AD / HD For Dummies book cover

AD / HD For Dummies

Published: October 29, 2004

Overview

Sound advice for parents whose kids have trouble concentrating

According to the National Institutes of Health, an estimated five to ten percent of children suffer from Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD). This book provides answers for parents of children who may have either condition, as well as for adult sufferers. Written in a friendly, easy-to-understand style, it helps people recognize and understand ADD and ADHD symptoms and offers an authoritative, balanced overview of both drug and non-drug therapies.

Sound advice for parents whose kids have trouble concentrating

According to the National Institutes of Health, an estimated five to ten percent of children suffer from Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD). This book provides answers

for parents of children who may have either condition, as well as for adult sufferers. Written in a friendly, easy-to-understand style, it helps people recognize and understand ADD and ADHD symptoms and offers an authoritative, balanced overview of both drug and non-drug therapies.

AD/HD For Dummies Cheat Sheet

Understanding and diagnosing attention deficit/hyperactivity disorder, or AD/HD, begins with learning the three types of AD/HD and recognizing that they can be exhibited through secondary symptoms as well. To cope with AD/HD, explore a number of treatment options and how they can be approached for better results.

Articles From The Book

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ADHD Articles

Picturing the Primary Symptoms of AD/HD

AD/HD has three primary symptoms: inattention/distractibility, impulsivity, and hyperactivity. These symptoms don't all have to be present in order for you to have AD/HD, and if you do have one or more of them, they may not be present all the time.

Inattention/distractibility

Inattention means you have a hard time focusing on something. Distractibility means your attention is easily pulled from one thing to another. Inattention is at the core of AD/HD. However, inattention isn't as simple as never being able to focus; nothing about this condition is as clear-cut as that. Inattention is more accurately a problem in being able to control or regulate how and when you focus on something.

A key thing to know about this symptom is that it can look different in almost everyone, and it can change from day to day in each person. But even with such variability, a few basic characteristics of inattention and distractibility are found in people with AD/HD. These are:

  • Not being able to concentrate: Keeping focused on something is difficult and, at times, impossible.
  • Being able to focus well on some things but not on others: Many people think that just because a person can concentrate on something, she must be able to concentrate on everything if she just tries hard enough. This is not the case for people with AD/HD.
  • Being able to focus sometimes but not other times: Scattered thinking makes it difficult for sufferers to tackle complex projects because they often lose track of what they are doing.
  • Being easily distracted by things happening around you: Many people with AD/HD are unable to filter out all the things going on around them and are easily pulled away from what they want to focus on.
  • Being easily distracted by your own thoughts: "Daydreaming," or having unrelated thoughts flowing through their minds, is commonplace for some AD/HD patients.
  • Losing track of your thoughts (spacing out): An extension of being easily distracted is spacing out. This is common with people with AD/HD — it seems like they have gaps in their awareness.
  • Being forgetful: A lot of people with AD/HD tend to lose their keys, forget appointments, and get lost.
  • Being late: Because many people with AD/HD have trouble organizing their time, they are often late to appointments.
  • Being unable to finish things: People with AD/HD are notorious for starting a project and then moving on to something else before finishing it.
  • Procrastinating: People with AD/HD often fail to even start something. Also, after repeated failures, many people avoid starting projects because of the fear that they'll fail again.
  • Not attending to details: People with AD/HD are often "big picture" people. They can think up new and exciting ideas, but when it comes to actually dealing with the details needed to make those ideas happen, they just can't seem to follow through. As well, when given instructions on how to do something, they often miss important details.
  • Making careless mistakes: Not attending to details leads to careless mistakes. This is a common problem with people who are easily distractible because they drift from one thought to another and lose track of what they've done and what needs to be done next.

Impulsivity

Impulsivity is the inability to consider the consequences of your actions beforehand — in other words, doing before thinking. When you have this symptom of AD/HD, it's almost as though you have an involuntary response to a stimulus. The response can take the form of actions or words.

Like the other symptoms of AD/HD, impulsivity looks different depending on the person. Some people have difficulty considering what they say before saying it, whereas others may act at times without thinking. Here are a few ways that impulsivity can manifest in people with AD/HD:

  • Blurting out answers before a question is finished: Many teachers of children with AD/HD complain that the children shout out answers before questions have been asked. Many AD/HD adults have a habit of finishing other people's sentences.
  • Saying inappropriate things: People with the hyperactive/impulsive type of AD/HD have a difficult time censoring themselves, and they respond to other people without considering the consequences of what they say.
  • Butting into conversations: Because of the inability to keep from saying the first thing that comes to mind, people with impulse problems often butt into conversations. This is partly due to the lack of impulse control but is also due to the difficulty that many people with AD/HD have in being able to pick up on and interpret subtle signals (body language) and the rhythm of a conversation.
  • Intruding on others: AD/HD sufferers often don't know where their bodies are in space, so they tend to be somewhat clumsy. Couple this characteristic with the lack of impulse control, and you often find people with AD/HD intruding on others — bumping into them, grabbing at a toy, and so on.
  • Acting without considering the consequences: Many people with AD/HD act from impulse to impulse. They see something in a store and "have to have it," even though that item may not have any useful purpose for them.
  • Engaging in risky behaviors: Because people with AD/HD often crave stimulus, they may get into situations where they do dangerous things. Pushing life to the limits can really help some people focus and feel more in control.
  • Being impatient: One thing that is particularly difficult for people with AD/HD is waiting in line, which requires someone to stand relatively still. They are more likely to fidget and squirm while waiting.
  • Wanting things immediately: This symptom can take many forms, such as wanting to have your needs met immediately, as in the case of a child who has a tantrum when you don't come running to his aid.

Restlessness/hyperactivity

Restlessness and hyperactivity are essentially the same thing — the inability to regulate your physical movements. For the person with this symptom of AD/HD, sitting still is difficult (especially at school or work where sitting for extended periods of time is expected), as is doing activities that require minimal physical movement, such as playing quiet games.

Keep in mind that most young children exhibit what would be called hyperactivity — frequent movement and activity. This isn't necessarily a sign that your child has AD/HD. Most children outgrow this level of activity by the time they're 4 or 5. And even before then, most kids have periods of time where they're able to sit quietly, such as when reading a book with a parent or older sibling.

Restlessness and hyperactivity are so variable in people that in one instance this symptom may be obvious, and in another it may be almost completely disguised. Following are a few of the ways this symptom can present itself:

  • Being unable to sit still for any length of time: This is especially obvious in younger children. As children grow older, they often develop the ability to sit, although they may squirm in their seats or, as they grow older still, just fidget.
  • Being always on the go: The classic descriptor is that people with this symptom of AD/HD seem to be "driven by a motor." As much as they'd like to stop moving sometimes, they can't seem to do so.
  • Feeling edgy: Adults with AD/HD feel the need to move and release the energy that builds up inside them. Restlessness also can show up in other parts of a person's life. People with AD/HD often move or change jobs just because they are restless.
  • Fidgeting constantly: Fidgeting can take on a number of forms, from seemingly repetitive tapping to random movements. Some people fidget to try to focus on a task.
  • Talking nonstop: Rather than move their bodies, some people with AD/HD run their mouths. Constant talking is simply another way to release the energy that seems to build up from AD/HD.

ADHD Articles

Exploring Current AD/HD Research

Although the exact cause of AD/HD is still unknown, there is no shortage of research into the biology of AD/HD. This research fits into four broad categories: genetic, anatomical, functional, and chemical.

Genetic

AD/HD runs in families — so much so that when diagnosing the condition, an AD/HD professional's first step may be to look at the person's family to see if anyone else has it. The precise genetic factor has yet to be confirmed, but recent research has identified a couple of genes that may contribute to AD/HD.

Many studies have examined AD/HD from a genetic perspective. These include studies that look at adoptive versus biological parents, the prevalence of AD/HD in families, twins' tendency to share AD/HD, and specific genes associated with AD/HD. Here's a short sampling of some of these areas of investigation:

  • A study conducted by Dr. Florence Levy of the University of New South Wales, Australia showed that if one identical twin has AD/HD, 81 percent of the time the other one will as well. By contrast, only 29 percent of paternal twins share AD/HD. Because identical twins share the exact same DNA, this strongly suggests a genetic component to AD/HD.
  • Several studies by Dr. Joseph Biederman and his colleagues at the Massachusetts General Hospital have shown that AD/HD runs in families. In one study, Dr. Biederman and his colleagues found that first-degree relatives (parents or siblings) of someone with AD/HD have a five times greater chance of also having AD/HD than someone who has no close relatives with the condition.
  • Studies by Dr. Dennis Cantwell on adopted children with the hyperactive/impulsive type of AD/HD found that these children resemble their biological parents more than their adoptive parents in their hyperactivity. His studies suggest that the environment in which children grow up has less impact on the development of AD/HD than their genes.
  • In a 1991 study, David Comings and his colleagues suggested that a mutation in the dopamine D2 receptor gene is connected to AD/HD. Research is underway now that is exploring several dopamine genes as possible links to AD/HD. A few researchers have suggested that two genes in particular — DAT1 and DRD4 — are the culprits. In fact, a recent study by researchers at the University of California, Irvine, suggests that the DRD4 7R gene may be associated with several AD/HD traits, such as novelty-seeking, increased aggression, and perseverance.

Anatomical

Researchers have conducted a few studies into the size and shape of the brains of people with AD/HD compared to people without it. A lot of conflicting data exists in this area, but a couple basic ideas have been suggested:

  • One study suggested that the size of the corpus collosum (a bundle of nerves that ties the hemispheres of the brain together) is different in some people with AD/HD than in some people without it. Other researchers have suggested that this part of the brain operates differently in people with AD/HD than in others, so this observation may have some validity.
  • Some research has indicated that asymmetry in the basal ganglia (a set of nuclei deep in the brain that are involved in regulation and control of the motor system) may be indicative of AD/HD.

While anatomical research continues, most of the AD/HD research being done right now focuses on differences in brain activity between the AD/HD and non-AD/HD populations.

Functional

The brains of people with AD/HD seem to function differently than the brains of people without it. This area of research is buzzing right now, not only because it helps explain the cause of AD/HD, but also because these studies use relatively new technologies for imaging. Here's a sampling:

  • A study by Alan Zemetkin, MD, using PET scans on adults with AD/HD discovered that when the subjects concentrated, the level of activity in the front part of the brain (the frontal lobe) decreased from its level at rest. People without AD/HD have an opposite response — an increase in activity in the frontal lobe when they concentrate. This study is generally credited with showing that AD/HD is a biologically based condition.
  • Dr. Joel Lubar at the University of Tennessee conducted several studies using quantitative electroencephalogram (EEG). The studies showed that when people with AD/HD concentrate, there is an increase in theta activity (slow brainwaves) in the frontal lobe of the brain. This finding corresponds to a lower level of activity in the region.
  • Dr. Daniel G. Amen conducted extensive testing at his clinic using Single Photon Emission Computed Tomography (SPECT) technology. He observed several variations in brain activity in people with AD/HD and has suggested that AD/HD is actually several different conditions, each with a different brain activity signature. According to his research, the areas affected by AD/HD include:

Frontal lobe: Dr. Amen found a decrease in activity in this area when people with AD/HD are asked to concentrate. This corresponds with research done by Drs. Lubar and Zemetkin.

Limbic system: The limbic system is located deep inside the center of the brain and is often involved with the way we feel and express our emotions. Dr. Amen's research found that some people with AD/HD have heightened limbic activity in addition to the decreased frontal lobe activity. This corresponds with a perspective put forth by researcher Paul Wender suggesting that the limbic system is at the center of the problems in AD/HD.

Parietal lobe: Located toward the back of the brain, this section is also referred to as the sensory cortex. Dr. Amen suggests that certain people with AD/HD have more activity in this area than other people.

  • Dr. Robert Chabot and his colleagues at New York University found that 11 different patterns of QEEG (quantitative electroencephalogram — a device that measures surface brain wave activity and compares it to normal measurements found in a database) are associated with people diagnosed with AD/HD. They also found that some of these people could be predicted to respond well to certain medications and poorly to others.

Chemical

For information to pass from one part of the brain to another requires the action of neurotransmitters — chemicals within the brain. A neurotransmitter is a small chemical messenger that allows one neuron (nerve) to communicate with another. When the upstream neuron gets excited and wants to pass on information to the downstream neuron, it releases the neurotransmitter molecules into a closed connection (like an airlock in a submarine or a space ship) called a synapse. The neurotransmitter then crosses the space to the downstream neuron's membrane and binds to specific receptors that cause an effect inside the receiving nerve.

One way to think about AD/HD is that it is a problem of balance between the activities of norepinephrine and dopamine two different neurotransmitters. When you have too much norepinephrine working, you are agitated, and you can pay attention only to things that may be threats or targets of opportunity (the "fight or flight" mechanism is very active). When you have more dopamine dominance, you tend to get stuck on repetitive activities, and you don't get bored doing the same things over and over. AD/HD is associated with having too much norepinephrine.

ADHD Articles

Improving Your Life When You Have AD/HD

Having AD/HD presents many challenges, especially when you interact with people who don't have the condition. Here are some of the more important issues that people with AD/HD have when they live with people who don't have it.

Managing moods

One of the main characteristics of AD/HD for most people is extreme, frequent changes in mood. One minute you may feel happy and hopeful, and a minute later you feel angry and frustrated without anything outside of you causing the change. This phenomenon is a product of several different factors, the most important of which are:

  • A biological disposition to react more strongly than other people to the ups and downs of life: This tendency is usually helped to some degree by biological treatments — such as diet, medication, and rebalancing therapies — all of which can change the way the brain works.
  • Past experiences: Most people with AD/HD have come up short on meeting their (and others') expectations, so they tend to have an internal dialogue that is demeaning and negative. That tendency to have a low opinion of oneself can be formed, worsened, or reinforced by . . .
  • Others' words: How many times can a person hear "I'm disappointed in you" or "You could do so much better if only you tried harder" before turning that criticism inward (and often making it even stronger)? Most people with AD/HD bear deep scars from criticism directed at them over and over again.
  • A tendency to jump to conclusions: People with AD/HD have a talent for jumping to conclusions ahead of the evidence. After you've jumped to a conclusion, an attitude isn't far behind. If you have an attitude about every conclusion you jump to, you're probably going to come across as moody.
  • Medication wearing off: If you take medication for your AD/HD, as it wears off you may experience changes in mood. If you notice a mood pattern that seems to coincide with your medication schedule, talk to your physician about adjusting your medication, dosage, or schedule.

Here are some suggestions to deal with negative thoughts that can lead to negative moods:

  • Stop the thought and ask yourself if it is based on what's happening at the moment. Most of the time, negative thoughts are simply popping up without relating to your life at the moment.
  • Breathe through it. When you have negative thoughts, your body tenses up, and your breath becomes shallower. Take a few deep breaths, and you'll begin to relax.
  • Cancel that thought. After you acknowledge that the thought isn't based on what's happening and you've had a chance to take a breath, you can let it go.
  • Reframe that thought. Even if you think a negative thought is based on what's really happening, you don't have to let it lead you to a negative feeling. Try to reframe negative perceptions, thoughts, or words into positive ones. If you can see the humor or the benefit in a difficult situation, you can probably feel better about it.
  • Don't take things personally. All of us have internal pressures, reasons, or ideas that make us do the things we do. When someone directs a negative comment or action your way, try to realize that it's not necessarily about you. If you can do so, you may not feel the need to have such a strong reaction. Work on understanding the causes and consequences of your own and other people's actions and reactions. If you succeed, you may be able to let us all off the hooks of blame, resentment, and general bad temper.

Extreme moodiness may be a sign of depression or bipolar disorder. Because both of these conditions are common among people with AD/HD, have a professional screen you for these conditions.

Taking responsibility

AD/HD is an explanation, not an excuse. You must take responsibility for your actions regardless of the fact that AD/HD has a biological cause. If your behavior is causing problems in your life, you need to seek the best possible help in getting it under control.

If you hurt someone, create a problem, or make situations more difficult — even unintentionally — don't use your diagnosis of AD/HD as an excuse. You and everyone else will benefit if you can focus on understanding how your actions caused the hurt or contributed to the problem. If you can find a way to express that understanding to the other people involved, all the better; they can then realize that you have not ignored their feelings and rights.

The most important thing you can do is to learn from situations in which your AD/HD plays a part in creating bad feelings or less-than-optimal outcomes. That way, you can take responsibility and continue on the road to self-improvement.