A Student’s Guide to Attention-Deficit/Hyperactivity Disorder (ADHD)
Attention-Deficit/Hyperactivity Disorder or ADHD is a psychological condition that begins in early childhood and frequently persists into adulthood. Although it is more prevalent in childhood with an estimated 7-8% of children being diagnosed in the United States with ADHD, approximately 4-5% of adults are diagnosed with the condition. In general, males have a higher prevalence rate of the disorder than women. There are three broad sets of symptoms associated with ADHD: inattention and distractibility, hyperactivity, and impulsivity. It is not necessary to have symptoms from all three areas to meet criteria for ADHD and many adults experience primarily the cognitive symptoms of inattention and distractibility. The hyperactivity and impulsivity symptoms are more common in males and are typically more severe earlier in childhood. In addition to these primary symptoms, many children with ADHD experience secondary problems, including significant academic difficulties during their early school years and/or interpersonal difficulties with peers.
ADHD is classified as a “Developmental Disorder” meaning symptoms should be present by early childhood and they typically persist into adolescence or adulthood. The symptoms associated with ADHD vary significantly across the lifespan in terms of severity and some symptoms may resolve entirely by late adolescence or adulthood. A child with ADHD may have difficulty sitting for long periods of time during classes, for example, whereas a young adult may feel “restless” during classes and have problems with concentration and attention-span during lectures. Adults may encounter different issues, such as problems starting and completing tasks in the workplace.
In general, hyperactivity and impulsivity symptoms diminish in severity during late adolescence, but problems with attention-span, time management and task completion persist and may become more significant. It is unlikely that the symptoms associated with ADHD actually become worse during the early adult years; instead, young adults encounter more problems because the symptoms interfere with their ability to manage the complex tasks and responsibilities necessary to be successful in their lives. The degree of autonomy and independence provided in college, for example, can be a challenge for individuals with ADHD who benefited from the structure of high school where class attendance was often mandatory and study periods were provided to complete homework assignments. The rigorous coursework in college also poses new challenges for individuals with ADHD as it becomes more necessary to pay attention during lectures and/or read assignments in order to understand the course material. The problems with attention-span and concentration have typically been long-standing for most adults with ADHD — as college students, these problems now interfere more substantially with their academic performance.
Many individuals experience some, but not all of the symptoms associated with ADHD or not at the level required to make a diagnosis. Many of the symptoms associated with ADHD (e.g., concentration problems) are also present in other conditions (e.g., depression). It is important to obtain a comprehensive evaluation by a mental health provider and/or a physician if you suspect that you may have ADHD.
Sub-types of ADHD
There are currently 3 recognized sub-types of ADHD:
- Predominately Inattentive
- Predominately Hyperactive- Impulsive
- Combined Inattentive and Hyperactive-Impulsive
The inattentive sub-type of ADHD is characterized by problems with concentration and attention-span, time management and procrastination. The symptoms of inattentive ADHD include the following:
- Fails to give close attention to details and/or makes careless mistakes
- Difficulty in sustaining attention (daydreaming)
- Does not listen when directly spoken to
- Does not follow instructions and fails to complete activities (not due to lack of understanding)
- Difficulty with organization
- Avoids tasks that require prolonged mental effort (doing homework)
- Loses things required for tasks (Notebook for class, work uniform)
- Easily distracted
- Forgetful in every day activities
Predominately Hyperactive- Impulsive
The Hyperactive-Impulsive sub-type of ADHD is characterized by excessive motor movements, impulsive decision-making and behavior. Hyperactive symptoms may not be present in adults even if they were present in childhood. Some adults describe a subjective feeling of restlessness rather than hyperactivity per se. The symptoms of hyperactive-impulsive ADHD include the following:
- Fidgety or restless while sitting
- Leaves seat in class when inappropriate
- In children, runs or climbs excessively. In adults, excessive feelings of restlessness.
- Difficulty engaging in leisure activities quietly
- Appears “on the go” or as if “driven by a motor”
- Excessive talking
- Blurts out answers, or difficulty thinking before speaking
- Difficulty awaiting a turn
- Interrupts others
If symptoms of both the Inattentive and Hyperactive-Impulsive subtypes are present, then a diagnosis of “Combined subtype” is made.
Co-morbidity is the occurrence of another condition or mental illness that people with ADHD may also experience. A mental health or medical professional needs to evaluate whether a person is experiencing symptoms from ADHD and not one of the following] other conditions below that may look like ADHD before diagnosis and treatment are made. Some common co-morbid conditions are:
- Sleep Disorders – Individuals diagnosed with ADHD may be more likely to exhibit a disrupted sleep pattern, including irregular sleep schedule, problems falling asleep and/or excessive activity levels during sleep. Some sleep disorders cause symptoms which are similar to symptoms typically associated with ADHD (e.g., concentration problems).
- Substance Abuse – There is a higher rate of alcohol and substance abuse for individuals diagnosed with ADHD and some substances can exacerbate symptoms associated with ADHD (e.g., concentration problems).
- Conduct Disorder – Significant conduct-related problems are uncommon in adults diagnosed with ADHD, but when present they are often associated with impulsivity symptoms (e.g., gambling, driving citations for speeding, gambling or alcohol/drug abuse).
- Learning Disorders – The majority of individuals diagnosed with ADHD have experienced some academic difficulties, but a significant minority of individuals diagnosed with ADHD have a co-morbid Learning Disorder. These individuals have a primary learning difficulty unrelated to ADHD (e.g., problems with reading comprehension or spelling).
- Depression – A significant percentage of adults diagnosed with ADHD also experience depressive mood symptoms and some have a co-morbid mood disorder such as Major Depression. In some cases, symptoms associated with ADHD are exacerbated by the mood disorder (e.g., concentration problems).
- Anxiety – A significant percentage of adults diagnosed with ADHD also experience anxiety symptoms. The anxiety is often secondary to ADHD meaning individuals tend to worry or become stressed because they are experiencing problems with time management, organization and task completion.
- Employment Problems – Individuals diagnosed with ADHD often experience a variety of problems in the workplace, including problems with task completion, poor performance reviews, and periods of unemployment.
Causes of ADHD
Research has identified several contributory factors to the development of ADHD:
- Neuro-developmental factors
- Neurophysiological deficits in several neurotransmitter systems
- Pre-natal causes such as smoking and alcohol during pregnancy, prematurity, complications during birth, or exposure to toxins after birth
- Genetic factors
Some other factors and actions are believed to cause ADHD in a person, however there is no evidence for these ideas, and all are considered myths.
Myth: Food additives and sugar cause ADHD.
Reality: The research does not support this explanation. Sugar and food additives may cause restlessness in anyone who consumes it, but it does not cause ADHD.
Myth: Excessive time viewing television or playing videogames causes ADHD.
Reality: The research does not support this explanation. Although individuals with ADHD sometimes engage in these activities more frequently than others, there is no evidence that it causes ADHD and there are good explanations why many individuals with ADHD prefer these activities.
Myth: ADHD is caused by poor parenting and/or intolerant teachers.
Reality: There is no research evidence to support this. There is evidence that caretakers experience frustration in response to symptoms associated with ADHD because hyperactivity and impulsivity can be difficult to manage, especially in a classroom.
Myth: Living in a fast paced, hectic society causes ADHD. This is why there has been an increase in the number of individuals diagnosed with ADHD.
Reality: There is no research evidence to support this. While ADHD had been more commonly diagnosed in recent years, there is no evidence of increased prevalence.
Myth: ADHD is a product of cultural factors within the United States and not a real medical condition.
Reality: There are similar prevalence rates of ADHD in most Western countries and prevalence of ADHD does not vary by race, ethnicity or socioeconomic status.
There are a variety of treatments available to help manage the symptoms associated with ADHD which have been shown to be very effective, especially when used in combination. There are no known treatments that resolve or “cure” ADHD, but symptoms can often be managed so that they do not interfere with a person’s functioning. Medication often plays an important role in treating ADHD, especially when symptoms are moderate to severe and interfere with functioning (e.g., difficulties reading or staying on task). Treatments that focus entirely on modifying the environment are frequently utilized in the secondary school system and can be helpful in managing behavioral symptoms of ADHD, but there is no research to suggest that these interventions treat the neurological symptoms of the condition.
There is research to support the following treatments:
- Medications: There are currently 2 types of medication approved by the FDA (Food and Drug Administration) to treat symptoms associated with ADHD. These are the stimulant medications, including Methylphenadate (Ritalin), and Strattera, which is a norepinephrine-reuptake inhibitor approved by the FDA for treatment of ADHD in 2002. The FDA is currently reviewing Modafinil, currently marketed as Provigil, for efficacy in treating ADHD. Please consult your physician if you have questions about medical treatments available to treat ADHD.
- Coaching: These are typically brief appointments (15-30 minutes) that focus primarily on time management, planning, and organizational tasks. A coach helps persons with ADHD develop strategies for managing their academic responsibilities and monitors progress towards these goals.
- Therapy: A therapist will typically address many of the same issues as a coach. In addition, therapy can be helpful in treating some of the issues frequently associated with ADHD, including low self-confidence, anxiety, and depression.
- Books and Web Resources: Many people find it helpful to learn about ADHD by reading books and web materials. A coach or therapist can make recommendations. The CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder) is also a good resource: http://www.chadd.org.
If you are diagnosed with Attention Deficit Hyperactivity Disorder, you may be eligible for academic adjustments, modifications and/or auxiliary aids and services under the Americans with Disabilities Act (ADA) of 1990 and the Rehabilitation Act of 1973. The University of Illinois has charged the Division of Disability Resources and Educational Services with the responsibility for coordinating the provision of reasonable academic accommodations for the documented manifestations of cognitive and/or psychiatric disabilities. For more information about disability services, you may contact DRES at 333-4603 (V/TDD), or by email at firstname.lastname@example.org or visit their website at www.disability.uiuc.edu.