Chapter 1

ADHD Basics

IN THIS CHAPTER

Recognizing symptoms of attention deficit/hyperactivity disorder

Understanding the origins of ADHD

Looking at ADHD diagnosis and treatment

Coping with ADHD in your life

In 1980, a new term entered the common vocabulary: attention deficit disorder. It described a condition that has been recognized since the latter part of the 19th century but called a variety of other names. This term — which later morphed into attention deficit/hyperactivity disorder (ADHD) — often rears itself whenever someone has difficulty in school or work, can’t sit still, or is unable to control their behaviors. The symptoms of ADHD can affect anyone — people of all ages, genders, and socioeconomic backgrounds. Because of this fact, and because the symptoms of ADHD are simply extremes of everyday behavior, this condition is often misunderstood and misdiagnosed.

In this chapter, we introduce you to ADHD. We give you a brief overview of the common symptoms, biological causes, diagnosis, treatment approaches, and life strategies for coping with ADHD. This chapter gets you up to speed on the basics, and we deal with each of these topics in much more detail in the rest of the book.

As we point out in the Introduction, ADHD is a complex condition that’s estimated to affect between 3 and 6 percent of the people in the United States. Rest assured that many happy, successful people live with ADHD, including both of us.

Having so many people around you with ADHD means that quality information, support, treatments, and life strategies are available that can help minimize the negative effects and maximize the positive. (And yes, ADHD does have positive attributes. You can read about these in Chapter 14.)

Identifying Symptoms of ADHD

If you have ADHD, you may have trouble regulating yourself. This difficulty can exist in the areas of attention, behavior, and motor movements. ADHD looks different in almost everyone. For example, one person may have no problem sitting still but gaze off into space unable to focus at all. Another person may constantly fidget but be able spend seemingly endless amounts of time focusing on one thing, often to the exclusion of everything else in their life. Yet another person may not be able to stop themself from impulsive and often dangerous behaviors but may be able to sit calmly in school. The following sections break down both primary and secondary ADHD symptoms.

Peering into primary symptoms

Despite all the different ways that ADHD manifests, the condition has three basic symptoms:

• Inattention/distractibility: People with ADHD have problems focusing. You may be able to focus sometimes but not others. This variable nature of being able to pay attention is one of the main features of ADHD. Because attention is inconsistent, people can easily rationalize or dismiss this symptom.
• Impulsivity: Many people with ADHD have trouble regulating their behavior. In this case, you often act without thinking, perhaps talking out of turn or taking unnecessary risks.
• Hyperactivity: Someone who is hyperactive is frequently moving in some way. You may be able to sit but may need to move some part of your body when doing so; leg rocking or shaking is one common example. This hyperactivity is more of a problem with children than adults because most ADHD adults have less physical restlessness as they get older and often find activities to channel it.

The term attention deficit/hyperactivity disorder (ADHD) comes from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The DSM-V outlines three types of ADHD:

• Inattentive type: Having this type of ADHD means that you have difficulty focusing but are able to sit still.
• Hyperactive/impulsive type: If you have this type of ADHD, you struggle to sit still and have difficulty considering consequences before doing or saying something, but focusing isn’t an issue.
• Combined type: If you have a hard time focusing as well as difficulty sitting still or doing things without thinking, you have the combined type.

The DSM-V also rates the current severity of ADHD from mild to moderate to severe. These ratings are helpful to understand where you fit within the overall spectrum of the condition.

Seeing a few secondary symptoms

Aside from the basic three symptoms of inattention, impulsivity, and hyperactivity (which we discuss in the preceding section), ADHD has a ton of other symptoms. These symptoms can include, but aren’t limited to, the following:

• Worry
• Boredom
• Loss of motivation
• Frustration
• Low self-esteem
• Sleep disturbances
• Hopelessness

In Chapter 3, we discuss these and other symptoms in detail.

These secondary symptoms are also connected to other common disorders. The overlap of symptoms among a variety of disorders is called comorbidity and is one of the reasons that diagnosing ADHD is so difficult. (See the “Getting a Diagnosis of ADHD” section later in this chapter, or check out Chapter 5.)

Clueing in on ADHD’s Origins

Many people used to believe that ADHD (before it even had this name) was merely a behavioral disorder and had no biological basis. However, research since then has shown that people with ADHD have something different happening biologically than people without the disorder. What exactly that biological basis is no one knows for sure. Some of the discoveries that researchers have made include the following:

• Genetic links: Having the disorder frequently is a genetic predisposition. ADHD runs in families; you’re more likely to see a child with ADHD born into a family where at least one parent has it.
• Neurological activity: Some studies show that people with ADHD have brain function differences. For example, some studies have shown a lower level of activity in the front of the brain — the area that controls attention. Others have discovered activity abnormalities in other regions deep within the brain.
• Chemical differences: Certain chemical activity, such as dopamine and norepinephrine, seems to be different in people who have ADHD. Several studies suggest that there are differences in the responses when neurochemicals are created and released by people with ADHD compared to people who don’t have the condition. This is an important component when it comes to choosing medication (Chapter 8 explores ADHD medications in more detail).

Even after decades of research, the actual cause(s) of ADHD aren’t known. But despite this lack of completely detailed understanding of the causes, they do know a lot about how to treat the disorder. We give you an introduction later in this chapter in the section “Viewing Various Treatment Approaches,” and we write about treatment options in detail in Part 3 of this book.

Getting a Diagnosis of ADHD

Diagnosing ADHD can be frustrating for some people because there’s no definitive way to check for it. You can’t see it in a brain scan. You can’t test for it with a blood sample. The only way to diagnose ADHD is to do a detailed evaluation of your (or your loved one’s) past and present behaviors. This job involves finding a professional who understands the subtleties and variations of ADHD and can make a differential diagnosis (a list of conditions that have the same symptoms). The following sections give you an overview of this important process.

Choosing your professional

The first step to finding out whether you have ADHD involves finding the right healthcare professional. You may start with your family doctor or pediatrician, but in order to get an accurate diagnosis (as accurate as possible, anyway), you need to see a professional who understands all the different ways ADHD looks and can review your history properly. Your options can include, but aren’t limited to, the following:

• Psychiatrist: A psychiatrist is a medical doctor who specializes in mental illness and behavioral disorders. A psychiatrist can prescribe medication and often is up-to-date on the neurological factors of ADHD.
• Neurologist: A neurologist is a medical doctor whose specialty is the brain. This person often views ADHD from a biological basis and can prescribe medication. They may not be up-to-date on the best ADHD life strategies or alternative treatments.
• Psychologist: A psychologist is trained in matters of the mind. Most psychologists understand the criteria for diagnosing ADHD and can offer many treatment options; some can prescribe medication depending on their license.
• ADHD specialist: An ADHD specialist can be anyone from a teacher to a therapist who has experience and expertise in working with people with ADHD. Specialists likely have knowledge of many treatment and coping strategies, but they aren’t able to prescribe medication.
• ADHD coach:An ADHD coach helps you improve your functioning in the world. Coaches can come from many backgrounds — education, business, psychology — and their focus tends to be on practical,...