ADHD or Attention Deficit/Hyperactivity Disorder is a neurodevelopmental disorder that primarily affects one’s ability to focus, control impulses, and regulate activity levels. It is commonly diagnosed in children but can persist into adolescence and adulthood.
It used to be categorized into two groups: Attention Deficit Disorder (ADD) and ADHD. However, in recent years, it changed to include a more inclusive approach by assigning three different subtypes of ADHD: Predominantly Inattentive Presentation, Predominantly Hyperactive-Impulsive Presentation, and Combined presentation.
Predominantly Inattentive Presentation, most similar to ADD, is characterized by difficulties with attention, organization, and focus. Predominantly Hyperactive-Impulsive Presentation is marked by hyperactivity and impulsivity, and combined presentation involves a combination of both symptoms.
There are seven recognized types of ADHD that are popular in the media and other informal discussions. Though they are not backed by the American Psychiatric Association, they are still commonly used in describing one’s symptoms and can be helpful in learning about your symptoms. We recognize that these do not correspond to a standard medical diagnosis.
The seven types of ADHD include:
- Classic ADD: Brain mapping in patients with Classic ADD often shows slow brainwaves in the brain’s frontal regions and abnormal connectivity within and/or between the prefrontal cortex and parietal lobes. Patients suffer from inattention, hyperactivity, and impulsivity. Symptoms include difficulty sustaining attention, difficulty organizing tasks, avoiding tasks requiring mental effort, being easily distracted, difficulty following instructions, forgetfulness, and daydreaming.
- Inattentive ADD: Inattentive ADD symptoms are often confused with anxiety or depression. Those with this subtype of ADD encompass a wide range of symptoms including trouble paying attention, difficulty paying attention, failure to finish tasks (e.g., schoolwork, chores, etc.), being lethargic, forgetful, avoidance of activities that require prolonged mental effort, and being distracted. Inattentive ADD is often due to dysregulation in the prefrontal cortex, and individuals often feel they need to be “pushed” to concentrate on tasks in front of them.
- Over-Focused ADD: Over-FocusedADD is often linked to irregular brain activity in the anterior cingulate gyrus, meaning that they have inflexible cognitive thinking. Symptoms one may experience include inattentive behavior, trouble shifting behaviors, being stuck in a “negative thought loop”, obsessive behaviors, compulsive behaviors, excessive worrying, and difficulty adjusting to changing conditions. Some individuals will exhibit hyperactivity, while others won’t. Those with Over-Focused ADD are also commonly misdiagnosed with obsessive-compulsive disorder (OCD).
- Temporal Lobe ADD: Our temporal lobes are responsible for inferring meaning from auditory and visual sensory input. Because individuals’ temporal lobes are impaired, it often has a drastic effect on their emotional and cognitive functioning. Their brains often have difficulty in school and work environments due to their inability to focus on tasks, understand social cues, and form meaningful relationships. They can also be emotionally overreactive due to their fight-or-flight responses. Temporal Lobe ADD may also cause issues with long-term and short-term memory, which affects their ability to function optimally in day-to-day life.
- Limbic ADD: This subtype of ADD affects the limbic system which is responsible for regulating emotions, motivation, memory, and behavior, and influences both the endocrine and autonomic nervous system. Those with Limbic ADD are thought to be suffering from an overactive limbic system and an underactive prefrontal cortex. Common symptoms include chronic low energy, moodiness, hopelessness, apathy, abnormal sleep, low self-esteem, and excessive guilt, as well as some inattentive ADD symptoms. These symptoms are highly similar to clinical depression.
- Ring of Fire ADD: Ring of Fire ADD is characterized by abnormally increased activity in multiple areas of the brain. Individuals with this kind of ADD may experience extreme moodiness, angry outbursts, anxiety, trouble falling asleep or staying asleep through the night, sensitivity to light and sound, and racing thoughts. Because there is so much activity in the brain, they can also be emotionally overreactive. Ring of Fire ADD can be correlated with bipolar disorder; however, they differ in the sense that patients do not experience symptoms episodically like they do in bipolar disorder; Ring of Fire ADD symptoms are experienced on a more consistent basis.
- Anxious ADD: Anxious ADD is affected by a dysregulated brain in areas responsible for attention and memory, anxiety, mood regulation, and executive functions. Symptoms are portrayed as the inability to focus, feelings of anxiousness, fear of disapproval or criticism, social anxiety, stress-related digestive symptoms, headaches, and/or sleeping difficulties, and pessimism. It is different from anxiety in the sense that anxiety occurs in conjunction with attentional deficits. They often struggle in stressful situations like exams, interviews, or social interactions.
Treatments for the seven types of ADHD vary, however, the common ADHD treatment includes a combination of behavioral interventions, psychoeducation, and sometimes medication. The patient’s age, severity of symptoms, and preferences all vary, and are very useful in developing a treatment plan. Common behavioral interventions for ADHD are behavioral therapy and parent training techniques.
Regarding behavioral therapy, Cognitive Behavioral Therapy (CBT) and other behavior modifications can help individuals develop skills that work to manage symptoms and improve organization, time management, and problem-solving skills. Parent training can be beneficial by learning different strategies that help manage their child’s behavior and implementing effective discipline and structure in their everyday life. Psychoeducation can also be very beneficial for individuals, families, and caregivers.
Gaining knowledge about the nature, symptoms, and challenges of ADHD can empower those to cope better and make better-informed decisions. Common medications for ADHD include stimulant medications (e.g., methylphenidate, amphetamine-based medications) and non-stimulant medications (e.g., atomoxetine, guanfacine). Stimulant medications may improve attention, focus, and impulse control, while non-stimulant drugs work better for those who cannot tolerate stimulants or don’t respond well.
Things like regular exercise, a healthy diet, adequate sleep, and counseling or other support interventions are also important when treating ADHD. In recent years the use of technology and brain stimulation has become more recognized in the treatment plan for ADHD. MeRT – Brain Performance Technologies (MeRT) is a form of brain stimulation that helps the parts of the brain that are not communicating as they should. A brain that is functioning optimally can lead to dramatic improvements and learning in all the traditional forms of therapy for ADHD. Research articles on MeRT and ADHD can be found here.
Treatment plans regarding children and adults usually take a different direction and may have different goals. These directions differ based on differences in cognitive development, responsibilities, and individual needs.
ADHD in Children
Children with ADHD have difficulty establishing peer relationships, understanding family dynamics, and struggling to perform well in school. Children rely on their parents and teachers for structure and support, making it important that we guide them into developing self-awareness and positive coping skills. When discussing the best ADHD treatment for children, behavioral interventions and parent training are very important. However, school-based interventions can be especially helpful. Most often, children with ADHD struggle in school due to a lack of ability to pay attention and focus on tasks. Accommodations and Individualized Education Plans (IEPs) can help to manage symptoms in an educational setting. It is important to remind the child that just because it may take them a little longer to finish a test or read a book, it does not mean that they are incapable of being successful. If behavioral interventions and psychoeducation are insufficient in managing daily symptoms, medication may be considered.
ADHD in Adults
The best treatments for ADHD in adults focus on skill development for organizing tasks, managing time, and improving focus at work and in their personal lives. Because adults have many more responsibilities, whether that be work, family, or their personal lives, developing strategies like those mentioned above is crucial. Things like self-esteem and emotional challenges are also more present in adults, so psychotherapy and other behavioral interventions can help to address these symptoms. Medication is more common in adults, especially stimulant medications to help them improve attention and focus.