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ADHD

What Is ADHD?Neurobiology, Symptoms, and Treatment

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What Is ADHD?Neurobiology, Symptoms, and Treatment

ADHD. Four letters, dozens of misconceptions, and hundreds of questions. As more and more people open up about their disorder and more psychologists talk about it, we start to wonder, “Do I have ADHD? I mean, I am forgetful, always late, and constantly fidgeting…”

If you ask yourself this question a lot, you could take an ADHD quiz for adults to find out (that one from Breeze tests is my favorite). 

But before you jump to any conclusions, let me explain ADHD to you. I’ll talk about the signs and symptoms of ADHD and what ADHD really means for women living with it.

What is ADHD?

Let’s start from the top. As you may know, ADHD stands for attention deficit hyperactivity disorder. But here’s what may come as a surprise: ADHD is a neurodevelopmental disorder with psychological aspects

You see, during childhood, atypical structural and functional changes that occur in the brain as it grows are the reason people with ADHD have symptoms. So, no amount of telling them to “pull it together” will help.

Structural and functional differences in ADHD involve several brain areas, including but not limited to the prefrontal cortex, which is the front part of the brain associated with reasoning and rational decision-making.

Other regions where structural changes associated with ADHD occur include the amygdala, hippocampus, and cerebellum. 

Researchers have found that the prefrontal cortex of children with ADHD matures more slowly than in neurotypical children. Plus, the cerebellum, hippocampi, and amygdalae appear to be smaller.

Main ADHD symptoms 

Here are some signs of ADHD this brings:

  • A slowly maturing prefrontal cortex leads to difficulties with executive functioning (self-regulating, prioritizing, planning, decision-making, etc.)
  • A smaller cerebellum may lead to difficulties with motor response inhibition (suppressing actions, particularly actions incompatible with the current task)
  • A smaller hippocampus and amygdala can make it hard to regulate memory, emotions, and behavior.

The good news is that some differences in brain development may become less noticeable as a child with ADHD gets older, but each child is different.

Another contributor to ADHD behaviors is atypically low levels of the neurotransmitters dopamine and norepinephrine (which is synthesized from dopamine). Both play a role in focusing attention, controlling our behavior, and executive function. Dopamine is also a key component of the brain’s reward system, which motivates behavior.

The exact causes of ADHD are complex and not fully understood. It can, however, involve genetic, environmental, and neurological factors. There are many questions and misconceptions surrounding it. I’ve rounded some of them to help you better understand this neurobiological disorder.

Can people with ADHD focus at all?

Yes, of course, they can! The name “attention deficit disorder” is a bit misleading.

People with ADHD experience difficulties regulating their attention rather than having a deficit of attention. I mean, when people with inattention disorder hyperfocus on something, they forget to eat, sleep, or shower. 

The problem comes with controlling that attention and the ability to direct it in appropriate ways. People with ADHD can seem distracted because they pay attention to things unrelated to the task at hand.

Are there any benefits of having ADHD?

Sure. People with ADHD can sometimes have behavioral advantages over neurotypical people in specific tasks:

  • Creative problem-solving and innovative thinking
  • Fearlessness when navigating outside their comfort zone (driven by interest)
  • Quickly moving on from things that bother them
  • Adapting to and bouncing back rapidly from consequences
  • Diverse interests that draw them to new experiences
  • The ability to absorb knowledge like a sponge

What are some primary ADHD symptoms?

ADHD manifests itself differently in every individual, but many people with ADHD share some common characteristics.

Listing all the symptoms is out of the scope of this post, but basically, ADHD is characterized by an inability to focus attention, hyperactivity, and impulsivity.

Other symptoms of ADHD are difficulty choosing or doing tasks (aka ADHD paralysis) and overstimulating by noises, voices, or simply the environment. Both of them may lead to complete ADHD burnout.

Boys with ADHD often display more externalizing symptoms like hyperactivity, while girls show more internalizing symptoms like inattention, but these are not exclusive and can vary widely among people. 

Is ADHD a disability?

Yes, it’s considered a disability under various laws, and people qualify for reasonable accommodations under the Americans with Disabilities Act (ADA). People who have severe ADHD that renders them unable to work can also qualify for disability benefits.

Is ADHD a mental disorder?

Yes, in addition to considering it a neurodevelopmental disorder, some specialists would also call it a mental illness. Plus, six out of ten kids with ADHD have at least one other mental, emotional, or behavioral condition (e.g., anxiety, depression, Tourette syndrome).

What’s more, sometimes people experience an autism and ADHD overlap, which is called AuDHD.

How can you test for ADHD?

There are various ADHD tests online you can take. But this one from the Breeze ADHD test is excellent. Try it out!

There are also DHD quizzes for teens and adult ADHD tests, but online tests aren’t necessarily accurate. For a proper diagnosis, you should see your healthcare provider regardless of the results of any online test, especially if you suspect you may have the disorder. 

A careful evaluation by a professional clinician can rule out other causes of your symptoms. A clinician can also help you figure out the best treatment plan.

How many people have ADHD?

As of 2020, worldwide, approximately 140 million children and adolescents (ages 5-19) worldwide and over 366 million adults had a diagnosis of ADHD.

But here’s the catch:

  • The percentage of people with ADHD varies around the world. Even in the US, it varies from state to state. The reported prevalence of ADHD does vary geographically, but this variation may be influenced by differences in diagnostic practices and awareness rather than actual differences in the occurrence of the disorder.
  • As we test more people and the tests get better at identifying cases, the number of people diagnosed will increase.
  • While many children with ADHD continue to have symptoms into adulthood, the expression of ADHD can change over time, and not all children with ADHD will have significant symptoms in adulthood.
  • When the diagnosis is missed in children, the disorder tends to go undetected in adults because the symptoms subside and change with age.

So, while it’s critical to diagnose a person with ADHD as soon as possible, we still face challenges with that.

Genetics and ADHD

Scientists believe there can be a genetic component. Although no particular genes have been tied to ADHD, researchers can clearly see that some cases are hereditary.

Dr. Russell A. Barkley, a renowned psychological researcher, found that:

  • If a parent has ADHD, there is up to a 57% chance that their child will also have it.
  • If one sibling has ADHD, the probability that another sibling will also have it is around 32%.
  • If one twin has ADHD, the probability that the other twin also has it is around 70–80%.

Other researchers, like Dr. Gabor Mate, believe that children inherit not ADHD but rather a heightened susceptibility. These kids want to tune out when their environment overwhelms them, especially during stressful situations, and ADHD emerges as a coping mechanism.

Can you develop ADHD later in life?

Surprisingly, yes. Typically, people are born with attention-deficit/hyperactivity disorder, with the average age of diagnosis being four to seven years. But new evidence suggests that adults can develop ADHD even if they didn’t have it as children.

For example, during childhood trauma ADHD can be developed.

Researchers from the UK found that more than two-thirds of people diagnosed with ADHD at the age of 18 had not been diagnosed with ADHD in childhood. In another study, Brazilian researchers found that a large proportion of adults with ADHD did not have the disorder in childhood.

However, this finding requires further research, and people who suspect they may have ADHD should see a healthcare provider at any age.

How do you know if you have ADHD?

If you have difficulty concentrating, are impulsive, forgetful, and have organizational difficulties that interfere with your daily life or relationships, you should at least take a free ADHD test online.

Does the test indicate that you have signs of ADHD? Then, find a psychiatrist or psychologist who is familiar with the disorder. They can guide you through a thorough assessment that considers your history and concerns.

catching symptoms of ADHD

Are there different types of ADHD?

Yes. In general, there are three types of ADHD: inattentive, hyperactive, and combined.

The inattentive type of ADHD is characterized by:

  • Difficulty prioritizing
  • Easy distractibility
  • Trouble starting and finishing tasks
  • Difficulty doing chores and routine tasks
  • No hyperactivity

Symptoms of the hyperactive type of ADHD include:

  • Difficulty sitting still for long periods of time
  • Talking a lot and quickly, making frequent interruptions
  • Restlessness and impulsivity
  • Difficulty waiting

However, the most common type is the combined type of ADHD, where the symptoms of the other two types come together, leading to distractibility and impulsive behavior.

And you know what? According to Johns Hopkins Medicine, hyperactivity is the least common type of ADHD! Which leads to our next question.

What’s the difference between ADD and ADHD?

The short answer is that they’re different terms for the same thing. ADD and ADHD were once used to describe similar conditions, but now ADHD is the official medical term that includes several subtypes, including one that represents what was formerly known as ADD.

What does ADHD mean? Attention deficit/hyperactivity disorder. What does ADD mean, then? It’s the same disorder but without hyperactivity.

In 1980, ADD was included in the diagnostic manual of the American Psychiatric Association, and in 1987, it was renamed to ADHD, with the recognition of different subtypes.

As a result, people who had attention deficit without hyperactivity went under the radar and weren’t getting the diagnosis or treatment they needed.

And do you know who most of those people were? Women.

ADHD in women

Have you ever put all of your effort into trying to fit in with others only to become worn out? Have you felt ashamed because you’re not organized? Have you experienced the isolation that comes from being perceived as unreliable? Did you ever feel completely drained, even though you didn’t seem to make any effort? Many women with ADHD feel this way.

ADHD symptoms in women

You already know that ADHD hits girls and boys differently: girls tend to internalize their symptoms, while with boys, the symptoms appear on the surface.

But here’s a detailed list of the symptoms girls and women with ADHD may experience daily. This list is by no means exhaustive.

  • Daydreaming, finding it hard to remember things, focusing attention, and getting easily distracted by unrelated thoughts
  • Talking a lot because thoughts move too quickly and interrupting others
  • Difficulty keeping things and thoughts organized
  • Problems managing time (time blindness, lateness, procrastinating, and struggling to meet deadlines)
  • Difficulty controlling emotions (ADHD emotion dysregulation)
  • Trouble making decisions unless they’re impulsive
  • Struggling to make friends or find a partner
  • Fear of rejection and sensitivity to criticism
  • Lack of energy to do things or be with people they love
  • Picking fights with others because they’re bored
  • Feeling ashamed for not meeting cultural expectations or fitting social standards
  • Being inattentive when listening to oral instructions
  • Staying up too late
  • Making careless mistakes
  • Avoiding tasks that require a lot of mental effort
  • Overeating or binge eating
  • Losing things and forgetting to do daily activities
  • Seeking activities that provide a quick boost of dopamine, like shopping or drinking
  • Doodling, fidgeting, and restlessness
  • Using coping strategies and masking difficulties
  • Exhibiting self-critical tendencies and harshly judging one’s own abilities
  • Taking risks even when unnecessary
  • Wanting to just do nothing

That’s a lot. But often, you wouldn’t even be able to tell that a woman has any side effects of ADHD. And you know why? Because we’re so darn good at masking them.

We do things like:

  • Speak very little and be extra cautious about what we say
  • React based on other people’s expectations, not our true feelings
  • Take excessive care about keeping our house clean
  • Conceal hyperactivity symptoms by appearing calm

And this intricate camouflaging actually hinders our progress because it makes ADHD diagnosis and management harder. Here are some issues women with ADHD face throughout their lives:

Self-loathing

Women with ADHD often struggle with negative labels, such as being seen as inattentive, spacy, clumsy, or forgetful. Also, societal expectations for women to excel at organizational tasks add to the pressure and self-loathing when they realize they fall short.

When girls internalize these symptoms as character flaws, they work even harder to hide perceived imperfections, leading to increased feelings of failure, anxiety, depression, eating disorders, and even suicidal thoughts.

Misdiagnosis

Internalized symptoms are hard to diagnose. And when the symptoms of attention deficit disorder go unnoticed, women start developing comorbid anxiety, depression, or other mood and personality disorders. Since the symptoms of those are more obvious, those disorders get treated, not the underlying ADHD.

As a result, many women develop unhealthy coping mechanisms, like self-medicating with addictive substances. Additionally, when a medical professional diagnoses them and prescribes medication, the medication rarely takes into account female hormonal changes.

Serious consequences

Thanks to the seminal ADHD research on women conducted by Dr. Stephen P. Hinshaw and colleagues, we now have evidence that girls and women with ADHD suffer severe impairments. For instance, girls with ADHD are more likely to experience peer rejection than boys who have ADHD.

His findings also show that nearly one in four girls with early ADHD attempt suicide by the age of 19 or 20, and more than half commit self-harm, such as cutting and burning. Alarmingly, the risk of unplanned pregnancies is 43% for women with ADHD, compared to 11% for women without it.

All of this underlines the urgent need to understand and address the profound difficulties girls and women with ADHD face.

ADHD treatment

Because ADHD is a neurobiological developmental disorder, it’s hard to fix with counseling alone. So, let’s look at how medication for ADHD, therapy, and hormones play a role in managing ADHD.

Think of ADHD as needing glasses for your brain—taking medication gives your brain the extra help it needs to focus better. But remember that while medication helps tremendously with ADHD symptoms in adults and kids, it doesn’t completely fix ADHD. 

Before starting medication, think of the side effects of both taking it and the consequences of not taking it. Consider how it might affect your life, health, finances, and relationships. Does dealing with ADHD without medication stress you out a lot?

The best results usually come when you use medication and therapy together. Talk therapy, cognitive-behavioral therapy (CBT), and dialectical behavior therapy (DBT) work best for treating ADHD symptoms.

Hormonal fluctuations, such as those during the menstrual cycle, puberty, pregnancy, post-pregnancy, and menopause, can affect ADHD symptoms.

Moreover, it may influence the effectiveness of medication. Some women may notice medication is less effective during certain points in their menstrual cycle. There are also concerns about taking ADHD medication during pregnancy. 

So, it’s crucial to stay mindful of symptom variations and discuss them with a healthcare provider.

Did you know birth control can be helpful for women with ADHD? Not only to prevent pregnancy but also to make ADHD symptoms more predictable. It helps control hormonal changes, making it easier to manage ADHD.

Women also tend to incorporate different habits and systems they develop to compensate, making support groups where women with ADHD can talk openly about their struggles very helpful.

Overall, there’s a lot to discuss with a healthcare provider before treating ADHD, so make sure to find a specialist and run from anyone who dismisses your concerns.

Summary

Navigating a world built for neurotypicals as a neurodivergent person can be challenging, but it’s vital to embrace ADHD without shame or stigma. ADHD isn’t exclusive to a specific group; it’s a neurobiological developmental disorder that occurs in both men and women. For women, symptoms can be more severe than they appear, with a primarily inattentive presentation.

But remember, it’s not a defect; it’s a unique difference. Seeking a diagnosis and support is crucial, so don’t hesitate to get checked out. You’re not alone, and accepting your neurodivergence is a powerful step toward self-love.

Po-Chang Hsu, MD (Dr. Hsu’s), also added some helpful thoughts about ADHD treatment: “ADHD is a neurodevelopmental disorder that can significantly impact various aspects of an individual’s life. Early diagnosis and medical interventions are crucial to managing disease symptoms. It is worth noting that some ADHD medications, such as amphetamine, can be addictive and prone to abuse. Therefore, it is always wise to communicate well with your healthcare providers and follow the prescription instructions carefully.”

Dr. Po-Chang Hsu, MD, MS photo

Reviewed by Dr. Po-Chang Hsu, MD, MS

Dr. Hsu holds a Master’s of Science degree from both Harvard University and Tufts University. He did research in MRI neuroimaging...