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Facts About ADHD

ADHD is one of the most overdiagnosed, underdiagnosed, and misunderstood mental health conditions.

ADHD is a real neurodevelopmental disorder that causes a host of challenges and impairments ranging from social difficulties to academic underachievement - even increased risk for car crashes!

Unfortunately, ADHD is also one of the most misunderstood and misdiagnosed mental health conditions.

ADHD is almost entirely caused by genetics. It's not an 'American invention' or caused by too much sugar, screen time, food additives, glutens, or poor parenting. In fact, the first medical documentation for what we now call ADHD comes from Hippocrates, the 'Father of Modern Medicine', over 2,500 years ago!

More facts about ADHD »

If you have questions, Incremental Health can help.

Incremental is led by clinical psychologist Dr. Michael Kofler, a nationally recognized expert who has spent the last 20 years researching ADHD and related conditions.

No one at Incremental Health receives funding or other compensation from drug companies. We have never received funding or other support from drug companies at any point in our careers.

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ADHD is a neurodevelopmental disorder

  • It isn’t a “new” disorder, an American fad, a “phase” they’ll grow out of, a motivation problem, or lazy parenting.
  • The earliest description of what we now call ADHD comes from Hippocrates (490 B.C.), who described patients with an “overbalance of fire over water.” The symptoms were "quickened responses to sensory experience, but also less tenaciousness because the soul moves on quickly to the next impression" - in other words, impulsivity and short attention span!
  • Rates of ADHD are highly similar around the world (about 5% of children have ADHD).
  • ADHD is caused by neurological factors. Their difficulties aren’t caused by diet, sugar, glutens, artificial coloring, food additives, or poor parenting. ADHD is about 80% genetic, which means that genes play a bigger role in ADHD than they do in determining your hair color, intelligence, or how long you’ll live.

Sources: Martinez-Badia & Martinez-Raga (2015), Sciutto & Eisenberg (2007), Polanczyk et al. (2007)

Medication is the best treatment we have, but it's not a cure

  • Stimulant medication results in huge improvements in behavior for about 80% to 90% of children with ADHD. It also appears to be a protective factor against later substance abuse.
  • On the other hand, medication only works on days you take it, and does not improve school grades, standardized test scores, or executive functioning.
  • For most children, behavior therapy and medication are recommended. In some cases, children who receive behavior therapy may not need medication, or may do well on a lower dose of medication than they might have needed without behavior therapy.

Sources: Kofler et al. (2020), Kofler et al. (2018), Pelham et al. (2016)

Hyperactivity may be a good thing

  • We all move our bodies to help us stay alert and focus. Next time you’re in a long meeting, watch as everyone starts to shift in their chairs and move around after a while. Movement serves a stimulating purpose for our brains - it helps "get the mental juices flowing."
  • Children with ADHD may get a bigger mental benefit from moving around than other kids. In fact, the more children with ADHD move, the better they do on mentally challenging tests!
  • The flip side of this is that if we're trying to force kids with ADHD to sit still, we're taking away a coping strategy that their bodies have found that helps them focus!
  • So … unless their behavior is seriously interrupting the class, let kids fidget, sit weird in their chairs, or do their work standing up.
  • Reinforce the work, not the motor activity! That means focus on whether they are working on what they're supposed to be working on - not whether they're bouncing or fidgeting while they're doing it.

Sources: Sarver et al. (2015), Kofler et al. (2020), Hartanto et al. (2016),

Executive functions and ADHD

  • One of the biggest problems for many children with ADHD is working memory, which is the ability to hold things in your brain while thinking about those things, or while doing some other task.
  • So if you tell a child with ADHD to “go upstairs, put on your pajamas, brush your teeth, and pick out a book to read before bed”, don’t be surprised to find her upstairs in her pajamas playing with her favorite toy. This usually isn’t oppositional behavior – it’s a working memory problem, and the child probably has no idea you wanted her to do something other than put on her PJs. She heard you just fine, but the other steps got lost from memory along the way.
  • You can help your family member with ADHD by breaking down instructions into parts, writing them down, setting reminders on their phone/tablet/smartwatch, using charts, and not giving multi-step directions.

Sources: Rapport et al. (2009), Kofler et al. (2019), Kofler et al. (2020)

"Subtypes" of ADHD

  • The latest version of our diagnostic manual, called DSM-5, came out in 2013, with important changes for how ADHD is diagnosed.
  • The biggest change was the elimination of ADHD “subtypes”. We used to diagnose different "subtypes" of ADHD - there was an Inattentive subtype, a Hyperactive/Impulsive subtype, and a Combined subtype. The thinking was that different subtypes may have different causes, need different treatments, and so on. But it turned out that for most kids, the different "subtypes" were just an artifact of how their symptoms were waxing and waning at the point when they were evaluated.
  • Using the new manual, we now describe children’s symptoms in terms of “current presentations” rather than subtypes. This change reflects new information suggesting that the “subtypes” are not distinct disorders, but rather part of the same ADHD.
  • For most kids, what we were thinking of as separate "subtypes" was really their symptoms waxing and waning. So children who fall in one category now often fall in a different category later.
  • Other changes included moving ADHD into the Neurodevelopmental Disorders category, and changing the age of onset requirement from age 7 to age 12. The behavioral symptoms themselves remain the same.

Sources: American Psychiatric Association (2013), Valo & Tannock (2010)

Kids with ADHD won't "grow out of it"

  • We now know that about 66% of kids with ADHD continue to have ADHD as adults. And even the ones who don't meet full diagnostic criteria anymore usually continue to have symptoms, and almost all of them continue to have difficulties in important areas of life functioning.

Sources: Barkley et al. (2007), Journal of Abnormal Psychology Volume 125 Issue 2 (Special Section on ADHD Across Development) (2015)

Most kids with ADHD are resilient!

  • Recent research suggests that parents and teachers view most children with ADHD as adapting positively to setbacks despite the risks associated with ADHD.
  • When planning services for a child with ADHD, it is important to think about their symptoms and areas of difficulty. But it is just as important to think about their strengths
  • Identify the child’s personal, family, and community assets and use that information to help them thrive. The best outcomes will come from not only weakening their weaknesses, but also strengthening their strengths!

Source: Chan et al. (2022) 

Fidget spinners are toys, not treatments

  • It turns out that kids with ADHD actually get less focused and more disruptive when they are given fidget spinners in class. When kids play with a fidget spinner, they focus on the toy instead of the teacher.
  • Fidget spinners are a lot of fun, but they are not a therapy device. This goes for other fidget toys as well. We want to get the kids moving, not their toys.

Source: Graziano et al. (2018) 

Is ADHD Overdiagnosed?

Yes!

  • Accuracy rates for ADHD diagnoses in the community are only about 50% - about as accurate as a coin flip!
  • ADHD is one of the most overdiagnosed mental health conditions, because kids can have difficuly paying attention or controlling their wiggles for a lot of different reasons
  • A comprehensive evaluation is needed to properly diangose ADHD. The gold-standard is called a psychoeducational evaluation. This includes a battery of reliable and valid tests and measures, collecting data from multiple informants (e.g., parent, teacher), and engaging in a process called differential diagnosis
  • Why is ADHD so hard to accurately diagnose? A big reason is that behaviors that look like concentration problems and impulse control difficulties are often actually symptoms of a lot of different mental and physical health conditions. Things like anxiety, depression, certain medical conditions, vision or hearing problems, sleep difficulties, traumatic stress reactions, other neurodevelopmental disorder, side effects of some medications ... even giftedness! This list goes on ....

Source: Sciutto & Eisenberg (2007)

Is ADHD Underdiagnosed?

Yes!

  • ADHD is also one of the most underdiagnosed mental health conditions. That means there are a lot of kids with ADHD who fall through the cracks and don't get the help they need
  • Missed diagnoses happen for a lot of reasons. Sometimes the provider isn’t an expert on ADHD, and may not know the different ways that ADHD can present, or may not know what ADHD looks like in girls, or teenagers, or children from different backgrounds. Sometimes ADHD is missed when children aren’t bouncing off the walls during the assessment session, even though we know from the research that children with ADHD often aren’t noticeably hyperactive in these kinds of situations.
  • A comprehensive evaluation is needed to properly diagnose ADHD. The gold-standard is called a psychoeducational evaluation. This includes a battery of reliable and valid tests and measures, collecting data from multiple informants (e.g., parent, teacher, child self-report), and engaging in a process called differential diagnosis.

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