The ABCs of ADD/ADHD

“Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) are really one in the same diagnosis,” says Dr. Denise Blad, a family medicine specialist with Lutheran Health Physicians in Fort Wayne. “It’s a neurodevelopmental disorder likely caused by several factors including genetics, the environment and problems during development,” she says. According to the Centers for Disease Control and Prevention (CDC), from 2016 through 2019 the number of U.S. children diagnosed with ADHD was approximately 9.8% or 6 million. The prevalence of adult ADHD has been difficult to identify, but a study including data from 2005 through 2019 showed persistent ADHD was 2.5% and symptomatic adult ADHD was 6.76% globally.

ADD/ADHD is characterized by three main components: hyperactivity, impulsivity and inattention. Dr. Blad says a child with this disorder may not be recognized as anything more than what appears to be a child whose behavior is significantly immature based upon their age. “In school, this might be the child who walks past another child and pulls their hair or cannot sit still in their seat,” she says. “Boys are three times more likely to be diagnosed with ADHD than girls because they exhibit the hyperactivity and impulsivity component more than girls. Hyperactivity and impulsivity are typically more recognizable than inattention alone. Moving into adulthood, hyperactivity and impulsivity symptoms tend to diminish, but they can appear in other ways like fidgeting, or frequently interrupting or finishing someone else’s sentence. If inattention alone is the symptom, the first step is to correctly diagnose whether the inattention is ADD/ADHD or a result of another problem.”

“With children, we do a thorough screening involving the parents, child and also the child’s teacher,” says Dr. Blad. “We ask lots of questions, such as, are they viewed as disruptive in their school environment? Are they up walking around and can’t sit down? How are their grades? Are they completing their assignments and turning in their homework? How do they interact with other children? We ask about behavior at home.” 

“I do think it’s important to point out that there is a lot of concern, and rightfully so, regarding the over-diagnosis of ADHD. Your provider needs to do an evaluation and assure there aren’t other problems because inattention, or difficulty focusing, can be caused by other mental health disorders — anxiety, depression, medical problems like sleep disorders or thyroid problems, and more. We want to be sure we’re diagnosing this correctly and providing each person with the appropriate treatment.”

The persistence of ADHD from childhood to adulthood ranges from 35-65%, according to recent studies. Dr. Blad says the good news is that ADD/ADHD patients have options when it comes to managing their issues.

“While there is no cure, some adults experience a decrease in symptoms and may no longer meet the diagnostic criteria. Thus, those patients may be considered to have ‘outgrown’ ADHD or they may be able to manage well using their organizational skills.”

Dr. Blad says as people’s lives change, so, too, may the disorder. 

“A patient may work at a job that doesn’t require intense cognitive ability and not require medication, but if they change to a job that does need that cognitive function for 10 hours a day, they may need medication to support them. Everybody is different and their needs can change as they go through life.”

“We look at ways to effectively manage the symptoms,” she says. “There are numerous medications that work well for children and adults. We also look at alternatives including psychotherapy, which may include Cognitive Behavioral Therapy addressing the development of goals, and skills training such as organization and time management, and family therapy.”

Once a patient is diagnosed, Dr. Blad says it’s important for them to stay in contact with their provider and have regular follow-up appointments. In the beginning, monthly visits may be needed. A treatment plan is developed for each patient based on their individual needs and response to treatment. A plan including changes in medication and follow-up should be communicated to the patient at each visit. The provider can navigate their patients through changes.

“If ADHD is treated, it really can change someone’s life. There are people who struggled for years and didn’t know why. Unfortunately, mental health disorders can be looked at differently (often negatively) compared to a physical health condition. Mental health disorders are quite often a problem with neurotransmitters, which is true with ADD/ADHD diagnosis. If treated, we see dramatic improvement in school and work environments, overall quality of life and productivity.”  

References: Centers for Disease Control and Prevention. Attention Deficit/ Hyperactivity Disorder ADHD. Data and Statistics. cdc.gov.ncbdd/adhd/data.html; Journal of Global Health. 2021; 11: 04009 National Library of Medicine. National Center for Biotechnology Information. PubMed Central. ncbi.nlm.nih.gov/pmc/articles/PMC7916320/; Owens, Elizabeth et all (2015) Progressive and Gender Developmental Differences among Individuals with ADHD. In R.A. Barkley (Ed.) Attention- Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, 4th ed (pp. 223 – 255)

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