What is ADHD?
Attention-deficit/hyperactivity disorder (ADHD) is a condition that impacts an individual’s ability to regulate their attention and/or causes difficulties with hyperactivity/impulsivity. There are three subtypes of ADHD. What was formerly known as ADD is now referred to as ADHD, Predominately Inattentive Presentation, and is diagnosed when symptoms primarily impact focus and concentration. Those with ADHD, Predominately Hyperactive-Impulsive Presentation primarily experience symptoms of hyperactivity and/or impulsivity. Finally, individuals with significant symptoms of both inattention and hyperactivity/impulsivity are diagnosed with ADHD, Combined Presentation. ADHD is a neurodevelopmental condition, which means that it is based in the brain and is present in childhood. However, some individuals are not diagnosed until later in life for a multitude of reasons (e.g., symptoms being attributed to other factors like anxiety, bright individuals that can compensate for difficulties due to high intellect, etc.). Diagnosing ADHD can be a complex process as it is associated with increased risk for other conditions and concerns, such as anxiety/depression, behavioral difficulties, and learning differences. Neuropsychological evaluations utilize clinical interviews, standardized symptom questionnaires, and objective neurocognitive testing to provide a comprehensive look at an individual’s neurocognitive strengths and weaknesses, as well as their social-emotional and behavioral functioning. This information is then used to confirm or rule out ADHD, as well as other co-occurring diagnoses. Accuracy in diagnosis is essential to ensure appropriate treatment recommendations, which may include learning cognitive strategies, making environmental changes, access to work or academic accommodations, and/or medication options.
Treatment for ADHD typically involves a combination of approaches, including therapy. Therapy can help the child and their parents better understand ADHD and support them in recognizing the child’s strengths, as well as addressing related concerns. Therapy typically focuses on learning strategies to address ADHD-related challenges, as well as related concerns, such as emotion and behavior regulation. Sessions should also provide support and skills training to the parents as well, to help them know how to best help the child. If non-pharmacological approaches are not sufficient to address the child’s needs, the family may benefit from a consultation with their pediatrician or a pediatric psychiatrist to discuss whether a trial of medication is warranted. ADHD is associated with underlying neurological differences that can impact the individual’s ability to adequately regulate attention, behavior, and emotions. Therapy can help teach strategies to compensate for symptoms, but may not be enough to address all concerns. Medication has been shown to reduce symptoms in a majority of individuals with ADHD by addressing these neurological differences. If medication is warranted, outcomes are generally best when utilized in addition to (not in place of) therapeutic, environmental, and educational supports. At school, students with ADHD can qualify for educational support through either a 504 plan or an individualized education plan/program (IEP). 504 plans are intended to ensure equal access to the educational environment, including addressing academic, social, and behavioral impacts of ADHD and any other co-occurring diagnoses (e.g., learning disabilities, anxiety, behavior disorders, etc.). Common accommodations include preferential seating, extended time for assignments or exams, the ability to take exams in a quiet space, note-taking assistance, etc. If ADHD symptoms impact academic performance, or if there is a co-occurring condition like a learning disability, the student may also be eligible for an IEP. IEPs include academic accommodations similar to a 504 plan, as well as additional support services (e.g., academic interventions, counseling, behavior plans, etc.). Results of the neuropsychological evaluation are helpful for determining what supports and services may best meet the child’s needs based on their neurocognitive strengths and weaknesses.
Treatment for ADHD in adulthood often includes similar approaches, including therapy and pharmacological options. Therapeutic interventions for ADHD typically focus on developing strategies to compensate for inattention and executive functioning difficulties. Support can be provided by a psychologist or counselor, cognitive rehabilitation specialist, or “ADHD coach”. Medication management can be provided by the person’s primary care provider or a psychiatrist. If in college or a training program, adults with ADHD can qualify for educational accommodations, similar to those offered by a 504 plan (e.g., extended time, note taking support, etc.). Individuals with ADHD are typically also entitled to reasonable work accommodations if symptoms limit one or more major life activities (e.g., concentration). These accommodations can include environmental modifications aimed at reducing distractions and increasing focus (e.g., having a quiet workspace, ability to wear noise cancelling headphones, etc.) and support for executive functions (e.g., explicit dates and deadlines, checklists for duties, peer supports, etc.). Again, the findings from the neuropsychological evaluation are helpful in identify the individual’s cognitive strengths and weaknesses to best inform subsequent treatment and interventions.