ADHD stands for Attention-Deficit/Hyperactivity Disorder and is a neurodevelopmental disorder that affects a person's ability to pay attention, control impulsive behaviors, and regulate their level of activity.
ADHD is typically diagnosed in childhood, but can also continue into adulthood. Some common symptoms of ADHD include:
Inattention: difficulty focusing on tasks, being easily distracted, forgetfulness, and poor organization.
Hyperactivity: restlessness, fidgeting, and difficulty sitting still.
Impulsivity: acting without thinking, interrupting others, and engaging in risky behaviors.
ADHD can have a significant impact on a person's academic, social, and occupational functioning. However, with proper diagnosis, treatment, and support, it is entirely possible for those with ADHD to manage their symptoms and lead full, successful lives.
As an integrative provider, I conceptualize "ADHD" a little differently than most (ADHD is in quotes here because I just don't like the acronym, but it's how we identify this presentation so I'll keep on using it). ADHD, to me, is just another shade of normal and certainly is not inherently bad. In fact, some of the most creative folks in human history have had ADHD (Bill Gates, Leonardo Da Vinci, to name a few).
The key here is to view this way of thinking as divergent, and not disordered. Keep this in mind as you read on. This approach guides my opinion of ADHD diagnosis, treatment, and more. My objective with ADHD, is not to dull an individual's shine or shape their personality, but instead to "hack" their symptoms and celebrate their unique qualities through targeted treatment and an individualized approach. Oh, and I have ADHD, too. So maybe that's why I view this in a more positive light.
What are the types of ADHD?
Before we dig into the types of ADHD, let me first mention a few cautions. First, this post is not designed to elicit self-diagnosis of ADHD. If you feel like you or someone you know might be struggling with ADHD, it is important to engage with a provider who can help determine a diagnosis from a clinical perspective. Second, and this might sound odd, but I typically avoid making a diagnosis beyond what is required for insurance and prescribing. Diagnosing can be problematic as it categorizes people. Instead, with an integrative and holistic approach, I assess for symptoms and work to reduce those symptoms, ideally at their root.
So here are the three types of ADHD according to the (problematic) DSM-5:
Inattentive type:
This type of ADHD is characterized by difficulties with attention and concentration. People with this type of ADHD may struggle with staying focused, completing tasks, organizing their thoughts, and often seem forgetful.
Hyperactive-impulsive type:
This type of ADHD is characterized by hyperactivity and impulsivity. People with this type of ADHD may struggle with sitting still, fidgeting, interrupting others, and acting without thinking.
Combined type:
This is the most common type of ADHD, which involves symptoms of both inattention and hyperactivity/impulsivity. People with this type of ADHD may struggle with a wide range of symptoms, such as difficulty focusing, impulsivity, hyperactivity, and disorganization.
Unspecified type (bonus!):
Generally speaking, this is what I choose for most folks who present with symptoms of ADHD. This covers the bases from an insurance perspective, but is the least categorical of diagnosis. With ADHD or any other diagnosis, I think this can help reduce stigma.
It's important to note that each person with ADHD may experience symptoms differently, and that the severity of symptoms can vary. I recommend working with an integrative provider who can help diagnose and determine the best course of action for the symptoms of ADHD a person may have.
What are the symptoms of ADHD?
ADHD can have a variety of symptoms that affect different aspects of a person's life. Sometimes symptoms can mimic that of anxiety, depression, other diagnoses.
Generally speaking, here are some of the most common symptoms typically associated with ADHD include:
Inattention:
Difficulty paying attention to details or following through on tasks
Easily distracted, forgetful, prone to procrastination
Trouble organizing tasks and activities
Often losing things or being forgetful
Hyperactivity:
Restlessness or constantly moving
Difficulty sitting still
Excessive talking or interrupting others
Impatience
Impulsivity:
Acting without thinking
Interrupting others
Engaging in risky behaviors
Difficulty waiting for one's turn
Of course, the severity of symptoms can vary. Also, not everyone with ADHD will experience every symptom. Symptoms may change over time or in different situations. Sometimes inattention, for example, can be related to an individual’s mood, like depression, or stem from generalized anxiety. So again, I encourage working with an integrative provider can help determine the specific source of any particular symptom, especially for symptoms consistent with ADHD.
How is ADHD diagnosed?
Testing for mental health, including ADHD, can be tricky and isn’t always straight forward because of the subjective nature. However, there are several tests that can be used to help diagnose ADHD. Remember, though, there is no single definitive test.
The process of diagnosing ADHD usually involves a comprehensive evaluation that includes several components, such as:
Medical history:
The provider may ask about the patient's personal and family medical history to rule out other conditions that may have similar symptoms or to understand if there is a familiar history of ADHD.
Physical examination:
A physical exam may be conducted to identify any underlying medical conditions that could be contributing to the symptoms.
Behavioral evaluations:
The provider may use questionnaires or rating scales to gather information about the patient's behavior and symptoms from the patient, family members, teachers, or other caregivers. This is especially important for school aged individuals.
Diagnostic criteria:
The provider will likely use established diagnostic criteria, such as the DSM-5. This is also typically used as the basis for symptomology.
Testing:
In some cases, additional testing for ADHD may be recommended, such as psychological testing, IQ testing, or neurological testing, to help identify or rule out other conditions. Additionally, I always recommend lab work and genetic testing can help us pinpoint potential root causes as well as guide treatment options.
As we talked about earlier, ADHD can be difficult to diagnose. The process may take time, so it as hard as it may sound, patience is key. Diagnosing is not a wham-bam-thank-you-ma’am type job. We want to make sure we dig deep enough to accurately diagnose, otherwise treatment could be ineffective and a waste of time.
What are the treatments for ADHD?
After diagnosis, treatment for ADHD is the next step. I believe this is where using an integrative approach for ADHD makes all the difference. With an integrative approach, it is not “here’s a script, see you in three months” kind of deal. Instead, together we will devise a truly comprehensive treatment plan based on the symptoms, needs, and goals, of the individual.
Integrative treatments for ADHD typically include a combination of medication, behavioral therapy, and lifestyle changes. Here is a list of potential treatment interventions, in no particular order:
First, let me say, medications are not necessarily first-line in my book, but they certainly have a place. Stimulant medications, such as methylphenidate or amphetamines, are commonly used to treat ADHD. These medications can help improve focus, attention, and impulse control. Non-stimulant medications are also a good option as an add-on or stand alone.
Therapy:
Therapy can help individuals with ADHD learn strategies to manage their symptoms and honing thought and behavior patterns. This might include skills training and social skills training.
Coaching:
The development of sound routines around things like sleep and time management can have a dramatic impact on the symptoms of ADHD.
Lifestyle optimization:
Certain lifestyle changes can be significantly helpful in managing symptoms of ADHD. Regular, targeted exercise and healthy eating habits can be more effective long-term than many other interventions. Things like meditation and mindfulness can also be huge assets in managing ADHD.
Supplementation:
Certain supplements and help soften ADHD symptoms, especially when there are nutritional or absorption deficits.
Support and education:
For individuals with ADHD, it can be helpful to connect with others who are going through similar experiences. Support groups, counseling, and education about the condition can help individuals and their families better understand and cope with the challenges of ADHD.
No two patients are alike, so no two treatment plans will be identical either. It is really important to find a solution that is customized to the goals and needs of each patient. Remember, medication-only approaches should typically be avoided with ADHD because of the reduced long-term efficacy of medication. Integrative psychiatry provides a platform where ADHD can be managed comprehensively, increasing the likelihood of success years down the road.
Summary: ADHD in a nutshell
ADHD stands for Attention-Deficit/Hyperactivity Disorder (yuck! there's that word disorder again) and it affects a person's ability to pay attention, control impulsive behaviors, and regulate their level of activity. There are three main types (and a bonus type) of ADHD: inattentive, hyperactive, combined, and unspecified types. Diagnosis of ADHD can be a challenge because symptoms overlap and can be difficult to pinpoint. Treatments for ADHD include medication, therapy, coaching, lifestyle optimization, supplementation, and support. Obviously I am biased, but I think using an integrative and holistic approach provides the strongest foundation for long-term success.
If you have any additional questions about ADHD medications or integrative psychiatry in general, shoot me an email or reach out through my website. If you're looking for a provider and you're in the Washington, DC area, I'd love to help you on your treatment journey!