ADHD: Debunking Myths and Unveiling Facts About Attention Deficit Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is one of the most misunderstood and debated mental health conditions. In the United States, 22 million children and adults have a diagnosis of ADHD. Despite being a commonly known disorder, many myths and misinformation continue to be attached to the condition. Myths have powerful implications; misinformation can impair rendering a proper diagnosis, impact treatment and can potentially upend research of ADHD. In this issue of the UICDR newsletter we debunk myths and unveil facts about ADHD.

 

Myths about ADHD

Long-standing myths and misconceptions about ADHD exist, such as what causes ADHD, how to properly diagnose ADHD, and beliefs that ADHD is simply a lack of focus or laziness on the part of the person being affected, rather than a complex neurodevelopmental disorder that significantly impacts daily life. The following are common myths about ADHD.

Myth 1: ADHD isn’t a real medical disorder

There’s no lab test to confirm ADHD, so many people have a hard time believing ADHD is a “real” medical disorder. ADHD is in fact a  neurodevelopmental disorder, with reliable and valid measures of assessing and diagnosing ADHD, and affects a person's behavior and development.

Myth 2: Only boys have ADHD, Girls don’t have ADHD

While boys are more frequently diagnosed with ADHD, girls can also be diagnosed ADHD.

Myth 3: ADHD Is Caused by Poor Parenting

One of the most harmful and common myths about ADHD is that it is caused by “bad parenting.” Parents of children with ADHD are often criticized for possessing poor parenting skills and not properly disciplining their child. Although parenting plays a significant role in how a child with ADHD manages  daily life, parents of children with ADHD shouldn’t be blamed and shamed for their child’s condition. 

Myth 4: Sugar Causes ADHD

There is no scientific evidence to support that sugar directly causes ADHD. This myth grew out of the belief that sugar causes hyperactivity in children which is widespread and continually perpetuated. The medical industry maintains there is no known link between sugar and hyperactivity.

 

What is ADHD?

ADHD is a biological, brain-based disorder. It is genetic, meaning that it runs in families. Those with ADHD struggle with focus/attention, hyperactivity/impulsivity, or both. Though everyone has trouble with focus or impulsivity sometimes, with ADHD these symptoms happen most of the time and cause impairment, or problems, in day-to-day life. Impairment could include failing classes, family conflict, and inability to keep a job. ”Those with ADHD may have trouble staying organized, keeping track of important items, or finishing tasks. They may be constantly moving around and talk a lot. They also may have trouble waiting their turn, including in conversations,” says Dr. Christine Lee, Assistant Professor of Clinical Psychiatry.

ADHD has been the subject of much debate and media attention, particularly regarding the rise in ADHD diagnoses among children.

“Estimates vary, but in general, the prevalence of ADHD is around 10-15% in children and 3-5% in adults. There is not strong evidence that indicates rates of ADHD diagnosis are higher in the United States relative to other resource-rich countries, although in general, the diagnosis of ADHD has been increasing,” says Dr. Brandon Hage, Assistant Professor of Clinical Psychiatry.

Rates of ADHD diagnoses have increased rapidly in the past decade. This surge in diagnoses can be attributed to numerous factors including a greater awareness and recognition of  symptoms associated with ADHD in the medical community, and a change in how ADHD is defined and diagnosed. Whereas previous definitions focused on hyperactive behaviors, a diagnosis can now be made even if hyperactivity isn’t present. In addition, expanded increased research on ADHD has increased understanding and knowledge of how the symptoms may manifest across diverse populations, whereas prior research centered primarily on hyperactive boys.

Early diagnosis during childhood is essential for preventing the life-long challenges associated with ADHD that can severely impact an individual’s emotional, social, and academic development.

Left untreated, ADHD can have severe negative consequences and can lead to a number of mental health complications, including depression, anxiety, mood disorders, and eating disorders.

 

Diagnosis and treatment

Diagnosing ADHD is a multi-step, comprehensive process.  Treatment involves a combination of medication and therapy. 

If you are concerned about whether someone might be struggling with symptoms of  ADHD, the first step is to talk with a healthcare provider to find out if the symptoms fit an ADHD diagnosis. ADHD can also be diagnosed clinically, meaning a mental health professional, like a psychologist, psychiatrist, primary care provider, or a pediatrician can make the diagnosis based on careful, thorough patient interviews and collateral.

ADHD can be diagnosed in children/adolescents through a clinical interview, including the use of standardized rating scales. Additionally, adults who know the child outside of the home setting – such as teachers - should be included in evaluation process. A thorough clinical interview is needed because there can be many reasons a person may have trouble with focus. For example, anxiety, depression, lack of sleep, and learning problems all negatively impact focus. A clinical interview is used to rule-out other causes for ADHD symptoms. Additionally, it is important to talk to another adult outside the home setting to determine if symptoms are experienced in different settings. If symptoms are just present at home, they could be due to family specific factors rather than ADHD. Teachers can be a valuable source of information because they see a variety of typically developing children and can then more easily note when a person’s behavior may differ from what is age appropriate or expected in that setting. Unfortunately, there is not a blood test or psychological test that can be given to a child and/or adolescent to specifically diagnose ADHD.

The most effective treatment of ADHD often involves a combination of medication, behavioral therapy, , and family therapy.

“The gold standard psychological treatment for ADHD in children/adolescents is behavior parent training. The treatment is actually focused on caregivers creating a consistent structure for their children and providing external motivation for children to complete their required tasks. Individual therapy is not found to be effective for children/adolescents with ADHD,” says Dr. Lee.

Those with ADHD often know what the “right” action is to do, but struggle with implementing this action. Additionally, they may lack motivation to complete tasks, such as homework. The long-term result of a change in grade may not be as immediately meaningful of a motivator. Therefore, the focus of treatment is for caregivers to find meaningful motivators for their children so that the children only earn these motivators when they engage in the appropriate behavior. For example, children could only earn electronics after their homework is completed for the night. This type of therapy focuses on creating connections between children’s behavior and the immediate consequences. There are no negative side effects of this type of treatment. It does, however, require a significant investment from caregivers to implement these changes at home. Simply attending regular psychotherapy sessions without home changes will not be effective.

There are two types of medication classes for ADHD, stimulants and non-stimulants. Stimulants have two main families, the methylphenidate family (brand name Ritalin) and amphetamine salt family (Adderall). They are called stimulants because they "stimulate" brain regions important for attention, executive function, impulse control, and working memory by increasing dopamine in the frontal cortex of the brain. The benefits of these medications are that they have demonstrated efficacy for improving symptoms of ADHD, tend to work very quickly to improve symptoms, and do not need to be taken every day to be effective. While stimulants do carry a risk for misuse and abuse, rates of misuse and abuse of prescription stimulants amongst ADHD patients are low. This is because ADHD patients recognize how valuable the medication is for their well-being and functioning.

Non-stimulants do not act on dopamine. These include atomoxetine (brand name Strattera), clonidine, and guanfacine. Benefits are that these medications do not have abuse potential, tend to be less anxiety-provoking, and may help more with sleep-related issues. The downsides include the fact that these medications tend to not work as well compared to stimulants in terms of symptom management, in particular clonidine or guanfacine for daytime symptoms. While atomoxetine is considered a second-line treatment for ADHD, it does have to be taken daily for several weeks to see clinical benefit.

 

Innovative and compassionate care for ADHD

UI Health and the UIC Department of Psychiatry recognizes that ADHD is considered the most common neurodevelopmental disorder in childhood, and that it is necessary to provide the communities they serve with new innovative technologies and therapies, provide more personalized and effective treatment options, and other resources to meet the critical needs of ADHD patients.

Providing these resources is the role of the Comprehensive ADHD Clinic (CAC). CAC focuses on treating children, adolescents, and their families with ADHD and related disorders, offering an array of opportunities for patients and their families to receive the care they need and deserve. “We provide diagnostic testing, individual and family psychotherapy, and medication management for children and adolescents with ADHD and any cooccurring disorders. We serve many ethnically, cultural, and socioeconomic diverse communities. Many of our patients are boys and girls of color facing significant socioeconomic challenges including poverty, exposure to violence/trauma, and lack of overall resource support,” says Dr. Brandon Hage.

“At the CAC, we understand the importance of not only recognizing how social determinants of health affect our patients but go further by advocating for and attempting to enforce change within structural systems to benefit the health and well-being of our communities. For example, we often engage directly with schools in order to advocate for individualized education plans (IEPs) or accommodations to provide our patients with equitable educational opportunities. We also frequently collaborate with primary care physicians and other specialties to ensure that our patient's overall health is being addressed appropriately. Lastly, our clinic brings together multiple interdisciplinary faculty and trainees to provide the most thorough, compassionate psychiatric care possible. I believe UIC to be a special place because of how dedicated we are to the betterment of the community with whom we share.”

 

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