Understanding ADHD. What is ADHD?
Attention-deficit/hyperactivity disorder (ADHD) is a neurobiological disorder characterized by developmentally inappropriate impulsivity, inattention, and in some cases, hyperactivity.
Everyone has occasional difficulty sitting still, paying attention, or controlling impulsive behavior. For some children and adults, however, the problem is so pervasive and persistent that it interferes with their daily lives at home, at school, at work, and in social settings.
Until recently it was believed that children outgrew ADHD in adolescence. This is because hyperactivity often diminishes during the teen years. However, we now know that many symptoms continue into adulthood. If the disorder goes undiagnosed or untreated, adults with the disorder may experience trouble at work and in relationships, as well as emotional difficulties such as anxiety and depression.
People with ADHD can be very successful in life. But without appropriate identification and treatment, ADHD can have serious consequences, including school failure, depression, conduct disorder, failed relationships, and substance abuse. Early identification and treatment are extremely important.
What are the symptoms of ADHD?
ADHD symptoms usually arise in early childhood. Current diagnostic criteria indicate that the disorder is marked by behaviors that are long-lasting and evident for at least six months, with onset before age seven. Because everyone shows signs of these behaviors at one time or another, the guidelines for determining whether a person has ADHD are very specific.
In children, the symptoms must be more frequent or severe than in other children of the same age. In adults, the symptoms must be present since childhood and affect the person’s ability to function in daily life. For both children and adults, these symptoms must create significant difficulty in at least two areas of life, such as home, social settings, school, or work.
Increasingly, researchers are studying ADHD in the context of executive functions—the brain functions that activate, organize, integrate, and manage other functions. Impairment of these executive functions is considered highly interrelated to symptoms associated with ADHD.
There are three primary subtypes of ADHD, each associated with different symptoms.
ADHD—Primarily Inattentive Type:
- Fails to give close attention to details or makes careless mistakes
- Has difficulty sustaining attention
- Does not appear to listen
- Struggles to follow through on instructions
- Has difficulty with organization
- Avoids or dislikes tasks requiring sustained mental effort
- Is easily distracted
- Is forgetful in daily activities
ADHD—Primarily Hyperactive/Impulsive Type:
- Fidgets with hands or feet or squirms in chair
- Has difficulty remaining seated
- Runs around or climbs excessively
- Has difficulty engaging in activities quietly
- Acts as if driven by a motor
- Talks excessively
- Blurts out answers before questions have been completed
- Has difficulty waiting or taking turns
- Interrupts or intrudes upon others
Meets both inattentive and hyperactive/impulsive criteria
How is ADHD diagnosed?
Children and Teens
As there is no single test to diagnose ADHD, determining whether a child has the disorder takes many steps. A comprehensive evaluation is necessary to establish the diagnosis, rule out other causes, and determine the presence or absence of coexisting conditions. Such an evaluation requires time and effort. It should include a clinical assessment of the child’s school, social, and emotional functioning, as well as his or her developmental level. A careful history should be taken from parents, teachers, and the child when appropriate.
Teens with ADHD present a special challenge, as the academic and organizational demands upon them increase. In addition, they face typical adolescent issues: discovering their identity, establishing independence, and dealing with peer pressure.
Several types of professionals can diagnose ADHD, including pediatricians, psychologists, social workers, nurse practitioners, psychiatrists, and other medical doctors. A thorough medical examination by a physician is important. Only medical doctors can prescribe medication if it is indicated.
Regardless of who does the evaluation, use of the most current diagnostic criteria according to established professional standards of diagnosis is essential. During the evaluation process, the evaluating professional will request that the child’s parents and teachers complete various forms, checklists, and behavior questionnaires in order to gather comprehensive information.
Growing up with undiagnosed ADHD can have devastating effects, with adults often thinking of themselves as “lazy,” “crazy,” or “stupid.” As a result, proper diagnosis can be profoundly healing, putting present difficulties into perspective and making sense of lifelong symptoms.
A comprehensive evaluation for adult ADHD is best made by a clinician with experience in the disorder. This may be a behavioral neurologist, psychiatrist, clinical or educational psychologist, nurse practitioner, or clinical social worker. A comprehensive evaluation should focus on past and present ADHD symptoms; the person’s developmental and medical history; and school, work, and psychiatric history, including medications, social adjustment, and general ability to meet the demands of daily life.
Various adult rating scales have been developed for clinicians to use in evaluating adults for ADHD. Self-report by the adult being evaluated will likely be the source of most of the information. The evaluation should ideally include several other sources of information, however, such as reports from a parent or significant other.
Across the lifespan, individuals affected by ADHD are at an increased risk of experiencing additional cognitive, emotional, or behavioral disorders. Dealing with “ADHD Plus” presents real challenges to individuals and families.
Around two-thirds of children with ADHD have at least one other coexisting disorder. Disruptive behavior disorders, mood disorders, anxiety disorders, tics and Tourette syndrome, and learning disabilities are among the most common conditions that co-occur in children with ADHD.
The lives of most adults with ADHD are complicated by overlapping symptoms of such conditions as anxiety, depression, or substance use.
Overlapping symptoms can make it difficult to get a correct diagnosis, which adds to the complexity of effective treatment. Accurate diagnosis by a skilled clinician is important, because treatment can only be as good as the diagnosis on which it is based. The clinician must discern whether a symptom belongs to ADHD, to another disorder, or to both simultaneously. Be sure to ask your clinician about the possibility of coexisting disorders.
Medication Abuse and Diversion
Parents of children and teenagers who have been prescribed medication for the treatment of ADHD are rightly concerned about the appropriate use and possible abuse of these medications. This concern is shared by educators and others who are involved in children’s daily lives. At the heart of this concern is ensuring that children who have been correctly diagnosed with ADHD and—in the judgment of their physicians and parents might benefit from ADHD medication—receive the full benefit of these medications to help manage the symptoms of ADHD and to help them lead more full and successful lives.
When properly prescribed and administered, medications approved for the treatment of ADHD have been shown to be highly safe and effective. CHADD recognizes, however, that the medications used to treat ADHD can, like any medication, be abused in a variety of ways. The National Institute on Drug Abuse defines prescription drug abuse as
taking a prescription medication that is not prescribed for you;
taking a prescription medication for reasons or in dosages other than prescribed.
Adults who take prescription medications are responsible for taking them as prescribed. Children and adolescents, on the other hand, need the guidance of parents and other adults to help them understand the benefits of taking medication, along with the serious consequences of failing to take their medication properly.
Most ADHD medications are stimulants and categorized by the Drug Enforcement Administration as Schedule II Medications. This means that any improper use of them—including providing them to someone without a prescription or taking them without a prescription—is a federal crime.
What is medication diversion?
One of the potential ways in which prescribed medications may be abused is known as diversion. This refers to the situation in which a medication prescribed for one person ends up in the hands of another. This diversion from one person to another may come about through various circumstances. This is a very serious issue.
For example, a child may be showing off at school and may share his or her medication with others. A child may also be coerced into giving away or even selling his or her medication. In a report prepared for the Judiciary Committee of the US House of Representatives, the Government Accounting Office stated that 8 percent of high school and middle school principals reported at least one instance of diversion or abuse of a medication used to treat ADHD. Most of these principals reported knowing of only a single incident. College-age students face unique challenges concerning potential diversion. Some students who do not have ADHD may seek out stimulant medications with the desire to enhance their academic performance or experiment with any possible physical reaction to taking the medications. This places an even greater burden on those students for whom the medication is prescribed to be diligent in ensuring that it is used properly.
Adapted from Medication Abuse and Diversion, prepared by the National Resource Center on ADHD: A Program of CHADD Created 2010 / Updated 2012
What can parents do to prevent diversion?
CHADD provided the following guidance to parents and young adults in Attention magazine in The Diversion of ADHD Medication: What You Need to Know. CHADD’s National Resource Center on ADHD also provides a related FAQ titled, Is it illegal to carry ADHD medication?
Protect your child – prevent diversion
Get the facts and avoid the myths associated with ADHD medication from your doctor.
Educate your child about his or her medication, the laws that govern its use, and how it can interact with other substances.
Speak with your child about respecting the purpose of the medication and using it only for its prescribed and intended purpose.
Stress the importance of reporting any side effects to you and your treating physician.
Consult with your child’s doctor and develop a solid medication plan that will work at home and school. Revisit that plan if and when your child goes away to college.
Make sure your child understands that he or she is taking what is considered a controlled substance that is illegal to all others.
Make sure that the school is aware of the medication that your child is taking, even if it is not dispensed by school medical personnel. This is especially important if your child is away at college.
Make sure your child understands the need to keep medication safeguarded inside its prescription container at all times.
Plan ahead, along with your child, for prescription renewals. Schedule II medications cannot be refilled verbally, or without a new prescription.
Provide your prescribing physician’s contact information to the school along with the prescription information itself in the event that any emergencies arise.
What you need to know and do
Know that your ADHD meds are a controlled substance. Possession of these medications without a prescription is illegal.
Safeguard your medication from theft on campus. It is an important tool to management of your ADHD symptoms and it should be there when you need it.
A gift is a sale. In the eyes of the law, giving a controlled substance to someone who does not have the legal or medical authority to possess it is the same as selling it.
Don’t share your medication with others. Giving controlled substances to your friends is not only illegal, but can cause them harm if they are not being supervised by a doctor.
Follow your medication plan. Changing your plan without consulting your doctor can have medical consequences and can create a surplus of pills that can lead to trouble. If you don’t feel that you need to take your meds on the schedule prescribed, tell your doctor and modify the plan with his or her guidance.
Have local resources. If you are away at school, have your prescribing doctor coordinate with a doctor located near your school to address any issues that may come up or emergencies.