Defining ADHD
Attention Deficit Hyperactivity Disorder (ADHD) has become an increasingly hot topic over the past two decades but how do we define it and why does it matter?
Definition
The NICE guidelines defines it as “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development”. It also goes on to say that you should have symptoms developing before the age of 12 and they must be present for over 6 months (1).
ADHD affects around 5% of children worldwide. Rates in the US where diagnosis and treatment is highest run between 8-10%. ADHD is more commonly diagnosed in boys than girls; this is thought to be because boys tend to present with disruptive symptoms which prompts referral (2).
The cause of ADHD is unknown but it is thought to be a mixture of genetic and environmental factors (3).
In our book club pick this month, Gabor Mate defines ADHD differently from most other clinicians I have come across but in my opinion his definition is much more hopeful for families and patients. He describes it as “a reversible impairment and a developmental delay…It is rooted in multigenerational family stress and in disturbed social conditions in a stressed society”. Viewing ADHD as an impairment rather than a disease makes it something that can be lived with and overcome well. Viewing ADHD as rooted in stresses in childhood, most of which is unavoidable at the time, also opens up possibilities of reversal (4).
Diagnosis
Now that we have discussed the definition it would be helpful to discuss the symptoms that underpin the diagnosis. We can split the symptoms into inattention symptoms and hyperactivity-impulsivity symptoms.
Inattention symptoms include:
Failing to give close attention to detail
Difficulty in maintaining concentration when performing tasks
Appearing not to listen to what is being said
Failing to follow through on instructions
Difficulty in organizing tasks and activities
Reluctance, dislike, or avoidance of tasks that require sustained mental effort
Losing items necessary for tasks or activities such as pencils, mobile phones, or wallets
Hyperactivity-impulsivity symptoms include:
Fidgeting with or tapping hands or feet
Leaving the seat where remaining seated is expected
Running about or climbing in situations where inappropriate
Talking excessively.
Difficulty waiting his or her turn.
Interrupting or intruding on others.
This list is not exhaustive and symptoms can vary greatly from one person to the next (5). A helpful screening tool for adults is the Adult ADHD Self-Report Scale which you can work through with a clinician prior to referral for assessment- link found below (6).
Once you suspect ADHD, getting a diagnosis through a detailed assessment with a specialist can help you manage and overcome the challenges that someone with ADHD may have. Decisions around management will be discussed in further blog posts but hopefully this serves as a first port of call for screening questions to ask and symptoms present for diagnosis.
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