Understanding, Assessing and Treating ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterised by persistent symptoms of inattention and/or hyperactivity-impulsivity that interfere with functioning or development. The symptoms must be present before the age of 12 and impair functioning in at least two settings, such as at home and at school.

The symptoms of inattention include difficulty paying attention to details, difficulty with sustained attention, forgetfulness in daily activities, poor organisation, and poor time management. The symptoms of hyperactivity-impulsivity include fidgeting, restlessness, excessive talking, and interrupting others.

There are three subtypes of ADHD:

• Predominantly Inattentive Type: characterised by symptoms of inattention, but with few or no symptoms of hyperactivity-impulsivity
• Predominantly Hyperactive-Impulsive Type: characterised by symptoms of hyperactivity-impulsivity, but with few or no symptoms of inattention
• Combined Type: characterised by symptoms of both inattention and hyperactivity-impulsivity

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) defines Attention-Deficit/Hyperactivity Disorder (ADHD) as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. The diagnosis requires that symptoms must be present before the age of 12 years, and that these symptoms must be present in at least two settings, such as at home and at school.

It’s worth mentioning that not all people with ADHD experience both sets of symptoms, and some may have primarily inattentive symptoms or primarily hyperactive-impulsive symptoms. The criteria for diagnosis as per DSM-5 specify that at least six symptoms of inattention or at least six symptoms of hyperactivity-impulsivity should be present for at least six months in at least two settings like school or home. These symptoms should be persistent and not just an occasional behaviour.

Attention-Deficit/Hyperactivity Disorder (ADHD) is typically diagnosed by a mental health professional, such as a psychiatrist, psychologist, or clinical social worker. The process of diagnosis usually involves a comprehensive evaluation, which can include the following steps:

Treatment for Attention-Deficit/Hyperactivity Disorder (ADHD) typically involves a combination of medication and behavioural therapy. The goal of treatment is to reduce symptoms of inattention, hyperactivity, and impulsivity and to improve functioning in daily life.

• Medications: The most commonly used medications for ADHD are stimulants such as methylphenidate (Ritalin, Concerta, etc) and amphetamines (Adderall, etc). These medications work by increasing the levels of certain chemicals in the brain, such as dopamine and norepinephrine, which can improve attention and reduce impulsivity. Long-acting formulations can be taken once a day, minimising disruptions during the day. Other non-stimulant medications, such as atomoxetine (Strattera) may also be used.
• Behavioural therapy: Behavioural therapy can be an effective treatment for ADHD, particularly when used in combination with medication. Behavioural therapies can include parent training and behaviour modification, as well as social skills training and therapy. These therapies teach individuals strategies for managing symptoms and improving social and academic functioning.
• Occupational therapy: Occupational therapists can help children with ADHD by teaching them organisational and time management skills, as well as fine motor skills. This can help improve their ability to complete tasks and improve functional skills related to activities of daily living.
• Counselling or psychotherapy: A form of counselling or psychotherapy such as cognitive-behavioural therapy, can help people with ADHD learn coping strategies, develop better problem-solving skills and improve self-esteem, relationships and self-perception.
• Parenting and family-based interventions: Parenting interventions like parent-child interaction therapy, behavioural parent training can be effective in managing the behaviour of children with ADHD and improving family functioning.

Observing that at least three of the above approaches involve therapies, we can note that there are several types of therapy commonly used to treat Attention-Deficit/Hyperactivity Disorder (ADHD). These include:

• Behavioural therapy: Behavioural therapy is a treatment approach that focuses on teaching individuals with ADHD strategies for managing their symptoms and improving functioning in daily life. This can include parent training and behaviour modification, as well as social skills training and therapy. Behavioural therapy can help individuals with ADHD learn how to better regulate their behaviour, improve their ability to focus and sustain attention, and improve their social and academic functioning.
• Cognitive-behavioural therapy (CBT): This type of therapy aims to help people change negative thinking patterns, beliefs, and behaviours that contribute to poor emotional regulation, poor motivation, and poor self-esteem. CBT can help individuals with ADHD to learn better problem-solving skills, improve self-esteem, and develop positive relationships.
• Occupational therapy: Occupational therapy can be particularly helpful for individuals with ADHD, as it can teach them strategies for organising and managing their time, as well as improving fine motor skills. This can help to improve their ability to complete tasks and improve their functional skills related to activities of daily living.
• Parenting and family-based interventions: Parenting interventions, such as parent-child interaction therapy and behavioural parent training, can be effective in managing the behaviour of children with ADHD and improving family functioning. This can involve teaching parents and caregivers effective parenting techniques, and how to support their child in managing symptoms and building self-esteem.
• Neurofeedback or biofeedback therapy: This approach uses real-time displays of brain activity to help people with ADHD learn to regulate their own brain waves, in order to improve attention and reduce impulsivity.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a complex condition that can often be accompanied by other conditions, known as comorbidities. Some of the most common comorbidities associated with ADHD include:

• Oppositional defiant disorder (ODD): A condition characterised by persistent patterns of disobedient, defiant, and hostile behaviour toward authority figures. Children with ADHD are at a higher risk of developing ODD.
• Conduct disorder (CD): A condition that is characterised by persistent patterns of aggressive, antisocial, and disobedient behaviour. Children with ADHD are at a higher risk of developing conduct disorder.
• Learning disorders: Children with ADHD often have difficulty with reading, writing, or maths and may be diagnosed with a specific learning disorder.
• Anxiety disorders: Children and adults with ADHD are at a higher risk of developing anxiety disorders such as generalised anxiety disorder, social anxiety disorder and panic disorder.
• Depression: Children and adults with ADHD are at a higher risk of developing depression, which may be related to difficulties with self-esteem and social functioning.
• Substance use disorder: Adolescents and adults with ADHD are at a higher risk of developing substance use disorder (SUD) due to self-medication or impulsivity.
• Tic disorders: Tourette's disorder and chronic tic disorder are more common in individuals with ADHD, particularly those with the combined type.

• CDC (Centres for Disease Control and Prevention) – ADHD Treatment Recommendation
• CHADD (Children and Adults with ADHD) –  Clinical Practice Tools, Toolkits, TOOLS Videos
• ADDA (Attention Deficit Disorder Association) – Resources and Article Library
• American Academy of Child & Adolescent Psychiatry – ADHD Resource Centre
• ADHD Foundation (Australia) – ADHD Resources
• AADPA (Australian ADHD Professionals Association) – Webinars

• A Clinician's Guide to ADHD (2013) by Joseph Sadek.
• Attention-Deficit Hyperactivity Disorder, Quarter Edition: A Handbook for Diagnosis and Treatment (2018) by Russell A. Barkley.
• Driven to Distraction: Recognising and Coping with Attention Deficit Disorder (2011) by Edward M. Hallowell M.D. & John J. Ratey M.D.
• A Radical Guide for Women with ADHD: Embrace Neurodiversity, Live Boldy, and Break Through Barriers (2019) by Sari Solden & Michelle Frank.
• Thriving with Adult ADHD (2018) by Phil Boissiere.
• Order from Chaos: The Everyday Grind of Staying Organised with Adult ADHD (2019) by Jaclyn Paul.
• What Your ADHD Child Wishes You Knew: Working Together to Empower Kids for Success in School and Life (2018) by Sharon Saline.
• The ADHD Effect on Marriage: Understand and Rebuild Your Relationship in Six Steps (2010) by Melissa Orlov.
• Organising Solutions for People with ADHD (2012) by Susan C Pinsky.
• ADHD 2.0: New Science and Essential Strategies for Thriving with Distraction – From Childhood Through Adulthood (2021) by Edward M. Hallowell M.D. & John J. Ratey M.D.
• Smart but Scattered Teens: The Revolutionary 'Executive Skills' Approach to Helping Kids Reach Their Potential (2013) by Richard Guare, Peg Dawson & Colin Guare.
• Thriving with ADHD Workbook for Kids: 55+ Fun Activities to Help Children Self-Regulate, Focus, and Succeed (2018) by Kelli Miller.

• Science Daily – ADD and ADHD News
• WebMD – ADHD: Latest Research
• CDC (Centres for Disease Control and Prevention) – Research on ADHD
• ADDitude – ADHD Research Roundup: New Studies, Findings & Insights
• Nature Portfolio – ADHD

• WebMD. (n.d.). Attention Deficit Hyperactivity Disorder (ADHD). Retrieved on 8 February 2023 from: https://www.webmd.com/add-adhd/childhood-adhd/attention-deficit-hyperactivity-disorder-adhd
• Healthdirect Australia. (n.d.). Attention deficit hyperactivity disorder (ADHD). Retrieved on 8 February 2023 from: https://www.healthdirect.gov.au/attention-deficit-disorder-add-or-adhd
• Mayo Clinic. (n.d.). Attention-deficit/hyperactivity disorder (ADHD). Retrieved on 8 February 2023 from: https://www.mayoclinic.org/diseases-conditions/adhd/symptoms-causes/syc-20350889
• American Psychiatric Association (APA). (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Washington, D.C., U.S.A.: APA. ISBN 978-0-89042-576-3.