TL;DR
THE ESSENTIALS
What is ADHD?
ADHD is the current term for a specific developmental disorder seen in both children and adults that is comprised of deficits in behavioural inhibition, sustained attention and resistance to distraction, and the regulation of one’s activity level to the demands of a situation (hyperactivity or restlessness) [1].
How many people have ADHD?
Rates of diagnosis of ADHD in Australia vary between 2 and 9.5 percent of the population [1]. In comparison, 20% of Australians will experience some level of depression in their lifetime [2,3].
What is executive functioning?
These brain functions are a set of complex mental skills that help you accomplish tasks. They work like an effective senior executive of a company, coordinating big and small groups of employees to attain larger company goals. Failures of these functions in ADHD are similar to an executive who goes on long lunches and sends passive aggressive emails to their staff. The systems don’t work well without good leadership (executive functions). These systems include inhibiting behaviour, focus on long term goals, internal goal directed speech, emotional regulation, and planning and problem solving.
Isn't this just a fancy way of saying someone is lazy?
Psychologists already have fancy ways of labelling people as lazy with personality measures of conscientiousness. ADHD is much different than being lazy.
ADHD is as real as depression, and our ability to see it within the brain has only improved over time. Many people we work with would give their right arm to make their difficulties as simple as being lazy.
Holly is a registered psychologist experienced in the diagnosis and treatment of ADHD in children and adults. She is available for appointments at Brave HQ Monday, Tuesday, & Thursday 9 – 7pm, and Saturday 9am – 12pm
Sheyan is a youth worker who facilitates the 1Up! Gaming Group on Mondays. He is currently completing a Bachelor of Psychology at Deakin University.
FOR THE READERS
Types of ADHD
There are three subtypes of ADHD that are diagnosed based on types and level of symptoms. The diagnosing health professional generally provides a severity rating from mild to moderate to severe to indicate how much ADHD has impacted the person’s life. The impact of ADHD on the person must be clear, and this is why many people may not receive a diagnosis until later in life.
ADHD predominantly inattentive type (ADHD-PI)
An individual with ADHD-PI has many symptoms of inattention but not many hyperactive symptoms. Someone with ADHD-PI makes careless mistakes in schoolwork or other work and often does not seem to listen when spoken to directly.
ADHD predominantly hyperactive-impulsive type (ADHD-PHI)
The individual has clear excessive symptoms of hyperactivity and impulsivity without many inattentive symptoms. Individuals with ADHD-PHI will display behaviours like being excessively active, have difficulty sitting still, following their impulses despite previous bad experiences, and acting out irresponsibly at school.
ADHD combined type
The individual has enough symptoms from both inattention and hyperactivity-impulsivity domains. This is also the most common form of ADHD.
Executive Functioning & ADHD
What are Common Executive Functioning Deficits in ADHD?
- Failure to inhibit behaviour: A person with ADHD can find it difficult to refrain from following their impulses, even if they know they will lead to negative outcomes or are not in line with personal goals.
- Maintaining goals in mind: Humans vary on their ability to hold information in their mind. Those with ADHD can find it difficult to maintain their memory of the sequence of steps that relate to a short or longer term goal. For example, a person may design a new budget but can’t keep track of how much of their coffee budget has been spent. They may want to lose weight but are likely to forget the steps they should be taking day to day to work towards that goal.
- Self-talk for self control: Self talk is the voice in our heads that can assist us and guide us with our everyday actions. Often this voice isn’t a strong presence, or is in disagreement with the impulses the person has.
- Emotional regulation: Emotional regulation is our ability to be aware of and modify our emotions so they stay in line with our long-term goals. Those with ADHD may find their awareness of their emotions is poor. They are then only likely to become aware of their emotions when they are particularly intense and then over-react. Many people can have a lot of difficulty in bringing their emotions back to reasonable levels.
- Compromised planning and problem solving: Individuals with ADHD often find it very difficult to organise themselves and find solutions to complications in multi-step tasks that aren’t intensely interesting to them. Their thinking can appear to others to be rigid or ‘black and white’, or they may be perceived as overly stubborn.
What does ADHD look like in Children? See if you can tell:
Diagnosing ADHD
Health professionals vary in how they diagnose ADHD. Our psychologists use a variety of assessment tools and information gathering techniques depending on the age of the person requesting an assessment. A clinical opinion is formed at the completion of the assessments and a brief report is written. As medications that treat ADHD symptoms are a schedule 8 controlled drug, it is common for referrals to be made to a paediatrician or psychiatrist after diagnosis.
Symptoms must be present before the age of 12, and are always considered within the intelligence, temperament, and family contexts of a person’s life. The symptoms must be excessive for a child’s developmental level. For example, children usually show signs of hyperactivity as they learn to regulate their own behaviours. However, a child with ADHD would show hyperactivity to excessive levels. Read the full article on ADHD diagnosis and how we complete an assessment at Brave HQ.
Treatment of ADHD
It is important to recognise that untreated ADHD tends to result in growing problems in a person’s life. This can include things like failures or underperformance at school, university, and work, loss of friends from forgetting to return calls, or legal problems from forgotten parking fines. Further impacts include secondary anxiety and depressive disorders, and poor self worth.
Evidence suggests that combined medication and coaching or therapy with a professional experienced in ADHD result in the best results overall [5,6,7]. We focus on making sure our clients understand their ADHD, and use a solutions focused therapeutic approach to remove barriers and create solutions. Often this can include some form of family therapy when it is likely to assist the client to manage their symptoms.
Read the full article on how Brave HQ works with children, adolescents and adults to manage their ADHD and related symptoms of depression, anxiety, and poor self-esteem.
REFERENCES AND FURTHER READING
- R. A. Barkley & K. R. Murphy (2006) Attention deficit hyperactivity disorder: A clinical workbook (3rd ed.). New York: Guilford Publications.
- Magill’s Medical Guide, Online, 2017.
- Australian Bureau of Statistics, 2008.
- National Survey of Mental Health and Wellbeing: Summary of Results, 2007. Cat. no. (4326.0). Canberra: ABS).
- Frodl, T. and Skokauskas, N. (2012), Meta-analysis of structural MRI studies in children and adults with attention deficit hyperactivity disorder indicates treatment effects. Acta Psychiatrica Scandinavica, 125: 114–126. doi:10.1111/j.1600-0447.2011.01786.x
- Prasad, V., Brogan, E., Mulvaney, C., Grainge, M., Stanton, W., & Sayal, K. (2013). How effective are drug treatments for children with ADHD at improving on-task behaviour and academic achievement in the school classroom? A systematic review and meta-analysis. European Child & Adolescent Psychiatry, 22(4), 203-16. doi:http://dx.doi.org/10.1007/s00787-012-0346-x
- https://www.ranzcp.org/Publications/Guidelines-and-resources-for-practice/Adult-ADHD-practice-guidelines.aspx
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