May I Have Your Attention, Please?

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In today’s day and age, many of us (and our kids) are overscheduled, overworked, and chronically distracted with the next thing. We procrastinate, we have too many projects going at once, and yet we might feel bored or restless at the same time. Others may have trouble concentrating to finish tasks, may have problems comprehending what they hear or see, or may struggle with managing impulsive emotional responses. As a licensed psychologist, I treat these complaints [from multiple etiologies] on a daily basis.

If any of the symptoms mentioned above are so persistent and pervasive that they are interfering with functioning at home, school, and work – it may be beneficial to talk to a doctor, a licensed mental health counselor, or a psychologist to determine if it could be Attention-Deficit/Hyperactivity Disorder (ADHD).

Commonly regarded as a neurodevelopmental disorder, ADHD classically affects the brain’s frontal lobe, which processes our highest order cognitive functions including time management, organizational, planning, impulse inhibition, and decision-making skills.

ADD or ADHD…Tomayto, Tomahto

Technically “ADD” is no longer a recognized medical diagnosis after the name was formally changed to ADHD in 1994. The term ADD is often used to refer to the inattentive subtype, in which individuals typically present few hyperactivity symptoms. However, many who meet diagnostic criteria for one of the three subtypes as defined by the Diagnostic & Statistical Manual, Fifth Edition (DSM-5) may present symptoms of both inattention and hyperactivity/impulsivity from time to time (American Psychiatric Association, 2013). The DSM-5 is the manual that professionals use to diagnose psychiatric conditions, which states that several of the following symptoms must be present prior to age 12:  

ADHD, Predominantly Inattentive Presentation (at least six must be present)

  • Fails to give close attention to details or makes careless mistakes

  • Has difficulty sustaining attention (concentrating)

  • Does not appear to listen

  • Struggles to follow through with instructions

  • Poor organization

  • Avoids or dislikes tasks requiring sustained mental effort

  • Loses things frequently

  • Is easily distracted

  • Is forgetful in daily activities

 

ADHD, Predominantly Hyperactive-Impulsive Presentation (at least six must be present)

  • Fidgets with hands or feet or squirms in chair

  • Has difficulty staying seated

  • Runs about or climbs excessively in children; extreme restlessness in adults

  • Difficulty engaging in activities quietly

  • Acts as if driven by a motor

  • Excessive talking

  • Blurts out answers before questions have been completed

  • Difficulty waiting or taking turns; Interrupts or intrudes upon others

 

ADHD, Combined Presentation

  • The individual meets criteria for both inattentive & hyperactive-impulsive presentations.

 

It is estimated that ADHD affects somewhere between seven to 10 percent of school age children (Thomas et al. 2015) and three to five percent of adults (Fayyad et al. 2007). When licensed professionals make the diagnosis, children must have six or more symptoms present across multiple settings; adolescents 17+ and adults must demonstrate at least five symptoms. In addition, other commonly co-occurring conditions must be ruled out as the primary reason(s) for these symptoms.

Is it ADHD or Something Else?

I always tell my patients that attention problems are like a fever – they simply tell us something is going on in the brain or body. Determining the cause requires further investigation. For instance, we may have a fever because we have the flu, and sometimes we feel like we have a fever, yet it’s actually a sunburn. Similarly, sometimes attention problems are caused by ADHD, and sometimes they are caused by other mental health conditions (such as depression, anxiety, or traumatic stress) and/or physical findings (such as nutrient deficiencies, heavy metal toxicity, or chronic pain, etc.). Evaluation by a licensed professional is important for determining the root cause for the symptoms to support an accurate and efficient treatment plan.

Distractibility or Hyperfocusing?

A phrase I often hear in my practice is, “It can’t be ADHD because my child can focus for HOURS on XYZ.” This is one of the very reasons why ADHD can sometimes go undiagnosed until later adolescence or even adulthood. The distractibility associated with ADHD is hyperfocusing. Often, focusing elsewhere on irrelevant information leads the observer to determine the actor is ‘distracted.’ For example, an individual whose concentration gets “stuck” while playing a video game may not realize that four hours has passed and it is dinner time because they were ‘distracted.’ What’s more, anxiety can complicate the clinical picture as worrying (or thought rumination) is yet another form of hyperfocusing and it can lead to trouble shifting gears to move on, problems concentrating, or fidgety behaviors.

Growing Into the Diagnosis, Not Out of It

While there is no cure for ADHD, individuals with this disorder can achieve satisfactory functioning through a combination of therapies that may include counseling, behavior modification, mindfulness, medication (both stimulant and nonstimulant options), educational/occupational supports, and parent training. Multi-modal treatment plans have progressed rapidly over the years as our understanding of ADHD has evolved.

Successful treatments and ongoing management strategies allow many adolescents and adults to function at a level where the diagnosis may be difficult to detect by the casual observer. This condition never goes away completely, meaning ADHD is a diagnosis that one grows into – the individual learns to anticipate their needs, create organizational structures, and plan for environmental adaptations to increase the likelihood of success.

 

Helpful Books:

  • Driven to Distraction (Revised): Recognizing and Coping with Attention Deficit Disorder by Edward M.

  • Hallowell, MD and John J. Ratey MD

  • Smart but Scattered: The Revolutionary "Executive Skills" Approach to Helping Kids Reach Their

  • Potential by Peg Dawson and Richard Guare

  • Smart but Scattered--and Stalled: 10 Steps to Help Young Adults Use Their Executive Skills to Set Goals,

  • Make a Plan, and Successfully Leave the Nest by Richard Guare, Colin Guare, and Peg Dawson

  • Taking Charge of ADHD, Revised Edition by Russell A. Barkley

 

For more information on ADHD, treatment recommendations, and latest research, visit https://chadd.org/about-adhd.

 

 

This post is intended as a service to visitors for informational purposes only. Dr. Leslie does not monitor this site and by posting or commenting, you are NOT entering into any type of treatment relationship with Dr. Leslie Jenkins. Dr. Leslie assumes no liability for any diagnosis, treatment, decision made or action taken in reliance upon information contained in this website or any other internet sites linked to it in any way. This post is not intended, nor should it be construed as providing medical or psychological care nor advice. As a general reminder, always seek advice from your physician or treating (licensed) clinician or provider.

 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

 

Fayyad J. et al. (May 2007). Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorderBritish Journal of Psychiatry, 190(5):402–409.

 

Thomas, Rae et al. (April 2015). Prevalence of Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysisPediatrics, 135(4), pp. e994–e1001.

 

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Dr. Leslie Jenkins is a dually-credentialed Licensed Psychologist and Nationally Certified School Psychologist. As the owner-operator of Another Look Psychological Services in Louisville, KY, Dr. Leslie specializes in second-opinion evaluations for ADHD, Autism, and learning concerns in children and adults. Dr. Leslie devotes special attention to address the nuanced aspects of healthcare. Her primary goal is to deliver psychological services that are practical, easy to understand, and holistically relevant. For more information about Dr. Jenkins’ practice, visit www.anotherlook.doctor.