Category: Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder, commonly referred to as ADHD, is classified as a neurodevelopmental disorder in which symptoms often manifest in childhood and can persist throughout adulthood. As the name suggests, individuals with ADHD may have difficulty concentrating on tasks, paying attention to others or their surroundings, or regulating impulsive behaviors. ADHD is divided into three subtypes: inattentive, hyperactive/impulsive, or combined type. Inattentive type ADHD is characterized when an individual predominantly displays inobservant behaviors or distractibility relating towards a task. This may include having a difficult time focusing on lectures or classroom discussions, forgetting daily tasks, or having difficulty following details in a conversation. In the hyperactive/impulsive type, one predominantly displays symptoms associated with erratic or restless behaviors such as difficulty engaging in leisure activities, appearing to need constant movement, or inability to wait for their turns in social functions or activities. In combined type ADHD, one presents symptoms of both inattentiveness and hyperactivity (American Psychiatric Association, 2021). 

ADHD is mostly diagnosed in early childhood, school-aged children with boys more commonly being the recipients of the diagnosis in contrast to girls,12.9% compared to 5.6% respectively (Centers for Disease Control and Prevention, 2020). While the prevalence of ADHD may appear more apparent in boys than girls, research shows that this gap in diagnosis is not necessarily the result of boys being more susceptible to ADHD, but rather, it may be due to girls being misdiagnosed or undiagnosed for ADHD in their younger years. 

Physicians Quinn and Madhoo, who specialize in ADHD treatment, conducted a review of varying clinical presentation of ADHD in women in contrast to men to analyze the differing factors in the recognition of a diagnosis and treatment options. In their review, they examined 41 ADHD articles, on Pubmed, over the span of the years 2002 to 2012 to identify the relevance of ADHD in women. Results signified that women and girls with ADHD to prominently display inattentive behaviors rather than hyperactive or impulsive symptoms. Internalizing symptoms, such as distractibility or inability to remain focused on a task, are more likely to be overlooked by teachers and parents in comparison to externalizing symptoms, which are associated with more disruptive behaviors as markers for ADHD diagnosis (Quinn & Madhoo, 2014). With public perception of ADHD heavily focused on the presentation of hyperactivity or impulsivity, behavioral symptoms relating to inattention are widely neglected in individuals who may present a different set of ADHD symptoms but are equally impacted by the condition. Typically, there is a greater emphasis on noticing disruptive or loud behaviors as common symptoms of ADHD; however, most do not realize individuals with inattentive or varying levels of combined type ADHD may have their symptoms go unnoticed and untreated for a great length of time. This inevitably would exacerbate negative behaviors that can disrupt the daily lives of individuals with these subtypes of ADHD. Quinn and Madhoo additionally noted that women and girls with ADHD are more likely to develop secondary presentations of anxiety and depression in association with their ADHD symptoms. Females with ADHD are more likely to exhibit lower self-esteem than males with ADHD. This negative self-perception is correlated with impaired peer and family relationships which is evident as females with ADHD are more likely to exhibit inattentive behavior which may make it difficult for them to focus on conversation building with others (Quinn & Madhoo, 2014). Overlooking an ADHD diagnosis in childhood can directly correlate with further exacerbation of symptoms related to depression and anxiety which travel to adulthood in women.  In this manner, it is seen how ADHD symptoms in women may be misdiagnosed even in adulthood for the coexistence of anxiety and depression. 

ADHD symptoms of all subtypes need to have greater recognition, so more individuals with ADHD can be included in the conversation for proper treatment and diagnosis. Because most diagnoses of ADHD happen in childhood years, it would be very beneficial to have additional instruction given to teachers, caregivers, and family members of the manifestation of ADHD behavioral markers that commonly go unnoticed. Additionally, with growing awareness of how clinical presentations of ADHD may be different in various groups, there should be a greater research focus on obtaining ADHD data on underrepresented populations. With proper diagnoses, more individuals with ADHD will be able to seek out proper medications and therapies to help them better understand their condition.

References

Image Citation: (Open Learn, 2021)

American Psychiatric Association. (2021). What is ADHD? https://www.psychiatry.org/patients-families/adhd/what-is-adhd

Centers for Disease Control and Prevention. (2020, November 16). Data and statistics about ADHD. https://www.cdc.gov/ncbddd/adhd/data.html

Open Learn. (2021, February 3). Understanding ADHD [Animated Photograph of a Young Girl with ADHD.]. The Open University. https://www.open.edu/openlearn/health-sports-psychology/understanding-adhd/content-section-0?active-tab=description-tab

Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/Hyperactivity disorder in women and girls. The Primary Care Companion For CNS Disorders, 16(3). https://doi.org/10.4088/PCC.13r01596

Emotional dysregulation, defined as “emotional response that is poorly regulated and does not fall within the traditionally accepted range of emotional reaction” (Webmd 2021), is a common symptom among a wide range of mental disorders including Attention Deficit/Hyperactive Disorder (ADHD). Emotional dysregulation for many with ADHD may not just feel like a constant struggle with oneself but can additionally feel like a constant battle with those around them. Its misunderstood nature frequently ends up causing conflict in the lives of those with it, and often results in the further exacerbation of other existing ADHD symptoms.

Emotional dysregulation is a relatively common symptom of ADHD with prevalence among adults ranging from 30-70% in adults and 25-25% in children (Rüfenacht et al. 2019). It is associated with impaired activity of the amygdala and cingulate gyrus of the limbic system in the brain,both of which are involved in emotion and pain regulation. In one study, activity of cingulate activity was found to be lower in study participants with ADHD in comparison to those without ADHD (Webmd 2011). Other studies have found amygdala hyperactivity in participants with ADHD (Shaw et al. 2014). Additionally, weaker connections between the cerebral cortex – which is notably involved in the perception of external stimuli and decision making – and the amygdala are associated with those with ADHD (Nigg 2021). This can cause emotional reactions that are disproportionate to the stimuli/cause.

In emotional dysregulation, emotional reactivity can manifest in a variety of ways. This may include intense levels of anger (or rage), high anxiety levels, dissociating, and even suicidal thoughts (Webmd n.d.). Those with ADHD and emotional dysregulation may have a much lower frustration tolerance and higher reactivity to situational stressors. At the opposite end of the spectrum, reactivity can include over-excitement, joy, or passion. At either end, people observing these reactions may seem frightening or distressing and can lead to the degradation of relationships. Outsiders looking in may understand neither the emotional reaction nor the degree of it and this type of misunderstanding could influence the perception of the person with ADHD emotional dysregulation. They can consequently (and incorrectly) see them as volatile, inflexible to change and overly sensitive as personality traits rather than a result of an ADHD symptom.

Emotional dysregulation in ADHD is not just misunderstood among the public and the people in the lives of those affected by it, it is also misunderstood by medical and mental health professionals. Emotional dysregulation is a common symptom among multiple unrelated disorders, including Bipolar Disorder, Borderline Personality Disorder, Post Traumatic Stress Disorder, and Autism Spectrum Disorders. Its commonality among mood disorders and personality disorders makes it easy for ADHD to be mistaken as a mood or personality disorder (Marangoni 2018). That is not to say that mood and personality disorders cannot occur in individuals with ADHD, in fact bipolar disorder and personality disorders have a comorbidity rate upwards of 47.1% and 50% respectively (Katzman 2017). However, the overlap of symptom criteria makes distinguishing ADHD from other disorders difficult. This is an unfortunate source of misdiagnosis that can lead to additional complications and difficulties.

Despite the disruptions that emotional dysregulation may cause, it is treatable. Before treatment can be recommended and/or administered it is important to recognize and address emotional dysregulation as a symptom. Many stimulant medications have been found to be effective in treating emotional dysregulation in ADHD, as have cognitive and behavioral psychotherapies (Shaw et al. 2014). It is additionally crucial that thorough and holistic examination of individuals occur by mental health and medical professionals.

Resources

Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2017). Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC psychiatry, 17(1), 302.

Marangoni, C. (2018). ADHD, Bipolar Disorder, or Borderline Personality Disorder. Psychiatric Times, 35(10)

Nigg, J. (2021). “How ADHD Amplifies Emotions”. ADDitude.

Rüfenacht, E., Euler, S., Prada, P. et al. (2019). Emotion dysregulation in adults suffering from attention deficit hyperactivity disorder (ADHD), a comparison with borderline personality disorder (BPD). Borderline Personality Disorder Emotional Dysregulation, 6.

Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. The American journal of psychiatry, 171(3), 276–293.

Study: Many With ADHD Can’t Control Emotions. Web M.D. (2011). https://www.webmd.com/add-adhd/news/20110506/study-many-with-adhd-cant-control-emotions

What is Emotional Dysregulation? Web M.D. (2021). https://www.webmd.com/mental-health/what-is-emotional-dysregulation

Pet peeves, we all have them. Perhaps it’s the repetitive cracking of someone’s knuckles, or the chronic lateness of a coworker or friend. Whatever it may be, you can feel that same feeling of annoyance creeping up your spine whenever you see, hear, touch or smell it. For most people, pet peeves are simply just that- an annoyance. They are things of discomfort that although might “grind your gears”, are relatively ignorable and can even be forcibly overlooked. For those with Attention Deficit Hyperactivity Disorder (ADHD) however, these “pet peeves” are much more than simple annoyances and can severely impede aspects of social, occupational and personal life. 

Hypersensitivities, also commonly referred to as sensory sensitivities, can be described as a temperament or personality “trait characterized by increased awareness and sensitivity to the environment”(Acevedo, 2021). These sensitivities can be broken into several subcategories including, noise sensitivity, touch sensitivity/aversion, movement sensitivities and visual sensitivities (PsychCentral, n.d.). In noise sensitivity, triggers can be anything from the repeated dripping of water from a faucet to the sound of saliva in someone’s mouth as they eat or even the volume of a particular sound. In touch sensitivity/aversion, it may be a particular material of a piece of clothing, a tag on a shirt or the sensation of other things against one’s skin. Visual sensitivities may be things like flickering lights (or lights of certain brightness) or repetitive movements. In any form of hypersensitivity, the particular stimulus may be overwhelming and overstimulating to an individual. A common, and often defining, symptom of hypersensitivity is emotional distress and outbursts in reaction to stimuli.  For someone with a form of noise sensitivity the sound of someone chewing may not merely irritate them, but it may send them into visible deep frustration and even rage. They can even have a physical reaction like chest pains or for those with touch sensitivity rashes or eczema (PsychCentral, n.d.). Not being able to remove the stimuli can prolong stress and intensify emotional outburst. 

Although the exact cause of hypersensitivity is unknown, hypersensitivities are generally considered to be caused by the brain’s inability to process multiple sensory inputs at once (Healthline n.d.). Hypersensitivity and other sensory processing disorders, according to some researchers, are considerably common in those with ADHD, with prevalence between 40-84% (PsychCentral, n.d.). Hypersensitivity is also not exclusively a symptom of ADHD. It is also commonly seen in other neurodivergent disorders like autism spectrum disorders (ASDs) as well as in post traumatic stress disorder (PTSD), general anxiety disorder and multiple sclerosis (MS) (Healthline n.d.). 

Hypersensitivities can often be overlooked or misunderstood by the people in the lives of those that it may affect. It may be regarded as a “bad” personality trait. People with ADHD and hypersensitivity may be told to “suck it up” or “stop being so sensitive,” by those who simply do not understand how impactful and stressful sensory triggers may be. Emotional reactions to hypersensitivities can even lead to the social avoidance of some people. There are various methods of treating and diminishing hypersensitivity, with most of them not involving medication. These methods include therapy, meditation and exercise (Healthline n.d., Acevedo 2021), but one thing we can all do is be mindful and have some consideration for those struggling with hypersensitivity. 

Resources

Acevedo, B. (2021). “What is Sensory Processing Sensitivity? Traits, Insights, and ADHD Links”. ADDitude.

ADHD: When Your Senses Are Extra Sensitive. PsychCentral. (n.d.). https://psychcentral.com/adhd/adhd-hypersensitivity#symptoms

What is Sensory Overload?. Healthline. (n.d.). https://www.healthline.com/health/sensory-overload#symptoms

Green, K. (2018). “ADHD Light Sensitivity: The Link with Hypersensitivity & Sensory Processing”. TheraSpecs.

Focus, and the act of focusing, is something that many people face. Think about your own life. There must have been a moment when trying to focus was a particular feat, whether it be the struggle of trying to study for an exam or complete an assignment, or even something leisurely like reading or drawing. When considering those with Attention Deficit Hyperactivity Disorder (ADHD), a key symptom is difficulty focusing. Individuals may find distractions overwhelming and deviations from the task at hand to be frequent when attempting to complete an activity. An often forgotten symptom of ADHD is hyperfocus, the complete opposite of focusing difficulty. Hyperfocus can be defined as “highly focused attention that lasts a long time” (Web M.D, n.d.) and can be difficult for people to understand or even comprehend, especially when one of the most visible symptoms of ADHD is difficulty sustaining attention for long periods of time. 

In instances of hyperfocus, individuals may feel completely engulfed in a particular activity, as if they are “in the zone.” For hours on end, nothing else can seemingly interrupt what they are doing. Hyperfocus may seem contradictory to the typical depiction of those with ADHD as it is assumed by many that those with ADHD have issues with attention. However, this is not true. In fact, having or keeping one’s attention may not necessarily be the struggle. Many people with ADHD can keep their attention on something. It is what the focus of attention is on that may be the struggle. For instance, someone can spend hours playing a videogame or even hours completely absorbed by a book, but they may experience significant difficulty finishing or even starting an assigned task. Hyperfocus can also include spending an extended amount of time completing projects and assignments. This can particularly work in one’s favor when behind on projects. It should be noted that hyperfocus does not eliminate procrastination and can even add to procrastination based on the activity being done. Hyperfocus in any particular activity can also influence how the individual is perceived. When hyperfocusing on an activity like gaming or watching television, one might be seen as lazy or unproductive. Yet if someone is hyperfocused on work or academic-related activities, they may be seen as motivated and be praised for their behavior.  

It is important to distinguish between hyperfocus and hyperfixation, another symptom that may be present with ADHD that, though similar, is considerably different. While hyperfocus is a state of being where someone is focused for long periods of time, hyperfixation is more of an obsession with something. The subject of obsession can be anything from a type of food to an activity like building miniature dolls. For some, this may look like eating the same meal every day, almost every meal for weeks and even months. Hyperfixation is similar to hyperfocus in the sense that it involves doing something for long periods of time and can have different impacts based on the different activities. However, a distinguishing factor is the presence of the particular obsession or fixation on something for much longer periods of time than hyperfocus. 

Hyperfocus is an often misunderstood and forgotten aspect of ADHD and can have a significant impact on someone’s life. It pushes against the assumed narrative of people with ADHD. Notably, hyperfocus provides a clear demonstration of how ADHD is not a homogenous condition. It may look very different in different people from what you think or thought it might be. As we inch closer to understanding hyperfocus and other aspects of ADHD, we move forward in understanding the general condition and the people that have it. With every step, we increase knowledge and information to help others and help ourselves understand the many differences that so many of us face. 

References

Hyperfocus. Web M.D. (n.d.). https://www.webmd.com/add-adhd/hyperfocus-flow

Yeah, so at first, it was like… Um…like…wait.. It’s happening again. The words are right there at the tip of your tongue, but you can feel them rapidly slipping from your mind. This isn’t the first time you trailed off in the middle of a thought, but it certainly is an annoying and often stressful struggle. Your friend furrows their brows as they stare at you looking off into the distance, squinting your eyes to try and bring it back as quickly as you can. Damn, you think, they probably think I’m a complete idiot. “Uh… heh…. Wait um … what was I just saying?” you ask. Occurrences of forgetfulness like this aren’t just embarrassing but can be a complicated struggle every day. Forgetting keys, important assignments, text messages, and more are only one aspect of Inattentive ADHD (sometimes referred to as Attention Deficit Disorder or ADD) that can frustratingly complicate the lives of people that have it. 

When many people think of ADHD, their minds instantly go to the stereotypical depiction of a hyperactive child, fidgeting and frequently talking out of their turn. This perception is more aligned with the Hyperactive type of ADHD, where individuals may experience difficulty sitting still, always feeling as if they need to be “on the move”, and impulsivity (ADHD Hyperactive-Impulsive Type). While this certainly could be what ADHD looks like in some people, an often forgotten type is Inattentive ADHD. In this type, key symptoms include forgetfulness, trouble focusing/learning information, and frequent daydreaming (Understanding ADHD Inattentive Type). While symptoms of the hyperactive type are typically observable, thus increasing the likelihood of diagnosis at an early age, symptoms of the inattentive type often end up flying under the radar, leading to either late diagnosis or none at all. Even worse, symptoms that are recognized are considered negative attributes of the person as lazy, careless and disorganized. 

For many people with Inattentive ADHD, completing tasks and focusing is not as easy or cut-and-dry as it is for people without ADHD. It does not mean that they don’t put in the effort to accomplish assignments or that they don’t care about what’s going on around them but that it is honestly quite hard. They may experience episodes of brain fog that inhibit focus on the task at hand; for example, spending large quantities of time to read through just one page of an assignment. The symptom of boredom adds an additional barrier, making it easy to deviate from prioritized tasks to completely unrelated activities. It does not necessarily mean that they don’t find the task important, but rather they may get intensely distracted or have the strong urge to do something else. Forgetfulness can cause them to miss important deadlines and due dates. These difficulties can interfere in academic and occupational performance, even if the person had previously excelled before, leading to the perception that they are lazy and do not apply themselves well. 

Symptoms of Inattentive ADHD can also hinder interpersonal relationships between friends, family and other loved ones. Forgetting important dates such as birthdays, anniversaries, and events may be misconceived as disinterest or carelessness. Losing a train of thought or zoning out in the middle of someone else speaking can be perceived as rudeness and disregard when, in reality, it may just be a representation of Inattentive ADHD. It is important to distinguish that Inattentive ADHD is not a personality type. Symptoms do not necessarily mean that a person is lazy and careless, but they can be an explanation for presented traits.

Inattentive ADHD is often an understated disorder that can significantly affect those with it. Misconceptions and misperceptions can add to the stress that symptoms may already cause, possibly degrading relationships and other aspects of their lives. It is vital to take a step back and realize that your experiences may not be the same as someone else’s. Regardless of the connotations of certain behaviors, steps must be taken in order to increase both awareness and accessible treatment for Inattentive ADHD. It is imperative that we recognize, destigmatize and ultimately understand that a situation may not be what you think it is, and it can be Inattentive ADHD. 

References

ADHD Hyperactive-Impulsive Type. Web M.D. (n.d.). https://www.webmd.com/add-adhd/childhood-adhd/adhd-hyperactive-impulsive-type 

Understanding ADHD Inattentive Type. Healthline. (n.d.). https://www.healthline.com/health/adhd/inattentive-type#behavioral-therapy

Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that influences the behavior of the millions of people that have it. Though ADHD is commonly associated with children, particularly since it is one of the most common mental disorders among children, it has an apparent presence among the adult population (National Institute of Mental Health, n.d.). About 2.8% percent of adults worldwide are diagnosed with ADHD, but the prevalence between men and women differs significantly (ADHD Institute). While 12.9% of men are diagnosed, only 4.9% of women are diagnosed (Broadbent, 2020). Even though there is an observable difference in the ADHD diagnosis between the sexes, that does not necessarily signify that more men have ADHD than women. In fact, statistics present the separate problem that ADHD is staggeringly misunderstood in women. 

To address misdiagnosis and underdiagnosis in adult women, it is necessary to point out the disregard and underdiagnosis of young girls with ADHD. Like with ADHD in adults, there is a reported higher prevalence of diagnosis and treatment among young boys than young girls, with studies revealing the ratio between males to females ranging from 2:1 to 10:1 (Slobodin, O., & Davidovitch, M. 2019). In general, the defining and most noticeable characteristics of ADHD include symptoms of the Hyperactive/Impulsive Type of ADHD, noted by constant motion, difficulty waiting for one’s turn, etc. Young boys are two to three times more likely to be diagnosed with this type than girls (Johns Hopkins Medicine, n.d.). The more subtle characteristics of the inattentive type are more common in young girls (noted by short attention span, forgetfulness, daydreaming, etc.) and are often attributed to their personalities rather than a disorder (Low, 2020). This can lead to a diagnosis much later in life when they are well into adulthood or no diagnosis at all, ultimately causing much more damage to their livelihood. 

A major contributing factor to the disparity in diagnosis and treatment of ADHD between men and women is the definition of ADHD itself. ADHD was first defined and described as a group of behaviors that were observed in young boys with more of the symptoms of the hyperactive type. Doctors assume this to be ADHD and, as a result of this, girls are much less likely to be diagnosed unless they display the hyperactive characteristics. Many doctors and mental health counselors aren’t trained to recognize ADHD in women, and are instead primarily familiar with the typical hyperactive depiction, further complicating the existing sex disproportion (Broadbent, 2020). 

With symptoms overlooked in childhood, daily activities can become increasingly difficult as girls with ADHD transition into adulthood. Symptoms that may not have had a visible or particularly negative impact in childhood can have an apparent detrimental effect on aspects of their lives. On top of having their symptoms dismissed, women seeking help may be misdiagnosed for a separate disorder, often anxiety or depression. Though the development of those disorders may have arisen as a result of the impact from their undiagnosed ADHD (Broadbent, 2020). 

Despite the lack of research specifically on women who have ADHD, the pattern of the discrepancy between diagnosis of men and women is important to recognize. Fortunately, both awareness of ADHD in women and the difference in how ADHD may present in women, have been increasing. However, the widespread tropes of ADHD still need to be eradicated, and it is time mental healthcare providers receive proper training and information. With this, we can get to a future where many women and young girls may finally feel seen and get treatment for their symptoms, and no longer be misunderstood. 

References

ADHD Epidemiology. (2019, April 10). ADHD Institute.  

Attention-deficit / hyperactivity disorder (adhd) in children. (n.d.). Johns Hopkins Medicine.

Attention-deficit/hyperactivity disorder (adhd). (n.d.). National Institute of Mental Health.

Broadbent, E. (2020, December 14). Too few doctors screen women for adhd – and we deserve better. ADDitute Magazine. 

Low, K. (2020, December 02). Why many women with adhd remain undiagnosed. Very Well Mind.

Slobodin, O., & Davidovitch, M. (2019, December 02). Gender differences in objective and subjective measures of adhd among clinic-referred children.