Attention-Deficit/Hyperactivity Disorder

ADHD and Other Conditions

Summary

  • Several other conditions tend to co-exist with ADHD.
  • This risk increases as a child reaches the teenage years.
  • ADHD and co-existing conditions should always be treated separately.

Living with attention-deficit/hyperactivity disorder (ADHD) by itself is difficult enough. However, there are several other conditions that tend to co-exist with ADHD. These ailments add extra obstacles to an already challenged life. Just as it is with ADHD, early detection is a key to successful treatment.

Co-existing conditions

The majority of kids with ADHD will also have another mental health disorder. Some children will have more than one.

Among the most common co-existing conditions are:

  • Oppositional defiant disorder (ODD)
  • Conduct disorder (CD)
  • Learning disorders
  • Anxiety
  • Depression

Less common co-existing ailments include obsessive compulsive disorder, bipolar disorder, sleep disorders and Tourette’s syndrome.

Oppositional defiant disorder (ODD)

ODD is expressed as outward anger and defiance, especially toward adults. A child with ODD will often argue with, and be hostile toward, parents and teachers. This results in many problems at home and in school. ODD is more common among boys with ADHD than girls.

Conduct disorder (CD)

Conduct disorder is less common, but more extreme than ODD. In addition to problems at home and school, CD may cause problems with the police. Children and teens with CD are more likely to carry weapons. They are also more apt to do harm to people, animals or property. Lying, stealing and bullying are common traits of a young person with conduct disorder.

Kids with ADHD and CD or ODD are far more likely to be suspended or to drop out of school. They are also more likely to be involved with substance use. Treatment for CD and ODD includes antipsychotic drugs and mood stabilizers. This is in addition to the stimulants that are used to treat the ADHD symptoms. Other therapies may involve parent training, family counseling, mentoring and anger management.

Learning disorders

About one-half of children with ADHD will also have some sort of learning disorder. This situation makes it doubly hard for a child to learn and progress in school. A tutor may be needed to provide one-on-one help, especially with reading, writing and math.
Anxiety

It is believed that nearly one-third of kids with ADHD will also have anxiety. This condition is not as easy to address because it often goes unnoticed. Students with ADHD and anxiety do not typically act out in school. They are more likely to try to hide out at school, or miss school completely.

Kids with ADHD and anxiety will overly stress about issues such as homework and peer pressure. They may not show these signs outwardly. Instead, they may choose to suppress their feelings. Sometimes kids will miss school to avoid fearful situations. These fears may eventually be expressed as panic attacks. It is important that parents and teachers work closely to identify children with anxiety.

Depression

Depression also tends to co-exist with ADHD. A depressed child or teen will show marked signs of sadness, irritation and aggression. They will often feel defeated and hopeless. The child will withdraw from activities and from other people. School work and attendance typically drops as well.

These negative thoughts increase the risk of suicide in youth. It is therefore vital that the depression and ADHD are both treated. Antidepressants may be prescribed for the depression along with stimulants for the ADHD. One-on-one counseling and family therapy can also be effective. A person who talks about suicide should be taken seriously, and not be left alone.

Substance use disorder

People with ADHD are at a higher risk for substance use disorder. This risk increases as a child reaches the teenage years. The use of stimulants to treat ADHD has sometimes been blamed for later substance use. However, studies do not support this theory. In fact, some studies suggest that taking stimulants actually lowers this chance.

Teens with ADHD and co-existing disorders are at an even greater risk for substance use disorder. Another issue is the abuse of the ADHD stimulant drugs themselves. Taking more pills than prescribed or giving or selling them to friends are common problems.

Treatment

ADHD and co-existing conditions should always be treated separately. Treating ADHD early may decrease the risk of developing some of these conditions. When untreated, ADHD can cause severe problems in many different areas of one’s life. Some of these include school, work, driving, dating, marriage and other relationships.

By Kevin Rizzo

©2013-2023 Carelon Behavioral Health

 

ADHD in Adults

ADHD is one of the most commonly recognized mental disorders among children. Despite this fact, sometimes ADHD is not detected until adolescence or even adulthood. This does not mean the person didn’t have the disorder as a child. It means he grew up without having the symptoms properly diagnosed as ADHD.

Some children seem to “outgrow” ADHD as they get older. For most, though, it will continue into adulthood. Adults with ADHD will face new challenges both at home and in the workplace. Trying to balance the pressures of work with raising a family can be stressful. Staying on medication and other forms of treatment will help adults cope with these issues.

Medication treatment

Stimulants are the drugs most often used to treat ADHD. Stimulants arouse the part of the brain that filters distractions. This results in a calming effect for a person with ADHD.

Some of the more common ADHD stimulants include:

  • Adderall®
  • Concerta®
  • Daytrana®
  • Dexedrine®
  • DextroStat®
  • Metadate®
  • Methylin®
  • Ritalin®

Not all ADHD medications are approved for adults by the U.S. Food and Drug Administration. A doctor may still choose to prescribe them, however. Some of these drugs may not react well with other medications. Therefore, the doctor should be made aware of any pills being taken for other ailments. Instead of stimulants, sometimes antidepressants such as Effexor® or Wellbutrin® are prescribed for adults with ADHD.

Medication is by far the first line of treatment for adults with ADHD. In addition, talk therapy may be useful for working through daily struggles. This can be individual, couples or group therapy. These sessions should be led by a mental health professional that is trained in treating ADHD.

ADHD and relationships

ADHD can hamper adult relationships in many ways. Making impulsive decisions, always interrupting and not picking up on social cues are among them. It is easy for others to believe the person is being insensitive. That is why learning as much as possible about the disorder is so important. This is true for those with ADHD as well as for those who spend a lot of time around them.

There are some simple steps you can take to improve your relationships. One is to make sure you keep an open dialog. This will allow your co-workers, friends or loved ones to provide you with healthy feedback. Try to stay positive and always think before you respond. You can also use these times to plan the week or weekend ahead. This will ensure you all are on the same page and no one is surprised.

Money and intimacy are two common areas of conflict in romantic relationships. These can be further provoked by the impulsive and inattentive traits of someone with ADHD. Be sure to discuss any major purchases ahead of time and use credit cards sparingly. If spending cannot be controlled, seek the help of a financial counselor. You may also want to consider couples counseling for any unresolved intimacy issues.

ADHD at work

Many of the problems at work for someone with ADHD involve organization and concentration. Staying alert and focused can be challenging. This makes getting work done in a timely manner all the more difficult.

Here are some tips for being more productive at work:

  • Avoid distractions by working away from windows, busy doorways or bathrooms.
  • Stay alert by taking frequent breaks, stretching or getting up and walking around.
  • Keep organized by using sticky notes, checklists and day planners.
  • Set up reminders on your computer or smartphone for important tasks or events.
  • Schedule regular meetings with your boss or co-workers to ensure you are staying on target.

Resource

FDA ADHD Patient Medication Guides

By Kevin Rizzo

©2022 Carelon Behavioral Health

ADHD: Coping Strategies

ADHD is one of the most commonly recognized mental disorders among children. Despite this fact, sometimes ADHD is not detected until adolescence or even adulthood. This does not mean the person didn’t have the disorder as a child. It means he grew up without having the symptoms properly diagnosed as ADHD.

Some children seem to “outgrow” ADHD as they get older. For most, though, it will continue into adulthood. Adults with ADHD will face new challenges both at home and in the workplace. Trying to balance the pressures of work with raising a family can be stressful. Staying on medication and other forms of treatment will help adults cope with these issues.

Medication treatment

Stimulants are the drugs most often used to treat ADHD. Stimulants arouse the part of the brain that filters distractions. This results in a calming effect for a person with ADHD.

Some of the more common ADHD stimulants include:

  • Adderall®
  • Concerta®
  • Daytrana®
  • Dexedrine®
  • DextroStat®
  • Metadate®
  • Methylin®
  • Ritalin®

Not all ADHD medications are approved for adults by the U.S. Food and Drug Administration. A doctor may still choose to prescribe them, however. Some of these drugs may not react well with other medications. Therefore, the doctor should be made aware of any pills being taken for other ailments. Instead of stimulants, sometimes antidepressants such as Effexor® or Wellbutrin® are prescribed for adults with ADHD.

Medication is by far the first line of treatment for adults with ADHD. In addition, talk therapy may be useful for working through daily struggles. This can be individual, couples or group therapy. These sessions should be led by a mental health professional that is trained in treating ADHD.

ADHD and relationships

ADHD can hamper adult relationships in many ways. Making impulsive decisions, always interrupting and not picking up on social cues are among them. It is easy for others to believe the person is being insensitive. That is why learning as much as possible about the disorder is so important. This is true for those with ADHD as well as for those who spend a lot of time around them.

There are some simple steps you can take to improve your relationships. One is to make sure you keep an open dialog. This will allow your co-workers, friends or loved ones to provide you with healthy feedback. Try to stay positive and always think before you respond. You can also use these times to plan the week or weekend ahead. This will ensure you all are on the same page and no one is surprised.

Money and intimacy are two common areas of conflict in romantic relationships. These can be further provoked by the impulsive and inattentive traits of someone with ADHD. Be sure to discuss any major purchases ahead of time and use credit cards sparingly. If spending cannot be controlled, seek the help of a financial counselor. You may also want to consider couples counseling for any unresolved intimacy issues.

ADHD at work

Many of the problems at work for someone with ADHD involve organization and concentration. Staying alert and focused can be challenging. This makes getting work done in a timely manner all the more difficult.

Here are some tips for being more productive at work:

  • Avoid distractions by working away from windows, busy doorways or bathrooms.
  • Stay alert by taking frequent breaks, stretching or getting up and walking around.
  • Keep organized by using sticky notes, checklists and day planners.
  • Set up reminders on your computer or smartphone for important tasks or events.
  • Schedule regular meetings with your boss or co-workers to ensure you are staying on target.

Resource

FDA ADHD Patient Medication Guides

By Kevin Rizzo

©2022 Carelon Behavioral Health

ADHD: What Is It?

Summary

  • Stands for attention-deficit/hyperactivity disorder
  • One of the most common disorders among school-age kids
  • Symptoms include inattention, hyperactivity, and compulsion

ADHD stands for attention-deficit/hyperactivity disorder. It is one of the most common disorders among school-age kids. ADHD can also continue into adulthood. People with ADHD have trouble paying attention and staying focused. Many of them are also hyperactive and compulsive. Boys are three to four times more likely to have ADHD than girls.

ADHD vs. ADD

Sometimes ADHD is referred to simply as ADD, or attention deficit disorder. This is especially true when there is an absence of hyperactivity. Although people often mean the same thing by both, ADHD is the clinically correct term. Within ADHD, there are three subtypes.

Types of ADHD

Predominantly hyperactive-impulsive: This is the most disruptive type. A person with this type will be more hyper than inattentive. This often causes problems in the classroom. It is more common among boys. Symptoms include:

  • Trouble sitting still
  • Constant talking
  • Interrupting
  • Impatience

Predominantly inattentive: This is sometimes called ADD. There may or may not be hyperactivity involved. If there is, it is less prevalent. This type is not as easy to notice. More girls tend to have this type. Symptoms include:

  • Short attention span
  • Easily bored and distracted
  • Trouble learning new things
  • Trouble finishing tasks

Combined type: This is the most common type among children. It is a mix of hyperactive-impulsive and inattentive symptoms.

Causes of ADHD

ADHD used to be blamed on poor parenting. This is no longer believed to be the case. It is now thought to be caused by a group of factors. Genes may play a major role. Other possible factors include smoking and alcohol use during pregnancy. Brain injuries and exposure to lead may also increase the risk of developing ADHD. Sugars, food coloring and other additives have also been blamed, but more research is needed.

Diagnosing ADHD

Most children act hyper, impulsive and distracted at certain times. A child with ADHD will behave this way more often and to a greater degree. It is important that the child’s doctor rule out other possible causes first. Some conditions that may mimic ADHD-like symptoms include:

  • Hearing problems
  • Vision problems
  • Learning problems
  • Middle ear infections
  • Seizures

Sometimes the child may simply be reacting to a stressful event or situation. To be diagnosed with ADHD, the child must display symptoms for at least 6 months. These symptoms should also be more severe than those of other children the child’s age.

ADHD is not as easy to detect in adults. The symptoms are the same as in children, but tend to be less obvious. An adult with ADHD will have had symptoms as a child, though they were undetected.

Diagnosis, whether for children or adults, should always be done by a licensed health professional.

Co-existing disorders

Certain disorders tend to co-exist with ADHD. Among these are:

  • Oppositional defiant disorder (ODD)
  • Conduct disorder
  • Bipolar disorder
  • Learning disorders
  • Depression and anxiety
  • Tourette’s syndrome

Treatment of ADHD

There is no cure for ADHD, but symptoms can be effectively controlled. Treatment consists of medication and therapy. Pills known as stimulants are typically used. Despite their name, stimulants have a way of calming down kids with ADHD. There are many different brands of stimulants, such as Adderall®, Dexedrine® and Ritalin®. Each may produce different results and side effects, depending on the child. Parents and doctors should work closely together to decide which drug and dose works best.

Therapy teaches children with ADHD how to adjust their behavior during difficult situations. Guidance is given in practical areas such as organizing and completing chores and homework. Social skills are taught to help these children interact better with their peers. Parents and teachers can also learn how best to encourage proper behavior in the child.

Resource

National Institute of Mental Health
www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

By Kevin Rizzo

©2013-2023 Carelon Behavioral Health

Diagnosing ADHD in Children and Adults

Summary

  • typically marked by inattention, hyperactivity and impulsiveness
  • children may act differently at school than at home
  • is not as easy to detect in adults

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders among children. Each year, the number of school-age kids diagnosed with ADHD rises. Sometimes ADHD is not detected until adolescence or even adulthood. This does not mean the person did not have the disorder as a child. It simply means the person grew up without having the symptoms properly diagnosed as ADHD. Diagnosis, whether for children or adults, should always be done by a licensed health professional.

Subtypes and symptoms

ADHD is typically marked by inattention, as well as hyperactivity and impulsiveness. ADHD is then broken into 3 subtypes, based upon these traits.

Predominantly hyperactive-impulsive: This is the most disruptive type. A person with this type will be more hyper than inattentive. This often causes problems in the classroom. It is more common among boys than girls. Symptoms include:

  • Trouble sitting still
  • Constant talking
  • Frequent interrupting
  • Severe impatience
  • Outwardly emotional
  • Randomly touching things
  • Always on the move

Predominantly inattentive: This is sometimes referred to as ADD because there may not be hyperactivity involved. If there is, it is less prevalent. This type is not as easy to notice. More girls tend to have this type. Symptoms include:

  • Short attention span
  • Easily distracted
  • Unorganized
  • Forgetful and careless
  • Trouble listening
  • Trouble learning new things
  • Trouble finishing tasks

Combined type: This is the most common type among children. It is a mixture of hyperactive-impulsive and inattentive symptoms.

Diagnosing ADHD in children

Sometimes ADHD is mistaken for other issues. The child may be thought to have a learning disability. Kids who are disruptive may be considered to be undisciplined. Children with inattentive type ADHD may not be diagnosed at all if they are well-behaved.

A child who displays symptoms of ADHD does not necessarily have the disorder. Most children act hyper, impulsive and distracted at certain times. A child with ADHD will behave this way more often and to a greater degree. To be diagnosed with ADHD, the child must display symptoms for at least 6 months. These symptoms should also be more severe than those of other children the child’s age.

Parents who are concerned their child might have ADHD should stay in close contact with school personnel. This includes teachers, guidance counselors and others who observe the child’s behavior. Children with ADHD may react differently in a school setting than they do at home.

Sometimes the child may be reacting to a stressful situation at home or at school. It’s a good idea for parents and teachers to compare “notes” concerning the child’s behavior. This information can then be shared with the child’s doctor. The doctor will try to determine other possible causes like hearing or vision problems. Tests may be needed to rule out more severe medical conditions such as seizures. The doctor may also refer the family to a mental health specialist.

Diagnosing ADHD in adults

ADHD is not as easy to detect in adults. The symptoms are the same as in children, but tend to be less obvious. An adult with ADHD will have had symptoms as a child, though they were undetected.

As an adult, ADHD can interfere with being successful at work. It can also cause problems in relationships. Marriage and parenting may be adversely affected. A doctor or specialist will want to get feedback from those closest to the person. They will also try to rule out other possible conditions. A thorough exam and further testing may be necessary.

Resource

National Institute of Mental Health
www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

By Kevin Rizzo

©2013-2019 Carelon Behavioral Health

Source: National Institute of Mental Health, www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml and National Alliance on Mental Illness

Reviewed by Craig Wronski, MD, Medical Director, Beacon Health Options

Medication Treatment for ADHD

Summary

  • Drugs called stimulants are the first line of treatment.
  • Several different pills and doses may need to be tried.
  • Common side effects are a decrease in appetite and trouble sleeping.

Attention-deficit/hyperactivity disorder (ADHD) cannot be cured, but its symptoms can be treated by medication and therapy. Drugs called stimulants are considered the first line of treatment.

In the past, a child with ADHD might have to take Ritalin® several times a day. This was less than ideal, especially when doses had to be taken during school hours. Today, Ritalin® and many other stimulants are available in long-lasting or extended-release pills or capsules. Some are also in a liquid or patch form. Despite their name, stimulants work well in calming down a person with ADHD. This is done by stimulating the part of the brain that filters out distractions.

Some of the more common ADHD stimulants include:

  • Adderall®
  • Concerta®
  • Daytrana®
  • Dexedrine®
  • DextroStat®
  • Metadate®
  • Methylin®
  • Ritalin®
  • Vyvanse®

Most of these medications are approved for kids ages 6 and older. Adderall®, Dexedrine® and DextroStat® are approved for kids ages 3 and older. Very low doses of Ritalin® may sometimes be prescribed for preschoolers with severe ADHD. Not all ADHD medications are approved for adults, and some may interfere with other drugs.

A psychiatrist will typically be the one to prescribe medication to the person with ADHD. The patient or parent should work closely with the doctor to see what works best. Several different pills and doses may need to be tried. Ideally, children should be diagnosed and treated by a child psychiatrist or pediatrician who deals with ADHD.
Some parents may worry that giving their child stimulants may later lead to substance use disorder. Studies do not support this viewpoint, however. In fact, some studies suggest that doctor prescribed stimulants may lower the risk.

Side effects

As with any medication, the benefits must be weighed along with potential side effects. This is even truer in regards to children. Stimulants have been shown to be safe and effective in the treatment of ADHD. Students seem to be better focused during class and while doing homework. Side effects depend on the child as well as the medication and dose. Most side effects are not serious and will go away in time or with a lowered dose.

The most common side effects are a decrease in appetite and trouble sleeping. If these do not go away, changing the dosage may be helpful. Taking the pills earlier in the day may help offset sleep problems. Other common side effects include mild headaches, stomachaches and feeling anxious or irritable.

Some children may develop certain changes in their personality, as well as tics. These are not common, but should be reported to their doctor right away. Children and teens that are given Strattera®, a non-stimulant, have an increased risk of suicide. These children should be watched very closely.

Stimulants have shown a slightly increased risk of heart-related problems in patients with pre-existing heart conditions. This includes the risk of heart attack, stroke and sudden death. Stimulants may raise a person’s blood pressure and heart rate. There is also a slight risk of patients developing certain mental health issues. For instance, patients may see or hear things, or display other paranoid or manic behaviors. Experts advise that a person with a heart issue or family history of sudden death get an EKG before taking stimulants.

The U.S. Food and Drug Administration (FDA) requires all ADHD medications to come with medication guides. These guides can also be found at the FDA’s website FDA ADHD Drug Safety Information.

Resource

CHADD: National Resource Center on ADHD
www.chadd.org/

By Kevin Rizzo

©2013-2019 Carelon Behavioral Health

Source: National Institute of Mental Health, www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

Reviewed by Craig Wronski, M.D., Medical Director, Beacon Health Options

Peer Relationships and ADHD

Attention deficit hyperactivity disorder (ADHD) can make peer relationships or friendships very difficult. Having friends is important to children’s well-being and may be very important to their long-term development.

Although some children with ADHD have no trouble getting along with other children, others have difficulty in their relationships with their peers. For example, they might not have close friends, or might even be rejected by other children. Children who have difficulty making friends might also more likely have anxiety, behavioral and mood disorders, substance abuse or delinquency as teenagers.

How ADHD interferes with peer relationships

Exactly how ADHD contributes to social problems is not fully understood. Children who are inattentive sometimes seem shy or withdrawn to their peers. Children with symptoms of impulsivity/hyperactivity may be rejected by their peers because they are intrusive, may not wait their turn, or may act aggressively. In addition, children with ADHD are also more likely than those without ADHD to have other disorders that interfere with getting along with others.

How to help your child

Not everyone with ADHD has difficulty getting along with others. For those children who do have difficulty, many things can be done to help them with relationships. The earlier a child’s difficulties with peers are noticed, the more successful intervention may be.

Although researchers don’t have definitive answers on what works best for children with ADHD, here are some things you might consider as you help your child build and strengthen peer relationships:

  • Pay attention to how your child gets along with peers. These relationships can be just as important as grades to school success.
  • Talk regularly with people who play important roles in your child’s life (teachers, school counselors, afterschool activity leaders, health care providers, etc.). Keep updated on your child’s social development in community and school settings.
  • Involve your child in activities with other children. Talk with other parents, sports coaches and other involved adults about any progress or problems that may develop with your child.
  • Explore peer programs. Peer programs can be helpful, particularly for older children and teenagers. Social skills training alone has not shown to be effective, but peer programs where children practice getting along with others can help. Schools and communities often have such programs available. You may want to talk to your health care provider and someone at your child’s school about programs that might help.

Source: U.S. Centers for Disease Control and Prevention, www.cdc.gov

 

Resources

Al-Anon Family Groups

www.al-anon.alateen.org