35: ADHD 101: What is ADHD?

ADHD 101: What is ADHD?

A bonus episode serving as a primer for ADHD basics

What is ADHD, really? In a bonus episode, host Eric Tivers discusses, via analogies and examples, the reality of ADHD. Breaking it down into its separate categories, Eric explains the different standardized presentations of ADHD along with their identifying symptoms. If you or others you know are looking for an introduction to ADHD as a technical topic, this is an ideal place to start.

ADHD Analogy:

  • The model of the US government we learn of in school is fairly simplistic, consisting of a description of the three branches and the process of passing a law. In reality, though, there are many other factors at play.

  • Political science : politics :: technical definition of ADHD : the reality of ADHD

  • The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) provides an accurate technical description, yet doesn’t tell the whole story of what ADHD really is.

What is ADHD?

  • ADHD is a developmental delay of key brain areas, primarily the prefrontal cortex

  • Two main categories of symptoms exist within ADHD, with an additional third combined presentation:

    • Inattention and distractibility

      • Eric: like ADHD without the H

      • Called “predominantly inattentive presentation” by DSM-5

      • Changed from a “sub-type” to a “presentation” due to its dynamically changing nature

    • Hyperactivity and impulsivity

    • Combined presentation

      • Most people fall under this category

      • Eric:  Initially thought he was only part of the first presentation, but gradually realized though studying ADHD that he displayed the impulsivity part of the latter

  • As a person gets older, the symptoms become less impairing

  • About the symptoms

    • According to the DSM, in order to have ADHD someone must have five out of nine symptoms if they are an adult, and six out of nine if they are a child.

    • There are a total of eighteen symptoms, with half pertaining to the inattentive type and half to pertaining to the hyperactivity type.

Specific ADHD Symptoms:

  • Note: Symptoms must be present for at least six months and have existed during one’s childhood. New DSM revisions specify an arbitrary age of twelve years old. The symptoms must cause, and have caused, impairment and be present in multiple settings (school, home, social, etc.). At least six of nine symptoms must be present to meet the standard for a child to have ADHD, and at least five must be present for the same for an adult. An official diagnosis should always be made by a trained clinician.

  • Predominantly Inattentive Presentation

    • Often fails to give close attention to details or makes careless mistakes; may overlook or miss details; work is often inaccurate

    • Has difficulty sustaining attention; may have difficulty remaining focused during lectures, conversations, or lengthy readings

    • Does not appear to listen when spoken to; mind seems elsewhere, even in the absence of any obvious distractions

    • Struggles to follow through on instructions or finish tasks to completion (not due to a lack of understanding or Oppositional Defiant Disorder); starts tasks but quickly loses focus and is easily sidetracked

    • Has difficulty with organization; this includes difficulty managing sequences of tasks, keeping materials and belongings in order, messy and disorganized work, poor time management, and failing to meet deadlines

    • Avoids or dislikes tasks requiring a lot of thinking or mental effort for a long period of time; this impacts schoolwork or homework for kids, for teens and adults preparing reports, completing forms, and reviewing lengthy papers

    • Often loses things: school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, cell phone, etc.

    • Is easily distracted: for teens and adults, this may include distraction from unrelated thoughts themselves

    • Is forgetful in daily activities: doing chores, running errands, returning calls, paying bills, keeping appointments, etc.

  • Predominantly Hyperactive-impulsive Presentation

    • Fidgets with hands or feet, or squirms around while seated in a chair

    • Has difficulty remaining seated

    • Extreme restlessness in adults and excessive running and climbing in children; inability to be comfortable when still for extended periods of time (in restaurants, meetings), and what may be described by others as restless or difficult to keep up with

    • Difficulty engaging in activities quietly

    • Acts as if driven by a motor – adults will often feel inside like they were driven by a motor

    • Talks excessively

    • Blurts out answers before questions have been completed

    • Difficulty waiting or taking turns

    • Interrupts or intrudes upon others; butting into conversations, games, and activities, starting to use others’ property without permission, or taking over what others are doing

  • Combined Presentation: contains symptoms from both prior presentations

Other Considerations:

  • Despite being established in the DSM-5, these definitions and symptoms are still being described in terms of behavioral characteristics.

  • There are differences in group study in the realm of brain scans.

  • From the DSM-5: “No biological marker is diagnostic for ADHD. As a group, compared with peers, children with ADHD display increased slow-wave electroencephalograms, have reduced total brain volume on Magnetic Resonance Imaging, and a possible delay in the posterior and anterior cortical at maturation. But these findings are not diagnostic.”

  • For instance, the SPECT Scans advertised by Dr. Amen are not considered diagnostic in effect.

  • ADHD used to be called “minimal brain dysfunction”

  • ADD is no longer used after it was phased out some thirty years ago

    • Some may focus on the “Hyperactivity” part of ADHD and believe that it does not apply to them

    • Eric: sometimes identifies as having ADHD “without the ‘H'”

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