This has changed over time. Before, we used to classify problems with concentration and attention through two different types of words. One was ADD and the other was ADHD.
ADD is attention deficit disorder, and ADHD is attention deficit hyperactivity disorder. What we did to simplify this, we actually consolidated and now there is one diagnosis and it’s just ADHD. We don’t use ADD anymore. We say a person has ADHD, either the inattentive type, the hyperactive type, or the combined type, which is both inattention and hyperactivity.
You really can tell when these behaviors are more than just being a kid based on the age and what we expect from that person. When a person is in kindergarten, for example, we expect them to be able to learn their ABCs, expect them to be able to sit down for a certain amount of time. If they’re not able to do that, we now know that inattention or that hyperactivity is affecting their learning. That’s when we really need to dive in to see what’s really going on.
Yes, the symptoms can absolutely change over time. They can be modified over time, meaning less symptoms. They can get worse over time, meaning that there are more symptoms.
There are no specific causes of ADHD, but ADHD is a learning disability and a neurodevelopmental disorder that we know is due to genetic and environmental factors. These can be due to in-utero drug exposure, meaning drug exposures in the womb. Anything that affects the brain development when the brain is developing in the womb can contribute to learning disabilities and ADHD.
Any types of hard drugs or alcohol can contribute, including cocaine, heroin, et cetera. There are different studies for different drug types, but any time there are drug exposures, there can be a higher risk for learning disabilities and neurodevelopmental disorders like ADHD. There are several risk factors, the most significant being when that child is in the womb and how they’re developing.
I want to mention that there are some misnomers or misunderstandings. Family stress and different lifestyles do not cause ADHD. They may cause depression or anxiety that may show up as ADHD symptoms, meaning that they may not be paying attention, having a difficult time concentrating. That is why when a child is having difficulty concentrating or paying attention in class, it’s important to really figure out everything that’s going on. What is the home situation like? Is there a history of depression or anxiety? Are there mental disorders? It’s really a full complex evaluation. Are there other potential genetic causes? Are there associations with neurodevelopmental genetic disorders?
We cannot just say we’re going to blame ADHD or we’re going to say this is normal. We’re going to do a full evaluation and really see what are the potential causes that are contributing to the symptoms that are ADHD.
If a patient is born with a low-birth weight or prematurely, for example, that can contribute to any of the types of neurodevelopmental disabilities.
There are no confirmed studies of that contributing to ADHD. It’s really still a vast area because there is no one test that says this is the cause of why you can’t concentrate or have attention problems. The really important thing to know about ADHD, is that it has variety of symptoms.
We do screenings to see if you have enough symptoms of inattention, of concentration, of both that affect your daily life and your learning? If it is yes, yes, yes, yes, then we say, okay, you have this diagnosis. Now, if there is nothing else associated, no mental illness, increased stress, behavior disorders, neurodevelopmental disorders, genetic disorders, then we say, okay, this is purely an ADHD diagnosis and we focus on that.
ADHD is a learning disability and affects people’s abilities to learn and to process information in a timely manner. The treatment options are really going to be on the severity of the symptoms. If a patient has milder symptoms that are only affecting their daily life or learning minimally, we may want to modify the classroom settings when they’re in the classroom, making sure that they’re closer to the teacher, making sure they have enough time to do their test taking. If they’re more severe symptoms or moderate symptoms, they may need medication to help them focus, to help their hyperactivity.
A lot of people are afraid of medications. But let me tell you, these medications are very important, especially if it’s affecting learning. Because what happens to a child when they fall behind, they notice that they’re behind. They notice that their peers are learning quicker. They start feeling that their peers are smarter, that their friends are smarter. They start wondering what’s wrong with them. They’re struggling every day to complete a task, their homework. They’re getting bad grades. Then they feel like something is wrong with them.
If a person truly has ADHD, the medications are variable. There are different types of stimulant medications and non-stimulant medications to help with focus. Of course, we always want to also look for underlying contributions to ADHD like poor sleep that can exacerbate symptoms and making sure that they’re sleeping well, and have a well-balanced diet to make sure that they’re in a healthy state to be able to manage the tasks that need to be accomplished for that day.
This goes back to what I was saying about medication and why it can be very important, especially if it’s affecting your daily life and your ability to complete tasks and learn. If a child has untreated ADHD, they know that they are learning at a slower pace. It affects their self-esteem. They have higher rates of depression, anxiety, suicide, divorce when they’re older. It affects you for the rest of your life if this goes untreated. I truly, truly encourage anyone that has any family members that may be suffering with ADHD or or learning disabilities to get the appropriate help and treatment.
ADHD can change over time. A lot of times outgrowing basically means the symptoms are there but they don’t affect you the same way. Someone may go through their entire life having ADHD and they were never diagnosed, they never knew. But you look back and you ask them questions about their childhood. “Oh, I never liked school.” “It wasn’t for me.” “It was boring.” “I couldn’t sit still.” “I didn’t do my homework.” “I just didn’t like it.” Then you get to adulthood. They choose fields where they don’t have to sit in an office. It’s more fields that might be outdoors or doing other activities. The ADHD or the symptoms that they may have had when you had to sit still and get jobs accomplished very quickly may not pertain. The symptoms may still be there, but may not be affecting their life the way it did when they were a child.
A lot of times I’ll hear, “Oh, well, he’s just being a boy.” “That’s just how boys are.” “His dad was the same way.” Or they might say, “Oh, well, she’s just shy.” “She doesn’t like to speak up.” “She just doesn't like the material. That’s why she doesn’t get good grades.” It’s really a lot of excuses.
Anytime a person is having trouble learning, we really have to evaluate it and see if this is normal or abnormal. That would be my take-home message today. Please allow a clinician, someone that is able to see if this is normal or abnormal, to do an evaluation.
Another misconception is if someone is growing up in an environment with multiple languages, that because they’re in an environment with multiple languages, they might have a harder time paying attention. They’re not up to par with the other kids because they’re in a multicultural family with multiple languages. That’s not true either. The developmental milestones and the expectations remain the same.
Any type of diagnosis that pertains to learning disabilities or any type of disability does have a stigma associated because it makes you feel not normal. The way we break stigmas is by normalizing it. Every person is unique and special and learns in a very different way. Just because you might need a little bit more support or a little bit more test taking, or you might need a medicine to help you focus, that’s okay. Many people suffer with ADHD on a daily basis in an untreated way, and it affects their mood, their behaviors, their relationships with other people. We live in a age where there is really no need to suffer. There are a lot of different treatment options. We can individualize a therapy so that you can feel better about your life and you can reach the optimal success that you’re meant for.
There are different avenues for doing this. Because ADHD really affects learning and abilities to get things done, you can always let your school teacher know, counselor, principal. You can go through the school system.
It’s always a good idea to let your pediatrician know because we really have to evaluate for other causes that could be contributing to these symptoms. Sometimes we need to do lab work to make sure there is not a hormonal imbalance causing some of these symptoms. If I had to simplify this, I would say let your doctor know and talk to the teacher at school. Always go to your primary care doctor first and they can help you route through the system.
Children with ADHD will have a special plan, not necessarily called special education, but it will be an individual plan. They will be able to have more time for tests. They’ll be able to have different teachers that may be able to help them focus by accommodating them in classrooms. But people with ADHD or children with ADHD that affect their learning do have the ability to have a classroom setting that is going to make them succeed. But the only way they can do that is if the school knows about it and creates the plan for them.
It really depends on the type of employment that you have and what the expectations of that role is. Per the American Disabilities Act, you do not need to disclose a learning disability or any type of disability when you are being interviewed. Afterward, if you feel that there may be something you might need that’s going to help you succeed, more time accomplishing tasks, then you may disclose to your employer. But usually if a person who’s an adult has ADHD and they’ve known and it’s been controlled, they usually do not disclose to their employer because they don’t need accommodations. It really depends on the severity, what their job is, and how it affects their day-to-day occupation.
There are no studies that show a specific type of diet is going to help a specific type of symptom. However, we know in general that if kids have processed foods or sugars, even without ADHD, they’re going to be more hyper. We might want to pay attention to those kinds of foods that we’re giving our kids. But there are no studies to say if you’re on this diet, this symptom is going to be eliminated. All we can really recommend is having well-balanced meals, staying well hydrated, getting enough sleep, and having your body in optimal level so that you can learn. If your brain is tired and not having nutritious ingredients, you’re not going to learn the way you really can. That goes for anybody whether or not you have ADHD.
That’s a personal choice, especially when you’re an adult. When you’re a child it’s also a personal choice. When you’re a child you may not quite understand what that means. But a parent should always be 100 percent transparent with the school district and the teachers regarding what the child has or what symptoms they may have or what diagnoses they may have.
As an adult, really breaking that stigma is the most important thing. But it’s really up to you to decide how much you want to share and with who. If you feel comfortable sharing that you have a certain diagnosis, that’s okay. You don’t have to tell everybody your diagnoses. You don’t have to tell everybody that you’re going through a divorce. You don’t have to tell everybody that you have diabetes or cancer. You can choose who you share information with. However, if you notice it’s affecting your abilities to do things, talk to your doctor. You may have to talk to your employer to get an accommodation plan. But just know that there are a lot of avenues for you to succeed.
Watch the San Diego Health video with host Susan Taylor and guest Dr. Shirin Alonzo discussing Attention Deficit Hyperactivity Disorder (ADHD).