ADD/ADHD

Overview

What is ADHD? 

ADHD is a persistent pattern of inattention and/or hyperactivity and impulsivity that interferes with a person’s functioning or development. ADHD can present as either inattentiveness or hyperactivity or a combination of the two.

What does ADHD stand for?

ADHD stands for Attention-Deficit/Hyperactivity Disorder.

What is the difference between ADD and ADHD?

This diagnosis has gone through several name changes over the years, which can sometimes confuse patients. ADD is an outdated term that only includes the inattentive symptoms that a patient can experience with ADHD. In the latest version of DSM-5 (otherwise known as the Diagnostic and Statistical Manual of Mental Disorders), psychiatrists have combined both the inattentive and hyperactive components to make one large diagnosis, ADHD. From there, the diagnosis becomes more specific:

  • ADHD, predominantly inattentive type (this most closely resembles the previously diagnosed ADD patients)
  • ADHD, predominantly hyperactive type
  • ADHD with a combined presentation

Causes

What causes ADHD?

The cause of ADHD in both children and adults is unknown. We do know that in ADHD patients, there is hypo functioning of dopamine and norepinephrine in some areas of the brain (1). When these two neurotransmitters are not as present as they should be, this can lead to some of the symptoms we see in our patients. We know that there is a genetic component to ADHD and that patients with parents or siblings who have ADHD are 2-8 times more likely to have ADHD themselves. Additionally, twin studies have shown heritability estimated at 76% (2).

Symptoms

What are ADHD symptoms?

Inattentive symptoms:

    • Failure to pay close attention to details
    • Difficulty sustaining attention
    • Not listening when spoken to
    • Not following through on instructions
    • Struggling with task completion
    • Lacking organizational skills
    • Avoiding tasks that require sustained mental effort
    • Easily forgetful
    • Frequently losing things that are necessary for task completion
    • Easily distracted by outside noises or other individuals

 

Hyperactivity/impulsivity symptoms:

  • Frequent fidgeting of hands or feet
  • Leaving your seat when you are supposed to stay seated
  • Feeling restless (adults)
  • Running/climbing when it is inappropriate (kids)
  • Inability to do activities quietly
  • Excessive talking
  • Constantly “on the go”
  • Struggling to wait your turn
  • Cutting other people off when they are speaking
  • Blurting out answers before the question is completed

Diagnosis

How is ADHD diagnosed?

A two-fold approach is used in diagnosing ADHD. Clinicians use diagnostic testing (such as the Cambridge Brain Science exam) and screening questionnaires, patient history, and physical exam before making an ADHD diagnosis.

How to know if you have ADHD?

If you believe you may have ADHD, it is recommended to consult with a qualified professional for a formal evaluation. In some individuals, teachers or loved ones have pointed out symptoms they have noticed that warrant further evaluation. In other situations, patients themselves see declining functioning in their work, school, or home life.

Treatment

How to treat ADHD?

ADHD is treated predominantly with stimulants. Stimulants work to modulate two neurotransmitters in your brain: dopamine and norepinephrine. There are two subgroups of stimulants which include:

    • methylphenidates (e.g., Ritalin, Focalin, Concerta)
    • amphetamines (e.g., Vyvanse, Adderall, Adzenys)

There are also non-stimulant options that can be used to treat ADHD. Examples include Strattera, guanfacine, and clonidine.

In addition to medication, we believe in an all-encompassing approach to ADHD management. This includes behavioral therapy, support groups, resources, and accommodations at school to help set patients up for success.

Why can amphetamines be used to treat ADHD in children?

Stimulants, both methylphenidate, and amphetamines have been studied for decades. They have shown long-term safety with considerable improvement to a very challenging diagnosis for patients to manage. Additionally, the FDA released a statement stating they did not find an association with children and adverse cardiovascular events (4). The American Academy of Pediatrics (AAP) has released their latest treatment recommendations (2019) with methylphenidate and/or amphetamines as first-line treatment for ADHD in children (5)

Our clinicians are sure to discuss the risks and benefits of every treatment option with patients and their parents. Our priority is to ensure both the patient and parent are comfortable with the medication that is being prescribed.

Are there any resources available for people with ADHD?

We recommend chadd.org for children with ADHD. Russell A. Barkley, Ph.D., is one of our favorite authors for ADHD resources for patients (adult or child) and loved ones (parents, spouses, siblings). There are also summer camps, magazines, podcasts, and therapists our clinic is happy to recommend.

Are there doctors for ADHD in Austin, TX?

If you’re looking for an ADHD doctor near you, Specialty Clinic in Austin has two locations in north and south Austin for in-person and telehealth appointments. Our team of providers has decades of experience diagnosing ADHD in adults and children and providing you with personalized care.

References:

  1. Arnsten AF. Fundamentals of attention-deficit/hyperactivity disorder: circuits and pathways. J Clin Psychiatry 2006; 67 Suppl 8:7.
  2. https://pubmed.ncbi.nlm.nih.gov/19302768/
  3. Removed
  4. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-safety-review-update-medications-used-treat-attention
  5. https://pediatrics.aappublications.org/content/pediatrics/144/4/e20192528.full.pdf


Information

Medically reviewed by:

Charles Sweet, MD, MPH

Dr. Sweet is a native Texan and attended The University of Texas at Austin for undergraduate studies. He earned his Doctor of Medicine and Master of Public Health degrees at the University of Illinois and then did residency training at the prestigious Johns Hopkins Hospital, Dr. Sweet came back to Austin, TX for specialized training in Child and Adolescent Psychiatry and has been in practice since 2009.Dr. Sweet believes strongly in working with, and training Physician Assistants to treat the behavioral health needs of adults, children and adolescents.

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