If you are trying to figure out if you might have ADHD or you have already received a diagnosis, one of the most frustrating things can be trying to find information you need and can trust.
It is not easy!
There is a lot of hype out there, making it almost impossible at times to separate the wheat from the chaff.
I’m sure you know what I’m talking about. After endless amounts of time googling I bet you are often left confused, wondering:
- Is ADHD real?
- If there isn’t some sort of blood test, MRI, CT scan or some other real test, how can I know I really have ADHD?
- If it is real, is there a cure?
- What is the “right” treatment?
If you’ve been reading my blog for awhile, you know I’m not a fan of hype or hyperbole.
And neither are you. You want the facts.
Here there are.
What is The Cause of ADHD?
You may have heard in the media that poor diet, food dyes, too much sugar, environmental chemicals, poor schooling, too much TV, poor pre-natal care or poor parenting are causes of ADHD.
It is possible that drug or alcohol use during pregnancy could alter the brain and may be a possible cause of ADHD. As for the other factors, while credible research has not been able to validate any of them as causes of ADHD, they definitely can exacerbate ADHD symptoms.
What we do think is that ADHD is a brain based biological disorder, caused by a number of factors that affect how the brain develops and functions. And the one factor that stands out is a neurotransmitter imbalance.
As you know, each region in the brain is responsible for a particular function; of course there are overlapping functions. But for the various regions to do their jobs, they must be linked to one another through neural circuits that carry information from one brain region to another.
For this to happen neurotransmitters must be available to transmit the messages. But, in the ADHD brain, because there an imbalance of dopamine and norepinephrine, the messages are not transmitted efficiently.
As a result, the various regions of the brain cannot perform their functions well, resulting in the ADHD symptoms you experience, such as difficulty:
- paying attention
- regulating emotions
- and more…
So, there you have it.
I’m sure continuing research will uncover more in the coming years.
Click here for in-depth information about the ADHD brain.
I know for some this may be more information than you want right now. In fact, if you are feeling overwhelmed, feel free to close this section now.
But, if you are interested in more detail, read on…
My primary goals are for you to:
- understand that your different brain wiring is the cause of your ADHD related challenges.
- be able to acknowledge you are not lazy, crazy or stupid!
In fact, if these are your only takeaways — and you forget all the details below — I am good with that, really.
You read above that the primary cause of ADHD seems to be an imbalance in neurotransmitters in four primary areas in the brain — below are highlights of what is happening in these four regions of the ADHD brain .
The primary job of the frontal lobe is to carry out higher mental processes — thinking, decision making and planning. You know, the stuff that is hard for you.
Another job is to inhibit and keep the rest of the brain under control. In particular, the frontal lobe or logical brain is supposed to help keep our emotions in check — sometimes referred to as emotional regulation.
But, because of the imbalance of dopamine, the messages between the neurons in this region are not transmitted efficiently — and the frontal lobe cannot do its job efficiently.
The result is your ability to carry out various executive functions and regulate your emotions is compromised.
The Limbic System’s primary job is to regulate our emotions.
But, as a result of the imbalance of dopamine and norepinephrine in this region, you may experience emotional volatility. That is you may:
- be quick to get sad, angry or excited.
- feel you emotions more intensely — high highs and low lows.
An imbalance of dopamine and norepinephrine in this region can only contribute to your restlessness and inattention.
The basal ganglia, when functioning properly:
- helps you decide what to do next.
- inhibits you from trying to do a million things at once so you can attend to what you need to do.
- gives you the mental energy you need to get-up-and-go.
Because of a deficiency of dopamine, the basal ganglia is underactive and can result in you having a hard time deciding what to do in the moment.
So, you may end up:
- stuck in neutral thinking, “I could do this or this or…”
- flitting about from one tasks to another.
- having a hard time transitioning from one activity to another.
The RAS (reticular activating system) is a network of neurons and neural fibers, located in the brain stem, that connects with other parts of the brain.
One of its primary functions is to sorted information from the outside and pass it along to the rest of the brain system to be processed and acted upon.
It is the key to turning on our brain so we give attention to the most important information.
But, because of a deficiency norepinephrine, the RAS is not able to filter and process incoming information effectively.
As a result:
- all the stimulai, information, from the outside floods your mind.
- you are not able to focus your attention.
- you become overwhelmed.
- and you miss the important information!
So, you don’t see important email lost in the deluge of all the others in your inbox. You don’t hear your colleague trying to get your attention in a crowded convention room. You miss the final boarding call for your flight over the intercom at the airport.
There is just too many competing incoming stimuli.
Who Can Diagnose Adult ADHD?
Don’t skip over this part.
Because getting an accurate diagnosis is one of the most critical pieces in managing your ADHD.
For an evaluation, it is best to see a psychologist, psychiatrist or psychiatric nurse practitioner.These professionals are trained in the field and are the most qualified to make a diagnosis.
The advantage of seeing a psychiatrist or psychiatric nurse practitioner for evaluation is that they can also prescribe medication, if a need is indicated by the evaluation.
If you have not yet received a diagnosis from a psychologist, psychiatrist or psychiatric nurse practitioner, I would suggest going back one step before considering taking ADHD medication.
You may be tempted to consult with your family doctor, as the process can seem easier and quicker. And some family doctors may be willing to diagnose and prescribe medication for mental health issues.
But I strongly caution against going this route.
As your family doctor likely does not have the necessary specialized and up-to-date knowledge to evaluate and treat mental health issues, including ADHD.
This lack of expertise can result in delays in receiving the correct diagnosis and treatment plan for ADHD or any other mental health issue. Consequently, the process may be longer and your ability to move effectively and efficiently toward your goals may be severely compromised.
However, your family doctor may be able to help you by making an appropriate referral.
How is Adult ADHD Diagnosed?
I’ve heard it all…
- “My therapist says I’m too successful to have ADHD.”
- “I got by for a long time and then all of sudden I start struggling. I had no idea I had ADHD!”
- “I was never impulsive or hyperactive. So, it never occurred to me that I might have ADHD.”
There is a lot of confusion and misinformation about ADHD symptoms.
So, before opening up the list below, a heads up…
First, ADHD symptoms can present themselves differently throughout your life time.
And you may have learned various coping mechanisms that worked during various times of your life. It’s not that the symptoms were not there, it was just that you could manage them in earlier contexts.
Maybe you did just fine in school or before your kids came along. You got by — until life got more complicated and your strategies stopped working.
You didn’t all of sudden get ADHD! Your strategies just stopped working well enough.
And then, when you sought out help to figure out what was going on, you received your ADHD diagnosis — inattention and / or hyperactivity.
Don’t listen to people who say, “I can’t focus either. Maybe I have ADHD!”
A diganosis of ADHD is given when your symptoms (see more below) are persistently getting in the way of your ability to function effectively at work and/or home.
Click here for a Adult ADHD symptom checklist.
DSM-5 Criteria for ADHD:
People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development:
1. Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
- Often has trouble holding attention on tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
- Often has trouble organizing tasks and activities.
- Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
- Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
- Is often easily distracted
- Is often forgetful in daily activities.
2. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
- Often fidgets with or taps hands or feet, or squirms in seat.
- Often leaves seat in situations when remaining seated is expected.
- Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
- Often unable to play or take part in leisure activities quietly.
- Is often “on the go” acting as if “driven by a motor”.
- Often talks excessively.
- Often blurts out an answer before a question has been completed.
- Often has trouble waiting his/her turn.
- Often interrupts or intrudes on others (e.g., butts into conversations or games)
In addition, the following conditions must be met:
- Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
- Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities).
- There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
- The symptoms do not happen only during the course of schizophrenia or another psychotic disorder. The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
Based on the types of symptoms, three kinds (presentations) of ADHD can occur:
Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months.
Because symptoms can change over time, the presentation may change over time as well.
Reference:American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.
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