Attention Deficit Hyperactivity Disorder, commonly abbreviated as ADHD, is a neurodevelopmental disorder with a variety of symptoms centered around a feature of the brain called executive function. According to the Cleveland Clinic, executive function “refers to skills that you use to manage everyday tasks,” with these skills being “working memory, cognitive flexibility, and inhibition control.” 

The first refers to the brain’s ability to hold and manipulate encountered information relevant to tasks at hand, such as important dates or ingredients in a recipe. Patients with ADHD often suffer from poor working memory, which can lead to such symptoms as forgetfulness or frequently leaving items behind. 

The second aspect, cognitive flexibility, is demonstrated by the ability to “smoothly shift gears between tasks, thought processes and situations. You use cognitive flexibility when you multitask — for example, answering a colleague’s question while writing an email,” according to the Cleveland Clinic. In ADHD, this reflects in the patient's inability to switch tasks effectively – a hallmark of the disorder. This can also result in emotional and intellectual rigidity, leading to frustration when forced to solve certain problems or make certain decisions.

Lastly, a lack of inhibition control can lead to the classical picture of hyperactivity commonly associated with ADHD. Inhibition control, as one may assume, is the ability to “control your thoughts, emotions and focus.” People with ADHD may often be very distractible, impulsive, and may face issues with emotional regulation, due to being overstimulated. This overstimulation is often a result of being unable to properly regulate attention on bothersome stimuli. 

This lack of executive functioning can cause many distressing symptoms in patients with ADHD, and as such, ADHD is often comorbid (as in, co-occurring) with other disorders like anxiety and depression. Moreover, autism is a common comorbidity with ADHD. Succinctly, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or the DSM-V, have these criteria for ADHD:

Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:

• Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
• Often has trouble holding attention on tasks or play activities.
• Often does not seem to listen when spoken to directly.
• Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
• Often has trouble organizing tasks and activities.
• Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
• Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
• Is often easily distracted
• Is often forgetful in daily activities.

Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:

• Often fidgets with or taps hands or feet, or squirms in seat.
• Often leaves seat in situations when remaining seated is expected.
• Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
• Often unable to play or take part in leisure activities quietly.
• Is often “on the go”, acting as if “driven by a motor”.
• Often talks excessively.
• Often blurts out an answer before a question has been completed.
• Often has trouble waiting his/her turn.
• Often interrupts or intrudes on others (e.g., butts into conversations or games)

This leads us to the next part of ADHD discussion:

While the above form the diagnostic criteria for ADHD, the process for ADHD diagnosis can vary widely; some clinical psychologists and psychiatrists may diagnose ADHD after a verbal consultation, complete with an assessment of symptoms, perhaps with reporting from family or other people in close contact. This is an important part of ADHD diagnosis; however, many neuropsychologists and other professionals will perform a much longer test, often computer-aided, to evaluate inattention and hyperactivity. These tests can take hours, perhaps spread out over multiple sessions, and they are intended to accurately assess cognitive function and assess ADHD, so as to guarantee the correct treatment options are being utilized. This is important – the cognitive symptoms of ADHD can look like depression, anxiety, PTSD, and other disorders, and the treatments for these conditions differ greatly from ADHD. But in the event that ADHD is diagnosed:

Treatment

There are many options for the treatment of ADHD. The first-line treatment of ADHD, stimulant medication, has been proven effective in alleviating the cognitive impairment of ADHD. However, these medications, such as Adderall (amphetamine/dextroamphetamine) or Ritalin (methylphenidate), may have side effects. The most frequent side effects are increased anxiety as well as heart palpitations. Patients who find this side effect profile intolerable may find other options. Additionally, these medications are controlled, so an official diagnosis is often needed for the prescription of these medications.
For those who cannot or prefer not to use stimulants, there are other options, which are also non-controlled. Wellbutrin (bupropion hydrochloride), an antidepressant, is often prescribed off-label for the treatment of ADHD. The “off-label” treatment is not to suggest that this is an unsafe method of treating ADHD – rather, it states that the efficacy of Wellbutrin has not been formally evaluated in the context of a randomized trial / long-term study specifically for ADHD. Other options for non-stimulant treatment include Strattera (atomoxetine), and Tenex (guanfacine hydrochloride).

ADHD is a complex disorder, and every patient’s treatment needs are different – we here at Tikvah Psychiatry are here to help you with your mental health needs, and would love to help you. Schedule a consultation today.