“The best way to think of [ADHD] is not as a mental disorder but as a collection of traits and tendencies that define a way of being in the world.”
– Edward M. Hallowell, M.D. ❤️
November 2021, Volume 4
The G.T.Health Letter
~Adding a dose of mental health awareness to our community~
Mental Health Spotlight – ADHD
Xtra Scoop of the Week – ADHD Around the World
Weekly Testimonial – COVID-19 Has Stolen My Attention Span
Mental Health Spotlight – Attention-Deficit Hyperactivity Disorder (ADHD)
What is ADHD?
ADHD (attention-deficit hyperactivity disorder) is characterized by prominent and impairing inattention or hyperactivity/impulsivity. It is often diagnosed in childhood, and for the most part girls are usually diagnosed with the inattentive subtype (ADHD-PI), and boys with the hyperactive subtype (ADHD-PH). There is also a combined subtype (ADHD-C), with both types of symptoms present. ADD, or attention-deficit disorder, is the precursor to ADHD; it is essentially the same disorder but does not recognize the hyperactivity side of things, so is much less commonly used these days. Primarily-inattentive ADHD is diagnosed based on at least six symptoms (5 for adults) that are both pervasive and developmentally inappropriate, such as trouble holding attention, failing to finish tasks, failing to organize tasks, and avoidance of tasks requiring mental effort. Primarily-hyperactive ADHD is diagnosed based on symptoms of a different kind: fidgeting with hands and feet, running/climbing/getting up at inappropriate times, acting as if driven by a motor, and talking excessively. A child simply hating school and acting out is not enough to warrant a diagnosis; the symptoms must be present in at least two settings. Another major symptom of ADHD, which can be tested in individuals, is temporal discounting, or the inability to see value in a reward if it is delayed and promised in the future versus the present. For example, if I had ADHD and were promised $10 now or $100 in a month, I would probably choose the $10 now, since the reward is immediate and there is no need for sustained attention.
ADHD Through the Ages: The Diagnosis Crisis
The prevalence rate of ADHD in all children is 9.4%, and is about 4% for the adult population (although this number is slowly increasing). Being a psychological disorder (a specific collection of traits that are unhelpful in specific environments), it does not simply disappear after childhood, when it is usually diagnosed. Instead, the presentation of the disorder changes; for example, adults might lack attention to detail, seem not to listen when spoken to, or ramble, and are generally more inattentive and impulsive than hyperactive. This seems fairly straightforward; however, the problem here is that we perceive ADHD as a disorder of childhood, and thus psychiatrists are less trained to look for symptoms of ADHD in adults. The DSM-5, the diagnostic manual that we use to understand symptoms of disorders, mentions ADHD almost with the assumption that it is referring to a child: the symptoms listed usually have more to do with childhood activities, like climbing things, failing to play quietly, or interrupting games. This imbalance leads to underdiagnosis in adults, whose troubles in life might go unrecognized or untreated, but also overdiagnosis in kids. Children, by nature, are rowdy and energetic, and it can be very difficult to separate normal levels of hyperactivity from disordered levels (this is where the “developmentally inappropriate” criterion becomes very relevant).
How can you help someone with ADHD?
Having ADHD is like having a swirl of thoughts constantly blowing around in your head that you can’t hold on to or chase for long. Therefore, people with ADHD might find it harder to develop social skills, especially because their inattention and/or hyperactivity symptoms likely began when they were younger and thus have been with them for years. Being interruptive, impulsive, and unable to regulate mood or agitation can make it difficult to hold conversations; your inattention might seem shy or ignorant and your impulsivity might seem aggressive or uncanny. When it is hard to keep your daily schedule in line, remembering appointments and basic tasks, it is even harder to do higher-order thinking like that which is required to keep up a friendship. If you have a friend who has been diagnosed with ADHD or has symptoms of ADHD, it is critical that you remember what I’ve just said: ADHD might not be visible to you, but it is very hard to cope with for the person who has it. Although it might be frustrating for you at times, know it is much worse for them, so some of the most important virtues you can practice are patience and compassion. If you notice your friend spacing out or losing track of the conversation, patiently redirect or remind them instead of becoming upset that they can’t keep up. Have a sense of humor about your friend’s slowness in keeping up with your train of thought. You don’t need to suffer in silence if their inattention takes a toll on you (don’t be afraid to be honest!), but you should try your best to be compassionate and assume they are trying rather than assume they are being a bad friend. Their behavior might not indicate their actual feelings.
How is ADHD treated?
ADHD can be treated through both medication and therapy, either alone or together. Behavioral therapy is the most effective therapy type for this disorder (in both adults and kids), as it essentially teaches focus and self-control. Prescription medication operates on the neurological level (helping regulate irregular brain waves), but therapy addresses specific behavioral problems with interventions like structuring time at home, increasing positive attention, and establishing predictable routines. The therapy is conducted with parents if the patient with ADHD is a child. Progress is made towards achievable and relevant goals; for example, it is more important to have a dressing routine than a bed-making routine, since friends won’t see your bed but they will see if you’re naked. Behavioral therapy also features progress monitoring to keep up with these goals (keeping a checklist, reminding when the person starts showing symptoms, etc). Since some medications can be ineffective or cause bad side effects (such as addiction/dependency in many cases), therapy is a great direction to take for all patients. Most medications that are used to treat ADHD are stimulants that enhance cognitive functioning; because it affects the central nervous system, it can help with focus, fidgeting, and increasing energy levels. Stimulant medications, the most common being Adderall, work for up to 80% of people who use them, and are employed in moderate or severe cases over the age of 3 or 6. Non-stimulant drugs also exist, and can help with concentration and impulse control.
If you want more information on ADHD from the perspective of those who have it, please visit ADDitude (www.additudemag.com) for lots of really important testimonials!
Excerpt from “Me” – Justin L.
To those who I will meet,
Or those I’ve already met
I must tell you something about me
That you have probably already guessed.
I have a disorder
That’s Attention Deficit Hyperactivity Disorder
And it’s not just common to me.
A lot of people have it
And it’s very hereditary,
Or, as other people say,
It runs in the family.
So, on to me.
My brain is different than
The brain “normal people” have. It’s also different than the brain
That other ADHD people have.
I must explain about ADHD
Using examples specific to me.
My brain moves at Hyperspace
From Tatooine to Naboo and then to Alderaan
While you watch the Death Star I’m on Coruscant
And then I arrive back to find Alderaan is gone. My brain works like this every day
And there is more that I didn’t say.
Let’s continue going this way.
If you watch Brain Games or MythBusters you’ll find
That men are better at spatial awareness
But for me that is not the case Things that I organize end up horrendous.
And watch out, I may step on your feet
I don’t even notice that you’re there
But don’t think that I did that on purpose,
And don’t even say that I don’t care.
Let’s talk about this poem.Justin seems to have symptoms of both inattention and hyperactivity, meaning that he not only has trouble getting his brain to focus but he also has trouble keeping still. Because ADHD so commonly emerges in childhood, and because children are usually pretty critical of each other, bullying is a very common experience for children with ADHD. It is a disorder (like most) that is impossible to fully understand unless you have it yourself, and this lack of understanding can contribute to a lot of negativity and mean assumptions about those with ADHD. Testimonials like this, therefore, are beautiful in multiple ways: they not only enlighten us to what it’s like to have ADHD, but they also spread awareness about the experiences people with ADHD have with the rest of the world.
Justin is also correct: ADHD is extremely hereditary, and children of parents who have ADHD are more than 50% likely to develop it themselves. This is likely because ADHD affects the brain so much, thus meaning it probably has a genetic basis: several brain regions, like the prefrontal cortex (high-order reasoning), cerebellum (coordination and motor skills), and basal ganglia (voluntary behavior) are all unique in people with ADHD, being less dense and less neurologically connected to the rest of the brain. It is for this reason that prescription medication helps so many people with ADHD; therapy can help with behavior, but for many this is not enough, as the brain itself functions differently.
Xtra Scoop of the Week – ADHD Around the World
Prevalence Rates by Country
ADHD is estimated to have a worldwide prevalence of around 2.2% in children and adolescents under age 18, and up to a 5.3% prevalence rate across all ages. Some of the highest childhood rates are in the US (8.1%) and Spain (5.4%), and some of the lowest are believed to be in Iraq (0.1%) and Romania (0.4%). The huge prevalence in the US in particular could be due to the barrage of colorful information children receive daily from cartoons, videos, commercials, etc; in the age of technology, it is very easy to lose one’s attention span because there is always something new and shiny to catch one’s eye. Adult ADHD, on the other hand, is reportedly highest in France (7.3%), but still lowest in Iraq (0.6%) and Romania (0.6%).
Prevalence Rates by Gender
ADHD is suggested to be more common in males than females, although this could be due to underdiagnosis in females (who are usually thought to be more inattentive) and overdiagnosis in males (who are usually thought to be more hyperactive). In a naturalistic (observational) study over 2 years of 1,478 children (age 6-18) in 10 European countries, the ratios of prevalence varied from 1:3 (one female for every 3 males) to 1:16 across those countries. In all cases, though, males were diagnosed more often, and this was the same in adults. Although the gender difference decreases with age, it still exists; there is a 1:1.6 female:male diagnostic ratio in people over age 19. There is no core genetic difference that makes girls more inattentive and boys more hyperactive, but these trends do still emerge generally, although symptom differences do decrease in adulthood as well.
Weekly Testimonial – COVID-19 Has Stolen My Attention Span
I am not diagnosed with ADHD, and probably never will be. But as I’ve learned more about its symptoms and presentation in adulthood, I’ve begun to notice certain patterns in myself that align with the diagnostic criteria. Some common symptoms in adult women with ADHD are as follows:
Indecision (I drive my boyfriend crazy with it),
Rambling/emotional outbursts (I have been made fun of for how quickly I talk)
Nervous procrastination (I’ve never started anything on time)
Overspending (new things lose my interest so quickly that I find myself needing to buy more)
Paper clutter/disorganization (you should see my desk and attempts at planners/checklists)
Problems listening (I usually space out in the middle of someone talking to me and then have no idea to respond, or I fixate on one idea I want to respond to and then miss the rest of what they’re saying)
As you can see, I can relate to a lot of these symptoms, and only 5 are needed to diagnose ADHD in adulthood. I also am incapable of multi-tasking, since I lose track of both things, and I have trouble keeping track of my thoughts whilst also saying them out loud. My checklists are so disorganized because I have to write every little thought down before I forget it, and am constantly bombarded with random, irrelevant thoughts that I then fixate on. I’ve also started bringing a small fidget toy to my 3-hour class, since I become very agitated sitting for so long.
These problems, I believe, have become exacerbated since I’ve entered the Ivy League, and especially since COVID. When we transitioned online, I suddenly had an avenue through which to stop paying attention to my classes in favor of watching Youtube, scrolling Instagram, etc. As a lot people experienced, I believe my attention span got even shorter because I could ‘escape’ class whenever I wanted, and now I’m having to work extra hard to get it back.
That’s all for this week, folks!
Next week’s topic:Anxiety Disorders
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