are distressing to them such as fears and worries. The close links between ADHD and potential struggle with mental health and wellbeing highlight the importance of encouraging open communication around emotions and feelings. Through encouraging a child to disclose how they are feeling as well as also being open and honest about your own wellbeing lays the foundation for a supportive and compassionate relationship as a child grows and develops. It is hoped that through the young person will not need support with their mental health but laying the correct foundations will make assist the young person in voicing their troubles if they do require further support.


Tips

So, now we have understood the explanations and causes of ADHD and the potential treatments and implications of this diagnosis, you may be wondering what is the best way for me to support a young person with ADHD?

We have put together our top five tips for supporting a young person with ADHD:

1. Understanding

Our first top tip is to understand what ADHD is and how it can affect a child and their behaviour. Before punishing difficult and challenging behaviour stop to think why this behaviour is occurring, is this a result of the young person’s brain development or chemical abnormalities. Recognising that the young person themselves may not understand why they have just displayed that behaviour is the first step in helping them to develop and control their challenging behaviours moving forward.

2. Practical Solutions

Go back to basics. Sometimes something that you may consider simple and require no thought can be a challenging task for a young person with ADHD. Giving simple instructions, setting clear boundaries, using routines and schedules, and supporting with organisation has the potential to provide a young person with the scaffolding they need to thrive and excel. It is also important to manage distractions that a young person may experience. For example, turning the tv off before talking to them, limit background noise or the number of visual stimuli can provide an environment where a young person may find it easier to concentrate. Allocating time for regular breaks and movement can also provide a child with a way of directing their energy and hyperactivity into a positive output.

3. Empathy and Compassion

The importance of being empathetic and compassionate in all interactions with a young person with ADHD should never be underestimated. Recognising activities that they may find difficult with and not downgrading this struggle will allow the child to feel their validated and supported in overcoming this adversity. Listening to and understanding what the young person feels and experiences is important to allow understanding in what works for them. It is also important to remember to praise and recognise achievements, no matter how small. We are all guilty, myself including of being quick to highlight when something is done wrong, but the importance of recognising another achievements and accomplishments is even more important, as after all, its always nice to be told you’ve done something well!

4. Asking and accepting help

A young person who is diagnosed with ADHD should be offered lots of different support from a wide variety of sources. Within their education they may for example be offered additional support or tuition. A young person may receive an educational health care plan to support them with their academic development. If you or a young person is struggling, reaching out for additional support is so important. We all need a little help now and then, so let the people help you, your later self with thank you for it!

5. Diagnosis

If you think either yourself or a young person may have ADHD reach out and seek a diagnosis. Early detection of ADHD has been recommended as treatment and support of symptoms has been shown to improve outcomes in the long term. Receiving a diagnosis is the first step towards receiving the support and help you both need and deserve.


Sources


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