Attention-deficit/hyperactivity disorder (ADHD) is a frequently diagnosed mental disorder, particularly among children, but it also affects adults. The acronym ADHD stands for Attention-Deficit/Hyperactivity Disorder. Understanding what each part of this name signifies is crucial to grasping the condition itself. Let’s break down “What Does Adhd Stand For” and delve into the core aspects of this disorder, which includes challenges with inattention, hyperactivity, and impulsivity. These symptoms can significantly impact various facets of life, from academic and professional achievements to interpersonal relationships and everyday functioning. If left unaddressed, ADHD can contribute to diminished self-esteem and social difficulties, especially in children. Adults with ADHD might grapple with feelings of inadequacy, heightened sensitivity to criticism, and increased self-doubt, often stemming from a history of negative feedback. It’s important to note that while ADHD is often identified in childhood, its presentation and assessment in adults can differ. This discussion will primarily focus on ADHD in children.
Approximately 8.4% of children and 2.5% of adults are estimated to have ADHD. Often, ADHD is first recognized when school-aged children exhibit disruptive behavior in the classroom or encounter difficulties with schoolwork. While ADHD is diagnosed more frequently in boys, this is partly due to symptom presentation differences rather than a higher prevalence in boys. Boys are more likely to show hyperactivity and externalizing symptoms, while girls may exhibit inattentive symptoms.
Symptoms and Diagnosis
Many children, at some point, may exhibit behaviors like restlessness, difficulty waiting their turn, inattentiveness, fidgeting, and impulsivity. However, children who meet the diagnostic criteria for ADHD display these symptoms of hyperactivity, impulsivity, disorganization, and/or inattention to a degree that is significantly greater than what is expected for their age and developmental stage. These pronounced symptoms lead to considerable distress and create challenges at home, school, work, and in relationships. It’s important to emphasize that these symptoms are not simply a result of defiance or an inability to comprehend tasks or instructions.
There are three primary presentations of ADHD:
- Predominantly Inattentive Presentation: Characterized mainly by symptoms of inattention.
- Predominantly Hyperactive-Impulsive Presentation: Dominated by symptoms of hyperactivity and impulsivity.
- Combined Presentation: Features significant symptoms of both inattention, and hyperactivity-impulsivity.
Diagnosis hinges on the consistent presence of symptoms over an extended period, typically noticeable for at least six months. Although ADHD can be diagnosed at any age, the disorder originates in childhood. For a diagnosis to be considered, symptoms must have been present before the age of 12 and must cause difficulties in multiple settings, not just at home.
Inattentive Type
The term “inattentive” within “attention-deficit/hyperactivity disorder” refers to difficulties with sustained focus, maintaining attention, and organization. For a diagnosis of predominantly inattentive ADHD, an individual must exhibit six (or five if 17 or older) of the following symptoms frequently:
- Fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
- Has difficulty sustaining attention in tasks or play activities (e.g., staying focused during lectures, conversations, or lengthy reading).
- Does not seem to listen when spoken to directly (mind seems elsewhere).
- Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (starts tasks but quickly loses focus and is easily sidetracked).
- Has difficulty organizing tasks and activities (e.g., struggles with time management, messy work, difficulty meeting deadlines).
- Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework, preparing reports, completing forms).
- Loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
- Is easily distracted by extraneous stimuli.
- Is forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).
Hyperactive/Impulsive Type
“Hyperactivity” in “attention-deficit/hyperactivity disorder” denotes excessive movement, such as fidgeting, restlessness, difficulty staying still, and being overly talkative. “Impulsivity” refers to acting without thinking about potential consequences. For a diagnosis of predominantly hyperactive-impulsive ADHD, an individual needs to exhibit six (or five if 17 or older) of these symptoms frequently:
- Fidgets with or taps hands or feet or squirms in seat.
- Leaves seat in situations when remaining seated is expected (e.g., in the classroom, in the office, in other workplaces).
- Runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless).
- Unable to play or engage in leisure activities quietly.
- Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be seen by others as restless or difficult to keep up with).
- Talks excessively.
- Blurts out an answer before a question has been completed.
- Has difficulty waiting his/her turn.
- Interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).
Combined Type
Combined presentation ADHD is diagnosed when an individual meets the criteria for both predominantly inattentive and predominantly hyperactive-impulsive presentations.
ADHD diagnosis is typically conducted by mental health professionals or primary care physicians. A comprehensive psychiatric evaluation involves gathering symptom descriptions from the individual and caregivers, utilizing rating scales and questionnaires completed by the individual, caregivers, and teachers, obtaining a thorough psychiatric and medical history, family history, and details about education, environment, and upbringing. A referral for a medical evaluation may also be recommended to rule out other medical conditions.
It’s crucial to recognize that several conditions can mimic ADHD, including learning disorders, mood disorders, anxiety, substance use, head injuries, thyroid conditions, and certain medications like steroids. Furthermore, ADHD can co-occur with other mental health conditions such as oppositional defiant disorder, conduct disorder, anxiety disorders, and learning disorders. Therefore, a comprehensive psychiatric evaluation is essential. There are no specific blood tests or routine brain imaging techniques for diagnosing ADHD. In some cases, patients may be referred for additional psychological testing (neuropsychological or psychoeducational testing) or computer-based assessments to gauge symptom severity.
The Causes of ADHD
While the precise causes of ADHD remain under investigation, scientists have made significant progress in understanding the contributing factors. Growing evidence points to a strong genetic component in ADHD, with multiple genes being linked to the disorder. However, no single gene or gene combination has been identified as the definitive cause. It is noteworthy that ADHD often runs in families. Brain imaging studies have revealed anatomical differences in the brains of individuals with ADHD compared to those without the condition. For example, children with ADHD may have reduced volumes of grey and white matter in the brain and exhibit different patterns of brain activity during specific tasks. Research has indicated that the frontal lobes, caudate nucleus, and cerebellar vermis regions of the brain are particularly affected in ADHD. Non-genetic factors also play a role, including low birth weight, premature birth, exposure to toxins (such as alcohol, smoking, and lead) during pregnancy, and significant stress during pregnancy.
Treatment
ADHD treatment typically involves a combination of therapeutic and pharmacological interventions. For preschool-aged children and younger, the recommended initial approach is behavioral strategies, including parent management training and school-based interventions. Parent-Child Interaction Therapy (PCIT) is an evidence-based therapy specifically designed for young children with ADHD and oppositional defiant disorder.
Current clinical guidelines recommend psychostimulant medications (amphetamine and methylphenidate) as first-line pharmacological treatments for ADHD management. In preschool children with ADHD, amphetamines are the only FDA-approved medication, though guidelines suggest methylphenidate might be considered if behavioral interventions are insufficient. Alpha agonists (clonidine and guanfacine) and atomoxetine, a selective norepinephrine reuptake inhibitor, are also FDA-approved medication options for ADHD. Newer FDA-approved ADHD medications include Jornay (extended-release methylphenidate), taken at night to provide effect in the morning; Xelstrym (dextroamphetamine patch); Qelbree (viloxazine), a non-stimulant; Adhansia (methylphenidate hydrochloride); Dyanavel (amphetamine extended-release oral suspension); Mydayis (mixed salts amphetamine product); and Cotempla (extended-release methylphenidate orally disintegrating tablets).
Many individuals and families may explore different medication options to find the best balance between treatment effectiveness and tolerability. The primary goal of treatment is to alleviate symptoms and improve functioning at home, school, and in social settings.
ADHD and School-Aged Children
Educators and school staff play a valuable role in supporting children with ADHD. They can provide parents and doctors with crucial information to aid in evaluating behavior and learning challenges and can assist with implementing behavioral strategies in the school environment. However, it’s important to note that school staff cannot diagnose ADHD, make treatment decisions, or mandate medication for a student to attend school. These decisions are solely the responsibility of parents or guardians in consultation with the child’s healthcare provider.
Students with ADHD whose learning is impacted may be eligible for special education services under the Individuals with Disabilities Education Act (IDEA) or a Section 504 plan (for students who do not require special education) under the Rehabilitation Act of 1973. Children with ADHD can benefit from tailored study skills instruction, modifications to the classroom setting, alternative teaching methodologies, and adapted curriculum.
ADHD and Adults
Many children diagnosed with ADHD continue to meet the diagnostic criteria as adults and may require ongoing management to address persistent impairments. In some cases, ADHD may go undiagnosed during childhood. Many adults with ADHD are unaware they have the disorder. A comprehensive evaluation for adults typically involves reviewing past and present symptoms, a medical examination and history, and utilizing adult ADHD rating scales or checklists. Treatment for adults with ADHD includes medication, psychotherapy, or a combination of both. Behavioral management techniques, such as strategies to minimize distractions and enhance structure and organization, along with support from family members, can also be beneficial.
ADHD is recognized as a protected disability under the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA). This protection means that institutions receiving federal funding cannot discriminate against individuals with disabilities, including ADHD. Adults whose ADHD symptoms cause functional impairment in the workplace may qualify for reasonable accommodations under the ADA.
Related Conditions
[List of related conditions would be placed here in a more comprehensive article, but is omitted based on the original text].
Physician Review
Rana Elmaghraby, M.D.
Stephanie Garayalde, M.D.
June 2022
