Understanding ADHD: What is it and how does it work?

Understanding ADHD: What is it and how does it work?


ADHD, or Attention Deficit Hyperactivity Disorder, is a common neurodevelopmental disorder that affects both children and adults. It is characterized by challenges with attention, impulsivity, and hyperactivity that interfere with daily functioning.

ADHD is considered a neurological disorder that is likely caused by differences in brain anatomy and chemistry. Research shows that people with ADHD tend to have lower levels of certain neurotransmitters, like dopamine and norepinephrine, which are important for regulating attention and behavior. There are also differences in the frontal regions of the brain that are involved in impulse control and executive functioning.

While ADHD is typically diagnosed in childhood, around 60% of children with ADHD continue experiencing symptoms as adults. For some, the hyperactivity component becomes less pronounced over time, but challenges with attention, impulsivity, and organization often persist.

ADHD exists on a spectrum, with some people experiencing mild symptoms while others are profoundly impacted. But for most, ADHD symptoms lead to difficulties in school, work, and relationships. Common struggles include:

  • Staying focused and avoiding distractions
  • Controlling impulses and thinking before acting
  • Staying organized and managing time
  • Regulating emotions and mood
  • Starting and completing tasks

The good news is that ADHD is highly treatable, especially when caught early. A combination of medication, therapy, lifestyle changes, and coping strategies allows most people with ADHD to minimize their symptoms and thrive in life. But first it’s important to understand the different types of ADHD and how this condition is diagnosed.

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The Different Types of ADHD: A Comprehensive Overview

There are three main presentations or subtypes of ADHD:

  1. Predominantly Inattentive: This is marked by significant challenges with attention and focus, but not hyperactivity. People with this subtype may seem daydreamy, disorganized, and easily distracted.
  2. Predominantly Hyperactive/Impulsive: This involves extreme restlessness and impulsivity, but less issues with inattention. Those in this category may be constantly ‘on the go’ and have difficulty controlling impulses.
  3. Combined Type: Most people with ADHD fall into this combined category, with moderate-to-severe symptoms of inattention, hyperactivity, and impulsivity.

The signs of ADHD often overlap with normal childhood behavior, especially in those under the age of 12. But in ADHD, the difficulties are more severe, persistent over time, and lead to impairment.

Some key distinguishing factors include:

  • Onset before age 12
  • Symptoms present in multiple settings (e.g. school and home)
  • Clear evidence of interference with development and functioning
  • Symptoms don’t disappear with focus or reward

Additionally, the latest edition of the Diagnostic and Statistical Manual (DSM-5) specifies that symptoms must be inappropriate for the person’s developmental level. This means that higher levels of hyperactivity are expected in younger kids, while teens and adults tend to struggle more with restlessness and inner feelings of impatience.

It’s also important to note that ADD or Attention Deficit Disorder without hyperactivity is no longer an official diagnosis. All subtypes are now referred to as ADHD, with qualifiers describing presentation. However, many people still use the term ADD colloquially to describe predominantly inattentive type ADHD.

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Symptoms of ADHD: Signs to Look Out For

ADHD symptoms arise from deficits in executive functioning – the set of mental processes that enables planning, focus, remembering details, and managing time and space efficiently.

Here are some hallmark ADHD symptoms:


  • Difficulty sustaining focus and avoiding distractions
  • Struggling to process information as quickly or accurately as others
  • Appearing forgetful and losing items
  • Failure to pay close attention to details
  • Difficulty listening and following directions
  • Avoiding tasks that require sustained focus (like paperwork)
  • Frequently zoning out in conversations or when reading


  • Constant motion and fidgeting
  • Non-stop talking
  • Acting as if ‘driven by a motor’
  • Difficulty sitting still for long periods
  • Running around or climbing in inappropriate situations
  • Discomfort being still for too long


  • Impatience
  • Difficulty taking turns
  • Frequent interruptions and intrusions
  • Little thought before taking action
  • Blurting things out
  • Problems thinking before speaking
  • Difficulty considering consequences of words and actions


  • Messy bedrooms, desks, and belongings
  • Losing homework assignments, deadlines, and obligations
  • Poor time management skills and tendency to procrastinate
  • Challenges managing long term projects
  • Forgetfulness around daily tasks
  • Difficulty structuring free time

Emotional Difficulties

  • Trouble regulating emotions and mood
  • Low frustration tolerance
  • Irritability and hot temper
  • Emotional outbursts and reactive behavior
  • Hyper-focusing on pleasurable activities
  • Difficulty transitions and handling change

Of course, every person with ADHD exhibits a unique collection of strengths and weaknesses. But monitoring core symptoms is crucial for diagnosis and accessing the proper treatment and support.

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Causes of ADHD: What We Know So Far

While the exact causes of ADHD remain unclear, research suggests a combination of genetic, environmental, and neurological factors contribute to its development.

  1. Genetics: ADHD tends to run in families, suggesting a genetic component 1 3 4 5. Research has shown that parents and siblings of individuals with ADHD are more likely to have ADHD themselves4. However, the exact way ADHD is inherited is complex and not related to a single genetic fault4.
  2. Brain Anatomy and Function: Studies have found differences in brain structure and activity in individuals with ADHD compared to those without the condition3 4. For example, certain areas of the brain may be smaller in people with ADHD, while other areas may be larger4. Lower activity levels in the parts of the brain that control attention and activity level have also been associated with ADHD3.
  3. Environmental Factors: While the exact role of environmental factors is still being studied, some research suggests that certain environmental exposures may contribute to increased ADHD symptoms1. Adverse social and family environments, such as low parental education, social class, poverty, bullying, negative parenting, maltreatment, and family discord, have been associated with ADHD2. Prenatal exposures to substances like alcohol or nicotine from smoking may also increase the risk of developing ADHD3.
  4. Neurotransmitters: Studies have suggested that an imbalance in the levels of neurotransmitters in the brain may be involved in ADHD4.


Studies show that ADHD tends to run in families and genes likely play a role. If one immediate family member has ADHD, the odds of a child having it are around 25-35%. For extended families, the rate is 10-15%. Certain gene variations involve the brain’s dopamine and norepinephrine systems which modulate attention and behavior.

Brain Differences

Brain scans reveal key structural and functional differences in the brains of people with ADHD versus those without the disorder. These include:

  • Smaller volumes in certain frontal lobe regions vital for focusing, planning, and self-control
  • Low dopamine receptor availability in the brain’s reward pathways
  • Abnormalities in the networks linking the frontal lobes with other regions involved in attention and execution

These brain differences go a long way towards explaining the hallmark challenges with executive functioning in people with ADHD.

Environmental Factors

Various environmental influences may interact with genetic vulnerabilities in the development of ADHD. High fevers, childhood illness, premature birth, low birth weight, brain injury, and environmental toxin exposure have all been potentially linked to ADHD.

  1. Prenatal substance exposures: Exposure to substances such as alcohol and tobacco during pregnancy has been linked to an increased risk of ADHD25.
  2. Heavy metal and chemical exposures: Some studies suggest that exposure to heavy metals and certain chemicals may be associated with ADHD1.
  3. Nutritional factors: While there is no direct evidence that specific foods cause ADHD, some studies have explored the potential impact of certain dietary factors, such as food additives and sensitivities, on ADHD symptoms5.
  4. Lifestyle factors: Certain lifestyle factors, such as childhood stroke, brain injuries, premature birth, low birth weight, and exposure to lead, have been identified as potential environmental contributors to ADHD25.
  5. Social and societal factors: Research indicates that social and societal factors, such as family stress, poverty, and family chaos, may influence the risk and severity of ADHD symptoms45.

The research is still evolving, but factors like insufficient sleep, screen overuse, nutritional deficiencies, and smoking or drinking during pregnancy also appear to elevate ADHD risks to some degree. However, these are considered secondary causes rather than the main drivers.

The bottom line is that ADHD likely arises from complex interactions between a person’s unique genetic makeup and their experiences early in development. Imbalances in brain chemistry and structure render the brain less able to regulate attention, behavior, and impulses. But identifying and addressing environmental risk factors can sometimes help reduce ADHD severity.

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Diagnosing ADHD: What to Expect

If ADHD symptoms are causing significant impairment in life, it is important to see a doctor or mental health professional for evaluation. There is no single medical test for diagnosing ADHD, but clinicians have a variety of tools at their disposal.

Here is an overview of the diagnostic process:

Medical Exam

A primary care doctor or pediatrician may perform the first examination, checking for signs of ADHD along with any other potential causes. Vision and hearing tests may be done to rule out sensory issues interfering with focus.

Parent and Teacher Input

Providing checklists and symptom questionnaires to parents and teachers gives clinicians a fuller picture of functioning across different settings. Since ADHD symptoms must be present in multiple spheres of life, this feedback is critical.

Psychiatric Evaluation

A child psychiatrist or psychologist specializing in ADHD conducts an in-depth clinical interview to assess a child’s learning, behavior, development, and family history. Neuropsychological testing may also be recommended.

DSM-5 Criteria

The clinician will determine if the core symptoms of inattention, hyperactivity, and impulsivity align with diagnostic criteria listed in the DSM-5 – the handbook used by mental health professionals. A diagnosis requires clear evidence of impairment from symptoms.


Clinicians will also look for signs of other conditions that might overlap with ADHD, such as anxiety disorder, mood disorders, sensory processing issues, or learning disabilities. These may be diagnosed separately or comorbidly with ADHD.

Age of Onset

Per the DSM-5 standards, impairment from ADHD symptoms must be present before age 12. Challenges that emerge only during adulthood require a different diagnosis.

Ultimately, a thorough evaluation process is needed to differentiate ADHD from normal developmental behaviors and pinpoint any co-existing issues requiring additional treatment.

Treatment Options for ADHD: What Works and What Doesn’t

ADHD is not curable, but it is highly treatable, especially when addressed early. Recommended first line treatments include:


Stimulant medications like methylphenidate (Ritalin) and amphetamine-based drugs (Adderall) are very effective for most people with ADHD. These function by increasing brain dopamine and norepinephrine – chemicals involved in regulating attention and behavior.

Non-stimulants like atomoxetine (Strattera) and alpha-agonists (Kapanyx) may be alternatives if stimulants cause side effects or are ineffective. Under medical guidance, medication significantly improves ADHD symptoms in around 70% of children and 60% of adults.

Behavior Therapy

Structured behavioral interventions provide coping skills training for managing ADHD. These may involve parents and teachers, and help establish organization habits, social behaviors, and consistency with homework and chores. Research shows behavioral therapy enhances functioning at home and school.

Lifestyle Changes

Exercise, sleep hygiene, reduced screen time, and a healthy diet can also help reduce distractibility and impulsivity. Creating structure through calendars, alarms, and daily routines is beneficial. Mindfulness training may improve ability to focus on the present moment.

School/Work Accommodations

Academic supports like extra time on tests, reduced homework, and seating near the teacher can really help students with ADHD thrive at school. Adults can request accommodations like quiet workspaces, flexitime, organizational aids, and extra task supervision from employers.

The most effective treatment plans utilize a combination approach of several of the above strategies. Medication works best when paired with behavioral therapy and lifestyle adjustments. Symptom improvement is greatest with comprehensive, multimodal care.

What Doesn’t Work for ADHD?

Some alternative approaches like restrictive diets, vitamin therapy, neurofeedback training, and vision training lack strong evidence for improving ADHD. Screening for learning disabilities and ensuring proper vision correction are beneficial. But other ancillary treatments should not replace standard medication and behavioral interventions.

ADHD Myths and Misconceptions: Separating Fact from Fiction

ADHD is a widely misunderstood disorder, even among medical and education professionals. Here are some common myths along with corresponding facts:

Kids can outgrow ADHD in adolescence.Around 50-80% of children with ADHD will continue experiencing symptoms as teenagers. About 50% maintain the full disorder as adults. ADHD is considered a chronic, lifelong condition.
ADHD is the result of lazy, undisciplined parenting.While parenting strategies can help manage behaviors, ADHD arises from neurobiological factors beyond a family’s control. With proper treatment and support, kids with ADHD can excel.
Diet is the main cause of ADHD.While nutrition may play some role, no foods have been shown to actually cause or cure ADHD. But maintaining a healthy, balanced diet supports brain development for all kids.
Medication is dangerous and turns kids into zombies.Stimulant side effects like appetite/sleep changes tend to be mild and short-term. These medications actually improve mood, cognition, and behavior in kids with ADHD when prescribed carefully by a doctor.
Most kids are being incorrectly diagnosed with ADHD.Diagnoses must meet strict DSM-5 criteria backed by impairment evidence. Around 5% of U.S. children have ADHD, while worldwide rates are 2.2%-7.2% – not excessive. However, symptoms can sometimes be missed by clinicians.
Kids with ADHD are doomed to fail in life.ADHD presents challenges, but those who receive proper treatment have normal life outcomes. Accommodations and tapping into strengths allow kids to excel in academics, careers, and relationships.

Spreading accurate information is key to destigmatizing ADHD and conveying that it’s a highly treatable condition. Medical science continues making strides in understanding and managing ADHD.

ADHD and Mental Health: The Connection You Need to Know

ADHD appears to interact with other mental health conditions in several noteworthy ways:

Anxiety Disorders

Feelings of inner restlessness can manifest as worry and nerves. Many kids with ADHD develop anxiety disorders, with rates estimated from 25% to 50%. Anxiety also sometimes develops in those treated with stimulants. CBT and relaxation techniques can help ease anxious thoughts.


Difficulty paying attention is a hallmark symptom of depression. Adults with ADHD have higher rates of major depressive disorder. Success at school and work is protective against depression. Evaluating mental health should be part of ADHD care.

Substance Abuse

Impulsivity and stimulation-seeking make those with ADHD up to 3 times more likely to develop alcohol, tobacco, and drug addictions. Also, some abuse stimulant medications. Careful prescribing and therapy helps prevent substance misuse.

Oppositional Defiant Disorder

Around 35% of those with ADHD also exhibit extreme stubbornness, temper outbursts, and defiance towards authority figures. Treating ADHD may resolve these behaviors. But additional behavior modification is sometimes needed.

Bipolar Disorder

The distractibility of ADHD can look like bipolar mania in some cases. Also, the disorders share genetic links. Careful screening for distinct episodes of mania versus chronic ADHD impairment aids diagnosis.

Learning Disabilities

Around 30-70% of kids with ADHD have learning disabilities in reading, writing, math, or language. Neuropsychological testing helps identify areas of difficulty that may require remedial instruction and academic support.

In summary, ADHD commonly co-occurs with – and potentially amplifies severity of – other psychiatric conditions. This makes ongoing management of ADHD and mental health critical for positive long-term outcomes.

Conclusion: Living with ADHD and Thriving in Life

While ADHD presents daily challenges, the good news is that the proper treatment plan allows most to live happy, fulfilling lives. The keys are:

  • Getting an accurate diagnosis from an experienced clinician
  • Beginning treatment early with medication and behavioral therapies
  • Having a structured home and classroom environment
  • Learning effective coping strategies and self-advocacy skills
  • Identifying strengths and nurturing talents/interests
  • Fostering positive self-esteem while accepting ADHD as part of oneself
  • Adhering to a healthy lifestyle with plenty of exercise and sleep
  • Maintaining open communication with family, teachers, and employers
  • Monitoring for co-occurring mental health issues like anxiety and depression
  • Practicing greater self-compassion and setting realistic goals/schedules
  • Tapping into support groups and resources

While ADHD is not something that can be cured, it is certainly manageable with today’s effective therapies and comprehensive treatment plans. By understanding the facts about ADHD – including its neurobiological basis and high treatability – we can help remove stigma and empower those impacted to maximize strengths and thrive in all areas of life.

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