What is ADHD?

Traditionally, ADHD was defined as a childhood mental health illness defined by the presence of multiple symptoms of poor attention and hyperactivity. For many years, ADHD was thought to be a condition that children “grew out of” as they entered adulthood. Further research, however, has shown that between 40-60 percent of children diagnosed with ADHD will continue to have symptoms into adulthood[1]. Currently, it is believed that about 4-5% of adults have symptoms that meet criteria for adult ADHD[2]. While the underlying etiology of ADHD is not yet fully understood, our current understanding of the disorder  has become more clear as advances in medical technology have helped identify some of the underlying causes of ADHD.

‍ADHD is a neuropsychiatric condition rooted in biology and genetics:

This means that ADHD originates in the brain. The brain is an extremely complicated organ that uses communication between brain cells to function optimally. In order to communicate, brain cells use molecules called neurotransmitters to send messages back and forth. Dopamine is the main neurotransmitter involved in brain functions such as planning, memory, emotional control, focus/attention, and rewarding beneficial behaviors. Patients with ADHD are thought to have impaired signaling of this neurotransmitter due to certain genetic, anatomical, and environmental factors[3]. Furthermore, brain imaging using MRI technology has shown that patients with ADHD have smaller brain structures in the area of the brain associated with attention, learning, and emotional regulation[3],[4]. 

Lastly, the greatest risk factor for developing ADHD is genetics. Studies looking at twins with ADHD suggest that about 75% of the risk for developing ADHD is heritable[6], [7]. Furthermore, adults with a sibling with ADHD have a 41% risk of having the disorder [7]. For parents with children with ADHD, they have a 2-8x risk of having ADHD[6]. ADHD is believed to be poly-genetic disorder - this means that no one single gene defines ADHD, but genetic studies have revealed multiple genes associated with increased risk for ADHD.

What are the signs and symptoms of ADHD?

ADHD presents itself in different ways in different people but some of the hallmark symptoms are:

• Difficulty remaining focused on a task, especially for long periods
• Difficulty planning or organizing activities
• Inability to follow through and complete day-to-day tasks
• Frequent forgetfulness
• Poor time management (e.g, missing appointments or deadlines)
• Increased impulsivity
• Difficulty controlling emotions
• Frequent feelings of fidgetiness or restlessness
• Strained interpersonal relationships
• Poor work performance

‍How is ADHD diagnosed?

Unfortunately, there is no single test that can diagnose ADHD. The ADHD diagnosis is based on the criteria defined by the Diagnostic and Statistical Manual of Mental disorders version V (DSM-V). The DSM-V has 5 very specific criteria to make the diagnosis of ADHD [5].  That being said, at ValueMed we see the diagnosis of ADHD as being a disorder of attention and executive function that is present from childhood through adulthood. To help make the diagnosis, we provide each patient with a proprietary intake form which provides a holistic view of our patients to help make an accurate diagnosis. In some cases, we recommend additional testing to help confirm the diagnosis of ADHD. Currently, there are also a number of well tested questionnaires such as the Conner’s Adult ADHD Rating Scale (CAARS) and the Diagnostic Interview for ADHD in Adults (DIVA) that can assist in making the diagnosis of ADHD[4]. Lastly, in some cases, ADHD can be evaluated using Continuous Performance Tests (CPTs) that objectively measure impulsivity and concentration problems. The most commonly used CPT is the QbTest. The QbTest uses an infrared camera to monitor the physical movements of a patient while they engage in a computer based test. This test is highly accurate in helping to diagnose ADHD and can be repeated to monitor the effect of therapy[3]. As the technology advances, genetic tests are also being investigated to determine an individual’s risk based on their genes.

While all of these various tests are useful and promising in helping to diagnose ADHD, the gold standard for the diagnosis of ADHD is still the evaluation of mental health or medical practitioner. If you are concerned that you or a loved one may have ADHD, please schedule an appointment with one of our providers to learn more. 

Citations

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1. Volkow ND, Swanson JM. Clinical practice: Adult attention deficit-hyperactivity disorder. N Engl J Med. 2013 Nov 14;369(20):1935-44. doi: 10.1056/NEJMcp1212625. PMID: 24224626; PMCID: PMC4827421.
2. Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, Faraone SV, Greenhill LL, Howes MJ, Secnik K, Spencer T, Ustun TB, Walters EE, Zaslavsky AM. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006 Apr;163(4):716-23. doi: 10.1176/ajp.2006.163.4.716. PMID: 16585449; PMCID: PMC2859678.
3. Kooij, J.J. Sandra Adult ADHD: Diagnostic Assessment and Treatment 4th Edition. Amsterdam, Netherlands. Springer Publications 2022
4. Barkley, Russel. Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment 4th Edition.. New York City. The Guilford Press 2018
5. Diagnostic and Statistical Manual of Mental Health Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013)
6. Smith AK, Mick E, Faraone SV. Advances in genetic studies of attention-deficit/hyperactivity disorder. Curr Psychiatry Rep. 2009 Apr;11(2):143-8. doi: 10.1007/s11920-009-0022-0. PMID: 19302768.
7. Franke B, Faraone SV, Asherson P, Buitelaar J, Bau CH, Ramos-Quiroga JA, Mick E, Grevet EH, Johansson S, Haavik J, Lesch KP, Cormand B, Reif A; International Multicentre persistent ADHD CollaboraTion. The genetics of attention deficit/hyperactivity disorder in adults, a review. Mol Psychiatry. 2012 Oct;17(10):960-87. doi: 10.1038/mp.2011.138. Epub 2011 Nov 22. PMID: 22105624; PMCID: PMC3449233.

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