Here’s the formal definition: Adult Attention Deficit Hyperactivity Disorder (ADHD) is a psychiatric disorder associated with debilitating inattention and hyperactivity/impulsivity.
In simpler terms: having ADHD means you can’t concentrate, can’t sit still, and maybe don’t think things through before acting.
Problems concentration and sitting still don’t necessarily mean you have ADHD. These symptoms can exist in many situations and disorders:
- Adjustment to change
- Adjustment to tough situations
- Substance use disorders (while using and after quitting)
- Cognitive problems
- Being normal
In this article, we’ll talk about ADHD briefly. We’ll also go over the differences between ADHD and non-ADHD causes of attention and hyperactivity/impulsivity symptoms.
So, what’s ADHD?
ADHD is a disorder of the brain. When comparing the brain of someone with the illness versus without, you can find changes in anatomy and activity. These differences affect the parts of the brain that control attention, judgment, patience, mental gymnastics (when you can juggle things in your mind), ability to respond or NOT respond to stimuli, and inhibition (when you can think about consequences and stop yourself from doing something).
A brain-based disease? It’s not that easy. You can’t diagnose someone with ADHD by getting an MRI or PET scan of their brain. Many people with the disorder don’t show these differences, and many non-ADHD conditions do. People’s brains don’t know they’re supposed to look like ADHD brains, so there’s a lot of variation.
What are the types of ADHD?
There are two subtypes, although it’s possible to have both. Here’s a breakdown:
(1) Inattention subtype means that people can’t concentrate. Specific symptoms include:
- Making careless mistakes and doing sloppy work
- Frequently losing stuff (like keys and cell phones)
- Frequently forgetting stuff (like appointments or returning important calls)
- Having difficulty focusing on and following conversations and not seeming to listen when spoken to
- Struggling to complete tasks that need organization
- Not following through on daily responsibilities, like chores around the house
- Avoiding or disliking things that require a lot of attention, like reading, balancing a checkbook, taking a college course, or doing complex work projects
- Being easily distracted by unrelated thoughts or noises in the environment
(2) Hyperactive-impulsive subtype occurs when someone has problems staying calm and quiet AND/OR they tend to react before thinking. Specific examples include:
- Saying things that are rude or inappropriate without thinking
- Acting recklessly on the spur of the moment
- Fidgeting and squirming a lot, being constantly “on the go,” or feeling restless
- Problems staying seated (like in long meetings)
- Difficulties engaging in leisure activities that require calm behaviors
- Blurting out answers before the question has been completed, or problems taking turns
- Interrupting others or being intrusive in conversations and activities
How is ADHD diagnosed?
You already know this, but on this end we’re psychiatrists and it has to be said out loud: you should never diagnose yourself with a mental health disorder based on an article you fin online! If you read through the criteria above and heard yourself say “check” and “check” and “check” to every symptom on the list, make an appointment with a psychiatrist. They’ll do a thorough evaluation and assess for ADHD, as well as all the other medical and psychiatric conditions that can mimic ADHD. The provider will probably ask permission to contact a family member or friend (preferably someone who’s known you since childhood) to get more history. They’ll also ask you about a drug history. When unsure, psychiatrists and other prescribers refer patients to psychologists for formal ADHD testing.
So how do doctors tell the difference between ADHD and non-ADHD causes of these symptoms?
NORMAL VS ADHD
Although there are many differences between “normal” concentration problems and ADHD, here are a few pointers to help clarify.
(1) ADHD symptoms don’t come and go. We all have moments of inattention, excessive energy, and poor decision-making, but for people with this disorder, the symptoms are severe and occur almost every day. Happy, sad, angry, rested, or not rested, the attention problems or hyperactivity/impulsivity are present. There might be some fluctuation in severity of symptoms, depending on the situation and person, but the problems don’t go away.
(2) Symptoms start before age 12. According to the psychiatric bible of diagnoses, the DSM 5, symptoms of ADHD must start before the age of twelve. Even when diagnosed as a grown-up, the person with ADHD has struggled throughout childhood and adolescence because of the disorder. The sudden emergency of attention problems as an adult is always caused by something else.
(3) They cause problems with daily functioning. The symptoms of ADHD cause problems in day-to-day life. Unlike most people, where the occasional inattention and impulsivity doesn’t cause much of a ruckus, adults with this illness tend to struggle with failing relationships and difficulty at work or school.
CONDITIONS THAT CAN MIMIC ADHD
It takes a lot of information-gathering and educated clinical judgment to determine what is what when it comes to mental health issues.
Attention problems related to stress, anxiety, depression, mania, and psychosis tend to disappear when the stress/other symptoms return to normal. For example, if a person has problems concentrating because of depression, once the depression is treated, their concentration stabilizes too. This usually takes time. Mood improves first, concentration later.
People who use drugs and alcohol experience the same effect, albeit more slowly. When they stop using or drinking, their brain eventually returns to baseline and, over time, concentration improves. This can take months to years.
Separating cognitive problems like brain trauma and dementia from ADHD is more challenging. In general, people with cognitive problems can have inattention, but these are always accompanied by other difficulties. Symptoms in brain trauma are always triggered by brain injury (unlike ADHD, where there’s no clear damaging event). Traumatic brain injury frequently includes personality changes, memory problems, and emotional irregularities like rage attacks. Dementia includes diseases like Alzheimer’s. These diseases never start in childhood and are usually associated with memory problems and deficits in self-care (not seen in ADHD).
It is possible to have ADHD and another psychiatric disorder at the same time. In this case, most psychiatrists try to stabilize the non-ADHD disorder first. Usually both conditions need to be treated individually, so you must treat the most acute.
Struggling with ADHD?
Check out Tips for people with ADHD. If you want more information about the disorder in general, look into this National Alliance of Mental Health’s web page on Attention Deficit Hyperactivity Disorder. The link opens in a new page.