CLINICAL REQUIREMENTS: What clinical requirements are required to confirm a diagnosis of attention deficit hyperactivity disorder (ADHD)?

A: All patients must have a full psychiatric evaluation and physical examination. Here is a cautionary note underscoring the need for a full assessment for late-onset ADHD in adolescents and young adults… | Keep reading on Medscape »

PEDIATRIC ADHD: Which diagnostic tests should I administer for the evaluation of pediatric ADHD?

A: Workup in attention deficit hyperactivity disorder (ADHD), previously termed attention deficit disorder (ADD), includes the following… | Keep reading on Medscape »

ADHD DIAGNOSIS: What steps comprise an authoritative ADHD diagnosis?

A: An accurate ADHD evaluation includes several standard diagnostic steps and nuanced considerations; other “tools” are unproven and worth neither your time nor your money… | Keep reading on ADDitude »

COMPLEX ADHD DIAGNOSIS: What tests, assessments, and questionnaires are used to evaluate patients for complex ADHD?

A: Many children and adults begin by taking an online test of common ADHD symptoms and then taking the results to an ADHD specialist for review and evaluation… | Keep reading on ADDitude »

Free Webinar: Expert Guidance for Securing an Accurate ADHD Evaluation

Expert Webinar with Thomas E. Brown, Ph.D. | Listen now on ADDitude »

Free Webinar: How Brain Imaging Helps Us Understand and Treat ADHD

Expert Webinar with Jonathan Posner, M.D. | Listen now on ADDitude »

7-Week Guide to Differential Diagnosis of ADHD, from Medscape x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
> DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

PATHOPHYSIOLOGY: How does ADHD impair the areas of the brain responsible for executive function? (ADHD)?

A: Findings from neuropsychological studies suggest that the frontal cortex and the circuits linking them to the basal ganglia are critical for executive function and, therefore, to attention and exercising inhibition… | Keep reading on Medscape »

DEFICIENT EMOTIONAL SELF-REGULATION: Is emotional dysregulation an ADHD trait? How does it affect diagnosis and treatment?

A: DESR, or deficient emotional self-regulation, is a core facet of ADHD that carries significant consequences. However, it is not included the disorder’s diagnostic criteria. As new research confirms…| Keep reading on ADDitude »

SLEEP: Why does ADHD impact a patient’s sleep?

A: Sleep disturbances caused by ADHD have been overlooked for a number of reasons, including the late age of onset. But recent studies confirm that ADD symptoms do not go away at night… | Keep reading on ADDitude »

COMPLEX ADHD: What is complex ADHD?

A: Most children and adults with ADHD have one or more co-occurring conditions, which almost always impact treatment and outcomes. “Complex ADHD” is a relatively new term that reflects this phenomenon… | Keep reading on ADDitude »

RSD AND ADHD: Is rejection sensitive dysphoria a symptom of ADHD?

A: Rejection sensitive dysphoria is not a formal ADHD symptom, but it is commonly experienced by patients with ADHD who experience extreme emotional sensitivity and emotional pain. It may imitate mood disorders with suicidal ideation and manifest as instantaneous rage at the person responsible… | Keep reading on ADDitude »

RESEARCH ON EMOTIONAL DYSREGULATION: What do I need to know about the latest research on ADHD and emotional dysregulation?

A:  Recent findings suggest that problems with emotional regulation, including anger and negative emotions, are genetically linked to ADHD… | Keep reading on ADDitude »

STIGMA: How can clinicians address the stigma around ADHD in Black communities to ensure better healthcare?

A: Battling stigma is nothing new in the ADHD community. The lack of understanding is surprising, even among professionals. But in Black and other marginalized communities, it abounds. | Keep reading on ADDitude »

RELATED RESOURCES

Deficient Emotional Self-Regulation: The Overlooked ADHD Symptom That Impacts Everything

Expert Webinar with Russell Barkley, Ph.D.| Listen now on ADDitude »

Complex ADHD: The New Approach to Understanding, Diagnosing, and Treating Comorbidities in Concert

Expert Webinar with Theresa Cerulli, M.D. | Listen now on ADDitude »

How ADHD Shapes Your Perceptions, Emotions & Motivation

Expert Webinar with William Dodson, M.D. | Listen now on ADDitude »

ADHD Then and Now: How Our Understanding Has Evolved

Expert Webinar with David Anderson, Ph.D. | Listen now on ADDitude »

7-Week Guide to Differential Diagnosis of ADHD, from Medscape x MDEdge x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
> DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

Social anxiety is a debilitating fear of judgment, humiliation, or rejection by others in social situations. Socially anxious adults carry distorted, negative self-perceptions driven by a core belief of deficiency. This restricts their participation in activities, relationships, and other areas of life.

We know that anxiety and ADHD frequently co-occur. Experiences common to ADHD, like rejection sensitive dysphoria, shame, and emotional dysregulation, may exacerbate social anxiety. ADHD symptoms, like hyperactivity and inattention, may also undermine social skills and cause difficulties. Social anxiety treatment often involves behavioral interventions and working to improve social skills.

Signs of Social Anxiety

Intense fear of negative judgment from others is a common marker of social anxiety disorder. Other signs include:

• Discomfort interacting with people outside the immediate family
• Difficulty making or keeping friends
• Excessive worry in the days or weeks leading up to an event
• Fear of being observed (e.g., when eating and drinking)
• Fear of performing in front of others
• Avoiding places or events that involve socializing
• Nausea, shaking, or excessive perspiration in social environments

Fear, anxiety, or avoidance of social situations must cause clinically significant impairment and persist for at least six months to merit a diagnosis.

[Self-Test: Does My Child Have Generalized Anxiety Disorder?]

Social Anxiety Treatment: Behavioral Interventions

Cognitive behavioral interventions effectively target the distorted thoughts that fuel social anxiety. Medication for anxiety may help, but as with ADHD, pills don’t teach skills. To cope with social anxiety, find ways to reduce your worries.

1. Shift your thinking. Identify limiting core beliefs and notice negative self-talk. What social situations trigger those thoughts and worries?
2. Recall positive social experiences. Anxiety erases memories of courage and success. Think back to times when you rose to a challenge despite your fears. What steps did you take?
3. Stay in the moment. Show curiosity about others and practice reflective listening, such as nodding. Notice your surroundings. Take deep breaths to quell physical symptoms.
4. Build up tolerance. Gradually expose yourself to low-risk, uncomfortable social situations. Join a hiking group, for example, and smile at a few new faces. On the second hike, talk to a few people. You might feel awkward and nervous, but you’ll see that you’ve survived.
5. Foster connection. Pay attention to body language that signals interest (like a relaxed posture) versus discomfort (looking away). Ask open-ended questions to encourage conversation and let others know that you’re listening.

[Download: Social Anxiety Facts and Falsehoods]

Improve Social Skills with an APPLE

To navigate social situations:

• Ask to join in a conversation.
• Physical proximity and volume. Are you too close? Too loud?
• Participate with curiosity. Use reflective statements and ask open-ended questions.
• Listen and lay off the self-criticism.
• Enjoy connection. Share what’s special and fun about you.

Social Anxiety in Children: Next Steps

• Download: Get a Grip on Tough Emotions
• Watch: Anxiety in Children: Overlooked Signs and Effective Supports
• Read: How Can I Help My Son Overcome Social Anxiety?

Sharon Saline, Psy.D., a licensed clinical psychologist, is an expert in how ADHD, learning disabilities, and mental health issues affect children, teens, and families. She is the author of What Your ADHD Child Wishes You Knew.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Most individuals with attention deficit hyperactivity disorder (ADHD or ADD) experience fluctuating symptoms between childhood and adulthood, with 90% of adolescents continuing to experience residual symptoms into young adulthood.¹ This finding, from a recent American Journal of Psychiatry study, challenges previous research that suggested around half of children with ADHD outgrow the disorder by adulthood.

Researchers followed 558 children with ADHD from the Multimodal Treatment Study of ADHD (MTA) for 16 years, checking their symptoms every 2 years, from age 8 to 25. At each time point, researchers identified children with fully remitted, partially remitted, and persistent ADHD, with the help of parent-, teacher-, and self-reports of “symptoms and impairment, treatment utilization, and substance use and mental disorders.”

Only 9.1% of participants demonstrated sustained remission by the end of the study, and only 10.8% demonstrated stable ADHD persistence across study time points. The majority of children and adolescents (63.8%) had fluctuating periods of remission and recurrence over time.

Although intermittent periods of remission could be expected, most children with ADHD continued to experience residual symptoms at some point through age 25, researchers concluded. Previous research studied participants only as adults, which would explain why symptom relapses could have been missed.

Sources

¹Margaret H. Sibley, et al. Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD. The American Journal of Psychiatry (2021). https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2021.21010032

Higher levels of ADHD symptoms predict lower-than-average economic outcomes, mental health indices, and adherence to preventive measures in response to challenges created by the pandemic, according to a new study out of Israel. Additionally, ADHD symptoms were linked to higher perceived risk of contracting COVID-19 but also to perceptions that encourage non-adherence to preventive measures, according to a Journal of Attention Disorders¹ study.

Data was drawn from 2,055 Israeli adults who completed an online survey after the first quarantine. Participants provided information about financial status, adherence to preventive measures, mental health, and COVID-19 related perceptions.

High symptoms of ADHD were associated with poor adaptation to pandemic challenges — namely, less optimal behavioral, emotional, and perceptual responses — as reflected in the findings outlined below.

Financial decline: Higher level of ADHD symptoms correlated to lower position and income, particularly during the pandemic. Inattention, rather than hyperactivity/impulsivity, predicted this inverse relationship.

Lower Adherence to Preventive Measures: Severe ADHD was correlated with non-adherence to preventive COVID measures, which reflected greater risk-taking behavior, lower perceived severity of the illness, and greater distrust regarding the efficacy of adhering to preventive measures.

Higher Psychological Distress: The direct correlation between level of ADHD symptoms and psychological distress was not unique to the pandemic and appeared linked to financial decline.

Researchers concluded that people with elevated ADHD symptoms are more vulnerable to challenges created by the pandemic and therefore deserve special attention and care. Vocational and mental counseling can help, as well as a healthy lifestyle that includes optimal adherence to preventive measures.

Sources

¹ Pollak Y, Shoham R, Dayan H, Gabrieli-Seri O, Berger I. Symptoms of ADHD Predict Lower Adaptation to the COVID-19 Outbreak: Financial Decline, Low Adherence to Preventive Measures, Psychological Distress, and Illness-Related Negative Perceptions. Journal of Attention Disorders. June 2021. doi:10.1177/10870547211027934

ADHD is a complex, heterogeneous, and often-misunderstood condition. For example, did you know that 75% of people with ADHD have at least one co-existing psychiatric diagnosis alongside ADHD? In fact, 60% of people with ADHD have two or more comorbid conditions. ADHD’s most common travel companions are depression, anxiety, in adults, and Oppositional Defiant Disorder (ODD) in children and adolescents, particularly.

The American Academy of Pediatrics (AAP) and the Society for Developmental and Behavioral Pediatrics (SDBP) are leading the charge with new diagnostic and treatment guidelines for Comorbid Complex ADHD that factor in the importance of addressing not only core symptoms of ADHD, but these common co-existing conditions simultaneously. Families and clinicians want to know the best practices for ADHD diagnosis, and all the associated features and comorbidities that affect quality of life. It’s time for parents and clinicians to take a fresh look at diagnosing and treating the whole child.

In this webinar, you will:

• Understand the brain science of Complex ADHD
• Learn to recognize ADHD’s most common comorbid conditions in children and adults
• Expand the toolbox of rating scales and screeners
• Review strategies to improve quality of life, not just symptoms
• Tap into treatments that set the table for successful living

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the  symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Google Podcasts; Stitcher; Spotify; iHeartRADIO.

Read More on Complex ADHD

What Is Complex ADHD? Symptoms, Diagnosis & Treatment

When It’s Not Just ADHD: Symptoms of Comorbid Conditions

ADHD Comorbidity: An Overview of Dual Diagnoses

Obtain a Certificate of Attendance

If you attended the live webinar on June 23, 2021, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker:

Theresa Cerulli, M.D., is a graduate of Tufts University, University of Massachusetts Medical School, Harvard Longwood Residency Program in Adult Psychiatry, and Harvard Fellowships in Medical Psychiatry and Neuropsychiatry. Dr. Cerulli is Board Certified in Psychiatry and is on faculty at Beth Israel Deaconess Medical Center in Boston and for NEI, the Neuroscience Education Institute. Dr. Cerulli is the co-founder and prior Chief Medical Officer of ADD Health and Wellness Centers, specializing in the holistic treatment of children and adults with ADD/ADHD and co-existing behavioral health conditions. Her vision is in combining traditional medicine with healthy living to promote cognitive and emotional wellbeing. |See expert’s full bio »

Listener Testimonials

“That was an excellent summary of the most up-to-date information about comorbidities and treatment. It was all the more impactful because the expert explained the ‘whys’ and how to make changes.”

“This was incredibly helpful! I am the parent of two children with ADHD who have comorbidities, and I have learned so much.”

“She is an excellent Presenter. Her well-designed slides were informative and engaging.”

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Young children work to build a foundation in the areas of reading acquisition, math skills, and understanding the social contract. Inside and outside of the classroom, they must learn to control and regulate their emotions, express themselves effectively, and moderate their behaviors. ADHD touches all of these milestones and complicates the picture for parents, children, and educators alike.

As children get older, these challenges do not wane — physical, intellectual, and social organizations grow more complex. These complexities, plus heightened expectations for smooth transitions, place increasing demands on executive functions. Early intervention is key.

In the first of three webinars, Meg Leahy offers practical strategies for supporting children with ADHD in the elementary school years. She will discuss common challenges during childhood, and provide insights, skills, strategies, and resources that deliver results.

You will learn to:

• Identify how ADHD manifests at home, school, and in relationships
• Determine how self-concept and familial relationships are enhanced through clarification of ADHD challenges
• Examine the unique challenges of ADHD during childhood and the impact that ADHD exhibits during this stage for children and their families
• Discover research-based strategies and resources that provide the building blocks necessary to navigate childhood successfully and build healthy self-esteem
• Understand how and when interventions (medical, therapeutic, coaching) should be used for maximum benefit

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the  symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Google Podcasts; Stitcher; Spotify; Amazon Music; iHeartRADIO.

Read More on ADHD in Young Children

ADHD in Children: Symptoms, Evaluations & Treatments
The ADHD Symptoms in Children No One Talks About

ADHD Ages & Stages on ADDitude

Access more articles from ADDitude’s 5-part “Ages & Stages” series exploring common ADHD-related challenges through the lifecycle, along with strategies and treatments for each:

• Ages & Stages Part 1: ADHD in Children
  
• Ages & Stages Part 2: ADHD in Teens
• Ages & Stages Part 3: ADHD in Young Adults
• Ages & Stages Part 4: ADHD in Adults
• Ages & Stages Part 5: ADHD Medication List

Download the Full Ages & Stages of ADHD Booklet

Register for other webinars in the Ages & Stages series: Part 2: Strategies for Teens and Young Adults with ADHD and Part 3: Practical Strategies for Adults with ADHD

Obtain a Certificate of Attendance

If you attended the live webinar on August 31, 2021, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker:

Meg Leahy, MS, NCC, BCC is a Nationally Certified Counselor (NCC) and a Board Certified Coach (BCC) with special certifications in life, leadership, and career coaching. An educator, counselor, coach, author, and mentor for 20+ years, Meg believes in providing the skills, understanding, and resources to help people change their lives. She is the co-author of two editions of Attention Deficit Hyperactivity Disorders Throughout the Lifespan and has written numerous articles, blogs, and webinars on ADHD and other mental health issues. Meg worked with college students and adults as a Clinical Associate in the Adult ADHD Treatment and Research Program in the Department of Psychiatry at the University of Pennsylvania and a mentor in the Macy Undergraduate Leadership Fellows Program at Drexel University. For more information, visit leahylearning.com. | See expert’s full bio »

Listener Testimonials

“I’m a counselor with ADHD and this webinar has given me so much more to offer both my parents and children with ADHD!”

“The webinar was incredibly well organized and a great, comprehensive overview of ADHD in children.”

Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
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Then, when subtle-but-lifelong symptoms of ADHD explode (as they are likely to do) under unique and stressful circumstances, they suddenly become unmanageable. And it’s only then that many adults get the help they need.

Here are commonly overlooked signs of ADHD, including unexpected symptoms and even those that seem contrary to the diagnosis.

Signs That Point to ADHD

1. Your lifelong difficulties with focus, restlessness, and impatience did not affect your work or family – until life drastically changed.

You can still have ADHD even if you were not diagnosed as a child. Commonly, symptoms of poor focus, hyperactivity, and impulsivity remain manageable thanks to well-honed coping mechanisms that fall apart with a major life event — like obtaining your first job, getting married, or starting a family. Perhaps, for example, your symptoms remained under control until you found yourself amid the global pandemic.

2. You are not hyperactive or impulsive, but instead have periods of little motivation and choice paralysis.

ADHD exists on a spectrum and presents with multiple symptom variations. The DSM-V classifies ADHD into three subtypes: predominantly inattentive type, predominantly hyperactive type, and combined type. Girls present with inattention more often than do boys, who are more commonly hyperactive and impulsive.

[Click to Read: 3 Defining Features of ADHD That Everyone Overlooks]

A disruptive little boy is more likely to trigger the concerned attention that leads to an ADHD diagnosis than is an unfocused yet non-disruptive little girl who forgets her homework assignments. When young girls do present with hyperactivity, it is usually the more benign and less disruptive form of excessive talkativeness. These “invisible” symptoms are seldom associated with ADHD in girls.

In addition, overt hyperactive and impulsive behaviors sometimes subside or morph earlier in girls, who commonly become more sensitive to others’ perceptions than do most boys. However, their hyperactivity does not disappear; it transforms into an internal restlessness and a noisy brain, which looks like difficulty making decisions and a seeming lack of motivation.

3. You can focus, sometimes to a fault.

“ADHD” is a misnomer. It is not so much a disorder of inattention, but rather a disorder of inconsistent attention. Attention fluctuates depending on a person’s level of interest in an activity. Hyperfocus, or intense interest, is on one extreme, but still tied to the dopamine deficiencies that also contribute to inattention.

ADHD is often missed in adults who hyperfocus more than they struggle with inattention. Hyperfocusing, in some ways, can be seen as a positive and helpful symptom. But it does have its cons – transitioning out of intense focus can be difficult, which can interfere with daily activities.

[Read: ADHD Hyperfocus Is a Blessing and a Curse]

4. You lack a history of difficulties at school – in stark contrast to your peers with academic problems that led to their earlier ADHD diagnosis.

ADHD is NOT related to your intelligence, school performance, or level of success. You can be a good student, highly knowledgeable and successful, and still have a diagnosis of ADHD.

Individuals with a high IQ are often overlooked for ADHD, as they may still function above average or at an adequate level despite their deficits. Often masking their “normal” functioning is the time and effort it takes to compensate for ADHD symptoms.

5. You are organized and meticulous, not disorganized and careless.

It is common for individuals with ADHD to develop somewhat obsessive and compulsive behaviors to manage their symptoms. You may, for example:

• Over-prepare for an exam to manage anticipated problems with time management, concentration, and planning that may impact your grade.
• Become obsessed with tidiness and have a fascination with decluttering techniques and gadgets. For you, it’s a must in order to compensate for your overconsumption and organizational difficulties.
• Engage in near-compulsive checking behaviors to manage chronic forgetfulness and the misplacing of items.

These ADHD coping strategies can mimic Obsessive Compulsive Disorder (OCD), but the two disorders are distinct.

6. You struggle to manage your feelings, fluctuate between excess emotions and lack thereof.

Whether diagnosed as a child or late in life, a person with ADHD is more likely to hear negative comments about their symptoms and behaviors. They may hear from parents, friends, and others about their underachievements, and be accused of laziness, immaturity, and selfishness. These lifelong criticisms can lead to feelings of guilt and shame, and they exacerbate problems with emotional regulation.

Rejection Sensitive Dysphoria, a phenomenon referring to intense negative feelings from perceived or actual criticism, is also part of emotional dysregulation as a major part of the ADHD experience for adults.

7. You already have a mood disorder and/or anxiety.

Unless you are directly assessed for ADHD, a more apparent mood or anxiety disorder may be diagnosed first — or misdiagnosed instead. A misdiagnosis, especially, may lead to multiple failures with medications before receiving a correct diagnosis.

Most psychiatrists are not as familiar with adult ADHD as they are with mood and anxiety diagnoses. It’s only in recent years that adult ADHD has been taught in psychiatry residency training programs.

ADHD symptoms can be confused for other conditions during an initial psychiatric assessment. Your clinician may inaccurately label your “overwhelmed and excitable” emotions as anxiety. You may even suspect you have a mood disorder because you feel “bored and unmotivated.” In fact, a study conducted in 2016 by Sternat found that 34% of patients referred for a treatment-resistant mood disorder met the criteria for ADHD.

8. You struggle with sleepless nights.

Historically, poor sleep had been considered a separate issue from ADHD. However, researchers have recently hypothesized that ADHD is also associated with a dysregulated sleep-wake cycle. It is estimated that 75% of children and adults with ADHD have a sleep problem. (European College of Neuropsychopharmacology)

Adults with ADHD often encounter several sleep problems. They find it difficult to fall asleep due to a brain that won’t turn off, and struggle to stay asleep due to physical restlessness. They also have problems waking, as they tend not to enter the deepest sleep stage until early morning.

9. You struggle with substance abuse and eating disorders.

The lack of sufficient dopamine in your brain can lead to boredom and impulsive behaviors such as misuse of illicit substances and even disordered eating, especially if ADHD goes undiagnosed.

When individuals finally seek help, they can be misdiagnosed, or diagnosed with only a mood and or anxiety disorder, leading to an ineffective medication regimen and more despair and hopelessness, perpetuating the cycle of substance misuse, self-medication, and disordered eating patterns.

10. You have trouble with all kinds of relationships.

It is harder to be mindful and emotionally attuned to others when distractibility is a problem. ADHD may affect your ability to communicate and naturally connect with a wide range of people. Your relationships may suffer, and you may ultimately feel disconnected from your partner, family, and friends.

You may easily lose touch with others because of ADHD symptoms like forgetfulness and disorganization. Unfortunately, it can cause others to label you as self-centered and selfish.

ADHD can also disrupt your emotional and physical intimacy with your partner, and possibly prevent you from forming romantic relationships in the first place.

ADHD Signs: Next Steps

• Read: ADHD Symptoms Explained
• Symptom Test: ADHD Signs in Adults
• Guide: Adult ADHD Guide to Symptoms, Signs, and Treatments

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

One-quarter to one-third of preschool students with ADHD demonstrated decelerating inattention and increasing hyperactivity over the course of an academic school year, according to a new Journal of Attention Disorders study¹ — one of the first studies of the developmental course of ADHD to incorporate teacher ratings and not rely exclusively on parent reports. Because an ADHD diagnosis requires the presence of impairing symptoms in multiple settings, charting and assessing the teacher perspective is a critical component to improving assessment in young children.

In this new study, teachers rated the ADHD symptom levels of 261 preschool children four times throughout the academic school year. Findings suggested that nearly a third of students’ inattention increased and then decelerated over time, while 26% of students saw hyperactivity and impulsivity steadily increase. Researchers noted three trajectories of inattention — stable low (57%), change (32%), and stable high (11%) — and three trajectories of hyperactivity/impulsivity — stable low (63%), increasing (26%), and stable high (11%). Children with stable high symptom levels were more impaired than were children with stable low symptom levels.

These results may help teachers better identify early signs of ADHD. Researchers concluded that, even though health care providers and educators might adopt a “wait and see” approach to avoid over-pathologizing normal behaviors, “results from the current study suggest that, on average, symptom elevations either remain stable or increase over the course of the year. Though certainly in need of replication, our findings suggest that we should not dismiss elevated ADHD symptoms in early childhood as transient or time limited.”

Sources

¹ Martin CP, Shoulberg EK, Hoza B. The Developmental Course of Teacher-Rated ADHD Symptom Levels in an Early Childhood Community Sample. Journal of Attention Disorders. March 2021. doi:10.1177/1087054721997561

More frequent television use at 11 years and greater total screen time at 18 years are linked to a higher likelihood of ADHD diagnosis at 22 years of age, according to a general population longitudinal study published in the Journal of Attention Disorders.¹

Researchers studied the records of 2,333 participants without diagnosed ADHD who participated in the 1993 Pelotas Birth Cohort Study through age 22. Researchers studied participants’ time spent using television, video games, and computers at ages 11, 15, and 18, and then they assessed for ADHD at 22 years.

Research found that time spent watching television at ages 11 and 18 was positively correlated with the presence of future ADHD symptoms. This finding is corroborated by other, similar research. Children of participants in the 1972 Birth Cohort from Dunedin, New Zealand, who watched 2 hours, and particularly those who watched 3 hours, of television per day between the ages of 5 to 11 years were found to have above-average symptoms of poor attention at 15.² Similarly, a U.S. study found that 14-year-olds who viewed television for three or more hours per day were more likely to have one or more symptoms of ADHD at age 16, compared to adolescents who watched less than three hours per day.³

The new study also demonstrated positive correlations between later ADHD symptoms and video-game use at age 15, as well as computer use at age 18. It yielded a statistically significant but modest relationship between total screen time and subsequent diagnosis of ADHD in adolescents. Researchers concluded that additional research is necessary to establish whether this association is causal, including information about what was watched on each device and the time spent on different devices.

Sources

¹ Soares PSM, de Oliveira PD, Wehrmeister FC, Menezes AMB, Gonçalves H. Is Screen Time Throughout Adolescence Related to ADHD? Findings from 1993 Pelotas (Brazil) Birth Cohort Study. Journal of Attention Disorders. March 2021. doi:10.1177/1087054721997555

² Landhuis, C. E., Poulton, R., Welch, D., Hancox, R. J. (2007). Does childhood television viewing lead to attention problems in adolescence? Results from a prospective longitudinal study. Pediatrics, 120(3), 532–537.

³ Johnson, J. G., Cohen, P., Kasen, S., Brook, J. S. (2007). Extensive television viewing and the development of attention and learning difficulties during adolescence. Archives of Pediatrics & Adolescent Medicine, 161(5), 480–486.

Individuals with attention deficit hyperactivity disorder (ADHD or ADD) and disruptive behavior disorders (DBDs) share approximately 80% of the genetic variants associated with aggressive and antisocial behaviors, according to a study published in the journal Nature Communications.¹  DBDs include oppositional defiant disorder (ODD) and conduct disorder (CD), which are associated with extremely disobedient and hostile behavior, including property destruction, theft, and cruelty toward animals in the case of patients with severe CD. This new study suggests that individuals with ADHD plus ODD and/or CD appear to possess a unique genetic segment that may be detected early in life to unlock proactive, rather than reactive, treatments, researchers say.

Researchers used data on roughly 4,000 individuals affected by ADHD and DBDs drawn from the European project Agressotype, which explored the neurobiological basis of aggressive behavior. Genome-wide association studies (GWAS) were used to analyze the genetic contribution of changes in a single DNA nucleotide (SNP) to these psychiatric disorders.

Researchers discovered a genomic segment in the chromosome 11 that increased the risk of comorbid ADHD and DBDs, suggesting that genetics are more determining in those with both comorbidities than in those with only ADHD. Bru Cormand, professor in the department of genetics, microbiology, and statistics at the University of Barcelona explained:  “If we compare the genome of patients with ADHD and DBD to that of those patients with only ADHD, we see that people affected by both disorders have a higher genetic correlation with risk genetic variants. These extra correlations of ADHD and DBD patients would probably correspond to alterations other authors had related to aggressive-related behaviors.”

Researcher Marta Ribasés concludes: “If we consider ADHD to be an open door to a negative trajectory, using genetic information to identify those individuals who are more vulnerable will have a strong impact on prevention, early detection and treatment, and will shed light on new research studies to find efficient therapies that can be specific for the disorder or shared between several disorders.”

Sources

¹Cormand Bru, et al. ADHD, DBD, and aggressiveness: Risky genetic Factors. Nature Communications (Feb. 2021).

²ADHD, DBD and aggressiveness: Risky genetic factors. EurekaAlerta! (Feb. 2021) https://www.eurekalert.org/pub_releases/2021-02/uob-ada021721.php

Sleep deprivation causes greater impairment in attentional regulation and emotional control among adults with subclinical ADHD symptoms than it does among those with low ADHD symptoms, according to a study published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging.¹ “Subclinical” refers to symptoms of ADHD not severe, numerous, prevalent, or debilitating enough to merit a diagnosis, according to the DSM-5.

The study included 180 participants ages 17-45 without an ADHD diagnosis who were assessed for inattentiveness and emotional instability, and then randomly assigned to receive a night of normal sleep or total sleep deprivation. The subjects then performed a computerized Stroop task that measured executive function and emotional control.

Researchers found that sleep deprivation caused impairment on all tasks. Subjects with higher levels of baseline inattention demonstrated increased cognitive conflict reaction after sleep deprivation but not after normal sleep. This relationship persisted after controlling for baseline cognitive conflict reaction time and emotional instability. In other words, participants with symptoms of inattention were more vulnerable to sleep deprivation and exhibited greater executive function impairment than did those with low ADHD traits.

Researcher Predrag Petrovic, M.D., Ph.D., of the Karolinska Institute in Stockholm, Sweden, explained the importance of these findings: “We know that young people are getting much less sleep than they did just 10 years ago. If young people with high ADHD traits regularly get too little sleep, they will perform worse cognitively and, what’s more, their symptoms might even end up at a clinically significant level.”

Sources

¹Floros O, Axelsson J, Almeida R, et al. Vulnerability in executive functions to sleep deprivation is predicted by subclinical attention-deficit/hyperactivity disorder symptoms. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. (Oct. 2020) https://www.sciencedirect.com/science/article/pii/S2451902220303086?via%3Dihub

Our understanding of ADHD has evolved considerably in the last three decades. Here, ADHD experts Dr. Ned Hallowell and Dr. John J. Ratey explain the latest and most consequential research, along with the most effective treatment techniques to manage it, based on their 30 years working with patients. To them, ADHD is not a deficit but an overabundance of attention that all individuals experience to different degrees. Most important, they say, ADHD can be managed and harnessed in productive, fulfilling ways.

In this webinar, Hallowell and Ratey will help adults and children develop a constructive, hopeful view of ADHD. They will provide a plan for parents and adults that minimizes the downsides and emphasizes the benefits of ADHD at any age by presenting an arsenal of new strategies and lifestyle hacks designed to help anyone thrive with the condition.

Webinar listeners will learn how to:

• Use behavior assessments to discover the work, activity, or creative outlet best suited to an individual’s strengths
• Enhance creativity and entrepreneurial spirit at home, at school, or in the workplace
• Take advantage of new findings about the brain’s default mode network and cerebellum
• Tap into human connection to manage the negativity that plagues so many people with ADHD
• Use exercise and play to increase focus, memory, and emotional wellbeing
• Understand the true benefits of ADHD medication

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Read More on ADHD Research

7 Keys to Living a Happy Life with ADHD

ADHD Needs a Better Name. We Have One.

ADHD Research Roundup: New Studies, Findings & Insights

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Meet the Expert Speakers

Edward (Ned) Hallowell, M.D., is a child and adult psychiatrist,  leading authority in the field of ADHD, the host of “Dr. Hallowell’s Wonderful World of Different” –  a weekly podcast for thriving in this CrazyBusy world, NY Times best-selling author, world-renowned speaker and the founder of The Hallowell Centers in Boston MetroWest, NYC, San Francisco and Seattle. Learn more at www.drhallowell.com. Dr. Hallowell does not have any financial affiliations.

John J. Ratey, M.D., is an associate clinical professor of psychiatry at Harvard Medical School and an internationally recognized expert in neuropsychiatry. He has published more than 60 peer-reviewed articles and 11 books, including the groundbreaking Driven to Distraction series with Ned Hallowell, M.D. With the publication of Spark: The Revolutionary New Science of Exercise and the Brain, Dr. Ratey has established himself as one of the world’s foremost authorities on the brain-fitness connection. Dr. Ratey is a consultant to GoNoodle and HS Performance of Beijing.

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Time perception among children with attention deficit hyperactivity disorder (ADHD or ADD) is less accurate and less precise compared to children without ADHD, according to a new Journal of Attention Disorders study¹, which states that, “Time perception refers to an individual’s subjective experience of event durations and the passage of time.” Previous research has shown that children with ADHD show lower accuracy in time-perception tasks, but results had been inconsistent.

The present meta-analysis drew 1,620 participants with ADHD (83% male) and 1,249 controls (57% male) from 27 studies that compared time-perception impairment among children and adolescents with and without ADHD.

Participants with ADHD demonstrated less accurate and precise perception of time, overestimated time intervals, and sensed time passing more slowly than did their non-ADHD counterparts. As children with ADHD aged, researchers found their time-perception abilities moved closer and closer to those of their non-ADHD counterparts. The male ratios in both groups significantly affected comparative time perception, though “the difference in time perception abilities did not significantly depend on task paradigm or stimulus modality.”

In the ADHD group, a higher number of male participants were associated with overestimation of time, compared to the control group. This might mean that males are more likely than females to overestimate time, or that ADHD has a larger impact on time perception in males than it does in females.

These findings led researchers to conclude that time perception may be considered an important neuropsychological manifestation of ADHD, separate from executive dysfunction and delay aversion. Measures of time perception as markers of timing deficits in ADHD could be included in clinical assessment to provide a more comprehensive profile of the individual’s functioning.

Related resources 

• Taking ADHD Symptom Management Seriously
• Study: ADHD May Diminish Brain Tolerance to Subconcussive Head Impacts
• Executive Dysfunction Test for Children
• Executive Dysfunction Test for Adults

Sources

¹Zheng Q, Wang X, Chiu KY, Shum KK. Time Perception Deficits in Children and Adolescents with ADHD: A Meta-analysis. Journal of Attention Disorders. December 2020. 10.1177/1087054720978557

For best outcomes, clinicians must help patients and families understand how ADHD impacts the adolescent and young adult brain specifically, and how early care and interventions can have positive effects. If the conversations and interventions begin early, and a family’s vigilance remains high, teens with ADHD will grow and launch into remarkable young adults.

ADHD in Adolescents: Developmental Overview

ADHD Persists into Adulthood for Many

While symptoms of attention deficit hyperactivity disorder (ADHD or ADD) tend to decline and shift with time, it is the rule – not the exception – that the majority of teens with ADHD (75 percent) continue to experience ADHD in adulthood¹. This fundamental aspect of the condition underscores the importance of creating supports and using strategies in earlier years that are built to last particularly through the critical transition from adolescence into young adulthood.

ADHD Adolescent Years and Brain Development

Significant brain growth, especially in the frontal lobe – the region involved in executive function skills like problem solving, conflict resolution, planning, and impulse control – occurs during the teenage years and continues until about age 25. With ADHD, however, brain development in this region is slightly delayed, meaning these skills may develop slowly.

Delayed frontal lobe development also makes regulating the limbic system – the circuitry associated with emotion, anxiety, reward, and risky behavior – more difficult. This differential brain development may explain some observable dysregulation and instability in adolescents with ADHD, and it builds a case for why families still need to remain involved and vigilant through the teen’s development in this period.

[Learn: The Neuroscience of the ADHD Brain]

ADHD in Adolescents: Challenges and Impacted Areas

Increased Academic Demands

Teens with ADHD progressing through high school must navigate and tackle increasingly difficult workloads. There are more exams, more homework, a grueling and increasingly competitive college or trades application process, and more to keep track of generally compared to prior school years. Missed assignments and truancy, for example, may have serious consequences.

Extracurricular activities also come with increased demands, especially in college or the trades. In sports, for example, playbooks are becoming thicker and more complex. Increased competition makes for a higher level of play, and self-discipline is required to keep up with practice, training, diet, and other aspects of the game while also maintaining grades high enough to qualify for play.

The risk of dropping out of high school is higher in those with ADHD compared to peers without ADHD², which has a strong influence over future income levels, hire-ability, and other realms.

Social Impairment

Many individuals with ADHD struggle with social skills, and the transition to adulthood can highlight these challenges. Studies demonstrate that teens and young adults with ADHD tend to:

• Be less socially competent than their peers³
• Be involved in fewer social activities⁴
• Have fewer friends⁴
• Have delinquent friends⁵
• Be socially isolated⁵

Adolescents with ADHD may also be unreliable sources for assessing their social functioning, giving themselves overly optimistic appraisals of their skills³. To improve peer relationships, teens can join in person or on-line groups and activities that align with their interests and hobbies.

[Click to Read: The Dangers and Promise of #ADHD Videos on TikTok]

Substance Use and Misuse

ADHD is associated with greater risk of cigarette or nicotine vaping, recreational drug use and substance use disorders⁶, particularly in those untreated for their ADHD. About one-half of young adults with ADHD report recreational drug use compared to just over 30 percent in the neurotypical group². This also includes cigarette smoking – the transition from adolescence to adulthood is where we see a dramatic increase with about 70 percent of teens with ADHD identifying as smokers compared to less than 40 percent of teens without ADHD².

Substances are deleterious to the developing adolescent brain. Alcohol alone impacts learning, information recall, memory, and sleep. Marijuana use, especially before the age of 16, creates significant problems with the brain’s connectivity and capacity, and hampers executive functioning. On a positive note, long-term, large-scale studies show that early stimulant treatment lowers the risk of cigarette smoking and substance use disorders in individuals with ADHD⁷.

Stimulant medication misuse and diversion is also a problem for teens and young adults with ADHD. Research suggests that up to 20 percent of youth have used stimulants non-medically, with the majority – up to 85 percent – diverting them from teens with ADHD and a stimulant prescription. Misperceptions around stimulants – that they’re harmless, that sharing is not illegal, and without ethical considerations – contribute to relatively high rates of misuse of stimulants. Immediate-release formulations are more likely to be misused than are extended-release formulas⁸, making a strong case for clinicians to prescribe extended-release medications when appropriate for adolescent patients with ADHD. Parents are encouraged to supervise and monitor their adolescent’s medications carefully; and in college or boarding schools, safe storage of stimulants-not in medicine cabinets-is highly recommended.

Other Comorbid Conditions

The risk for other comorbid conditions with ADHD is high, especially during the transition from adolescence into young adulthood. Depression and anxiety problems are perhaps the most common and pressing comorbid conditions among teens with ADHD. Treatment of young people with ADHD includes a focus not only on the ADHD, but also the comorbid conditions.

Research shows that treatment has a protective effect against the development of multiple comorbid disorders in individuals with ADHD⁹. But apart from stimulant misuse, teens with ADHD may face barriers to medical adherence for a number of reasons, including stigma, cost, side effects and insurance problems, plus simple lack of consistency.

Driving

The frequency of automobile accidents and violations is greater among teens with ADHD compared to their neurotypical peers. According to the National Highway Traffic Safety Administration, teens with ADHD are:

• Two to four times more likely to be in an automobile accident
• Four times more likely to be at fault for accidents
• Up to six times more likely to get speeding tickets
• Six to eight times more likely to have suspended licenses

All young people with ADHD should be aware of the increased risks for accidents-and to minimize distractions such as cell phones during driving. It is critical to note that the higher rates of motor vehicle accidents improve dramatically when young people with ADHD are receiving effective ADHD treatment⁹.

ADHD in Adolescents: Core Treatments

An effective treatment plan for youth with ADHD centers on ongoing education about possible challenges and interventions, and also has the following components:

• Awareness of the individual’s unique strengths and weaknesses
• Supports and interventions for areas of most need
• Collaborative monitoring by parent and teen of ADHD symptoms, activities, and habits

Accommodations and Self-Regulation Skills

If heading to college and the trades, teens and young adults with ADHD must accept that they will need to seek out help. Many accommodations available in the educational setting can be helpful, such as extended time for tests and additional help from writing and math tutoring centers.

The importance of tapping into one’s self-help skills cannot be overstated in college and early occupational training. It is best for caregivers to help instill healthy habits — like adequate sleep and nutrition, exercise, and stress management — in early adolescence. They should check in with the young adult regularly by asking questions about how they’re maintaining these habits. Teens will also need to know how to independently create structure, and if receiving certain medications, how to study during medication coverage periods. Also consider reducing the academic load per semester, especially when transitioning to the tough first semester.

Outside the college route, families can consider vocational assessment and career counseling to explore options for their teen. Many occupational fields offers training with some type of accommodations.

Therapy

Cognitive behavioral therapy (CBT) for ADHD is an effective treatment that improves ADHD symptoms and self-management overall, and new research shows that it is specifically effective for young people with ADHD. In this therapy, patients learn to compensate for residual symptoms and are taught to see their patterns of thought , emotion, and behavior and their consequences. Group and individual modes are available, and both settings are helpful.

Medication

Medicines should not be promoted as cure-alls, but they are helpful for ADHD. Stimulants are first-line treatments, followed by non-stimulants, antidepressants, and other empirically based medications. The patient and clinician should work with the goal of reducing target symptoms by about 50 percent.

To ensure medical adherence, clinicians and/or parents can suggest a reminder system at home, or offer more information on engagement programs (designed to boost independence and self-advocacy, which may help reduce negative feelings toward medication)

The transition from adolescence to young adulthood marks an important period for independence and development. ADHD in not a cosmetic or trivial disorder; it brings with it struggles, suffering, and impairment. Now, can you harness ADHD and use it to your benefit? Absolutely, yes. Knowing yourself existentially will help you do that. With the right care and special attention, teens with ADHD will grow and flourish as they transition to adulthood.

ADHD in Teens: Next Steps

• Read: When ADHD Meets Puberty
• Understand:  Warning Signs of Conduct Disorder in an Oppositional Teen with ADHD
• Learn: Abandon Your Pre-Conceived Notions of ‘Success’ (and More Advice for Parents of Teens with ADHD)

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The content for this article was derived from the ADDitude Expert Webinar “Navigating the Life Stages of ADHD: Key Concerns in Diagnosing and Treating Adolescents” by Timothy E. Wilens., M.D. (available as ADDitude ADHD Experts Podcast episode #321), which was broadcast live on August 26, 2020.

Sources

¹ Adler, L., Shaw, D., Kovacs, K., & Alperin, S. (2015). Diagnosing ADHD in children and adults. In L. Adler, T. Spencer, & T. Wilens (Eds.), Attention-Deficit Hyperactivity Disorder in Adults and Children (pp. 16-23). Cambridge: Cambridge University Press. doi:10.1017/CBO9781139035491.003

²Biederman, J., Faraone, S. V., Spencer, T. J., Mick, E., Monuteaux, M. C., & Aleardi, M. (2006). Functional impairments in adults with self-reports of diagnosed ADHD: A controlled study of 1001 adults in the community. The Journal of clinical psychiatry, 67(4), 524–540. https://doi.org/10.4088/jcp.v67n0403

³Barkley RA, Anastopoulos AD, Guevremont DC, Fletcher KE. Adolescents with ADHD: patterns of behavioral adjustment, academic functioning, and treatment utilization. J Am Acad Child Adolesc Psychiatry. 1991;30(5):752–761

⁴Bagwell, C. L., Molina, B. S., Pelham, W. E., Jr, & Hoza, B. (2001). Attention-deficit hyperactivity disorder and problems in peer relations: predictions from childhood to adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 40(11), 1285–1292. https://doi.org/10.1097/00004583-200111000-00008

⁵Greene, RW., Biederman, J., Faraone, SV., Sienna, M., Garcia-Jetton, J.Adolescent outcome of boys with attention-deficit/hyperactivity disorder and social disability: results from a 4-year longitudinal follow-up study. J Consult Clin Psychol. 1997; 65: 758-767

⁶Wilens, T. E., Martelon, M., Joshi, G., Bateman, C., Fried, R., Petty, C., & Biederman, J. (2011). Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 50(6), 543–553. https://doi.org/10.1016/j.jaac.2011.01.021

⁷Boland, H., DiSalvo, M., Fried, R., Woodworth, K. Y., Wilens, T., Faraone, S. V., & Biederman, J. (2020). A literature review and meta-analysis on the effects of ADHD medications on functional outcomes. Journal of psychiatric research, 123, 21–30. https://doi.org/10.1016/j.jpsychires.2020.01.006

⁸ Timothy Wilens, Courtney Zulauf, MaryKate Martelon, Nicholas R. Morrison, Andrew Simon, Nicholas W. Carrellas, Amy Yule, Rayce Anselmo. Nonmedical Stimulant Use in College Students. The Journal of Clinical Psychiatry, 2016; 940 DOI: 10.4088/JCP.14m09559

⁹Biederman, J., Monuteaux, M. C., Spencer, T., Wilens, T. E., & Faraone, S. V. (2009). Do stimulants protect against psychiatric disorders in youth with ADHD? A 10-year follow-up study. Pediatrics, 124(1), 71–78. https://doi.org/10.1542/peds.2008-3347