What Is It?

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder featuring a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

It begins and is usually first diagnosed in childhood, often lasting into adulthood. It is common for some of these traits to be present in every single person, but in ADHD, these symptoms can cause significant impairment at home, in school, or with friends.

In this post you will find information about the following:

1. Signs and symptoms
2. Types
3. Causes
4. Diagnosis
5. Treatment
6. How to manage this disorder
7. ADHD in different life stages
8. How to help your child
9. Coexisting conditions
10. ADD vs. ADHD
11. FAQs

Signs and Symptoms

According to the DSM-5, symptoms of ADHD include inattention, hyperactivity, and impulsivity.

To be diagnosed, children must meet the diagnostic criteria of at least 6 symptoms, while adults have to meet at least 5 of the following symptoms:

Inattention symptoms:

1. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).
2.  Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
3. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily side-tracked).
5. Often has difficulty organising tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganised work; has poor time management; fails to meet deadlines).
6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).
7. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
8.  Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).
9. Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, and keeping appointments).

Hyperactivity and impulsivity symptoms:

1. Often fidgets with or taps hands or feet or squirms in their seat.
2. Often leaves a seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).
3. Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, they may be limited to feeling restless.)
4. Often unable to play or engage in leisure activities quietly.
5. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for an extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).
6. Often talks excessively.
7. Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for a turn in conversation).
8.  Often has difficulty waiting his or her turn (e.g., while waiting in line).
9. Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).

Types

ADHD is generally classified into three main types, depending on which symptoms are strongest in the individual or a combination of symptoms:

• Predominantly Inattentive Presentation

Individuals with this type often struggle with attention to detail, organisation, and finishing tasks. They may appear forgetful, easily distracted, and have difficulty sustaining attention on tasks. Hyperactivity and impulsivity are typically less pronounced in this subtype.

• Predominantly Hyperactive-Impulsive Presentation

Individuals with this type may fidget, have difficulty staying seated, feel restless, talk excessively, and act on impulses without considering the consequences. Inattention may be present but to a lesser degree than hyperactivity-impulsivity.

• Combined Presentation

Individuals with this type exhibit a combination of inattentive, hyperactive, and impulsive symptoms. They may struggle with focus, organisation, and self-control in various aspects of their lives.

It is important to note that the presentation of ADHD can change over time as symptoms can change over time as well. Symptoms might also look different at older ages.

Causes

The causes of this condition can be genetic or environmental.

1. Genetic causes

It is a neurodevelopmental disorder with a strong genetic component, where several genes have been identified as contributing to a higher risk of an individual developing it.

Some key genetic factors of Attention-Deficit/Hyperactivity Disorder include dopamine-related genes, serotonin-related genes, neurodevelopmental genes, and genetic variations in related neural pathways.

Therefore, the interplay between both genetic and environmental factors will likely determine an individual’s risk of developing the condition.

2. Environmental causes

While genetics play a significant role in the onset, it is important to note that the environment also may contribute to its development.

For instance, prenatal and early childhood exposure to substances including alcohol or tobacco as well as maternal stress during pregnancy or complications during birth may increase the risk of developing ADHD.

Poor nutritional intake and exposure to toxins may also negatively impact a child’s brain development and increase the risk of this disorder.

Stressful, volatile, and dysfunctional family environments, marital conflict, or inconsistent parenting may also be contributing factors.

Brain injury

Brain injuries can complicate the diagnosis of ADHD by causing overlapping symptoms, affecting cognitive function, influencing treatment responses, and other diagnostic challenges.

A comprehensive assessment by a skilled psychologist and allied healthcare team is fundamental to accurately diagnose and address the condition in individuals with a history of brain injury.

Low birth weight

A low birth weight has been shown in research to be associated with a higher risk of developing ADHD. This is due to the low birth weight being linked to disruptions in brain development, specifically in areas that are responsible for attention, impulse control, and executive function, which are the core areas affected by this disorder.

Premature Birth

Similar to low birth weight, premature birth is associated with an increased risk in comparison to a full-term birth.

The immature brain development of preterm infants, particularly in regions responsible for attention, impulse control, and executive function may also be contributing factors for the symptoms later in life.

Exposure to toxins (alcohol, smoking, etc.) during pregnancy

Exposure to toxins during pregnancy can potentially influence the diagnosis in several ways including negatively impacting fetal development.

For instance, increased exposure during the critical periods of brain development in babies, particularly in the first trimester, can disrupt neural pathways and neurotransmitter systems involved in attention, impulse control, and executive function, which are central to ADHD.

Thus, exposure to toxins during pregnancy can influence the diagnosis by increasing the risk of symptoms and complicating the clinical picture with comorbidities which may potentially alter the response to treatment.

Extreme Stress during Pregnancy

Extreme stress during pregnancy can influence the diagnosis by contributing to hormonal imbalances, impaired neurodevelopment, and maternal behaviour.

Psychologists and allied healthcare professionals should therefore consider prenatal stress exposure as a potential risk factor when evaluating children for Attention-Deficit/Hyperactivity Disorder.

A comprehensive psychological assessment of prenatal and early life experiences should be integrated into the diagnostic process.

Diagnosis

To be assessed for Attention-Deficit/Hyperactivity Disorder, whether for an adult or a child, several steps need to be taken.

Now, you will read what this type of assessment looks like in Psychology Blossom.

Comprehensive Adult ADHD Diagnostic Assessment

Our Comprehensive ADHD adult assessment includes an initial consultation which lasts 90 minutes with one of our psychologists.

We first administer the Wechsler Adult Intelligence Test (WAIS) test and the Conners’ Adult ADHD Rating Scales (CAARS) questionnaires for the client to complete.

The CAARS is a set of self-report questionnaires that is designed to allow us to screen for any ADHD symptoms you may be presenting.

We then score the client’s responses to the CAARS, and we then schedule a follow-up 90-minute observer interview (e.g., a family member).

The client then receives a formal diagnostic report which includes a detailed summary of all client consultation notes, observer interviews, and test score results.

The assessment package ends with a 90-minute feedback session for the client to raise any further questions or concerns.

Child ADHD Diagnostic Assessment

Our Comprehensive ADHD child assessments involve a slightly longer process than our adult assessments.

This includes an initial consultation which lasts 80 minutes, with both the child and parents present during the session.

One of our psychologists will then administer two tests called the Wechsler Intelligence Scale for Children (WISC) between the ages of 6-16 and the Wechsler Individual Achievement Test (WIAT).

We also administer the Conners 3 questionnaire, and the BASC-3 Behaviour Assessment System for Children. Scoring of these tests is then completed to screen for ADHD symptoms in the child.

Next, we often send the child’s school a questionnaire to complete, and we can also conduct a school observation of your child as well as a school interview with your child’s teacher.

This is helpful for us to gain a broader and more in-depth understanding from an educational professional’s perspective who observes your child’s behaviour closely and regularly at school.

Finally, a formal diagnostic report will be written which will include a summary of all consultation and school observation notes and test score results.

One of our psychologists may ask the child’s school to complete a questionnaire and conduct an interview with your child’s school teacher. We also offer an optional school observation service if this is of interest.

Once all the responses have been collected and the scoring has been completed for the formal diagnostic report, we deliver a one-hour feedback session and an 80-minute parent support session to complete the assessment.

Please note that the turnaround time for receiving a diagnostic report from our clinic is usually 1-2 weeks.

Treatment

The treatment includes medication, psychotherapy, and behavioural therapies.

Medication

Medications that psychiatrists commonly prescribe for ADHD treatment fall into two main categories: stimulants and non-stimulants.

These medications aim to improve attention, focus, impulse control, and hyperactivity by influencing the neurotransmitter levels in the brain.

It is crucial to note that medication management and dosage prescribed should be tailored based on factors such as symptom severity, coexisting medical conditions, potential side effects that may occur, as well as an individual’s response to medical treatment.

Medication may also be part of a comprehensive treatment plan involving consistent and regular behavioural therapy, psycho-education, and healthy lifestyle modifications from your psychologist and broader healthcare team.

Additionally, it is important for individuals who are prescribed the medication to be monitored regularly and closely by a healthcare provider to assess treatment effectiveness, adjust the dosage if required, and monitor for any adverse effects.

Stimulants

Some examples of stimulant medications prescribed include Methylphenidate (Ritalin, Concerta, Metadate, and Daytrana) and amphetamine-based medications (Adderall, Vyvanse, Dexedrine, and Evekeo).

Nonstimulants

An example of a non-stimulant medication prescribed to treat ADHD symptoms is Atomoxetine (Strattera) which affects the neurotransmitters in the brain.

This medication is often used when stimulants are ineffective due to side effects experienced. Other non-stimulant medications include Guanfacine (Intuniv) and Clonidine (Kapvay) which are used to manage symptoms in individuals with other comorbidities such as insomnia.

Psychotherapy and Behavioural Therapies

Psychotherapy, otherwise known as talk therapy, is often used as part of a comprehensive treatment approach and plan for an ADHD diagnosis.

Some popular therapeutic techniques used to treat persistent symptoms and behaviours of Attention-Deficit/Hyperactivity Disorder include cognitive behavioural therapy (CBT), mindfulness-based therapy as well as social skills training.

While medication is commonly prescribed to manage symptoms, psychotherapy can help individuals develop coping strategies, improve their organisational skills, address emotional challenges, and enhance their self-esteem and quality of life.

Managing ADHD: Staying Healthy and Organised

Role of Diet and Nutrition

Diet and nutrition can play a key role in managing ADHD symptoms, however, the effect of diet on symptoms can vary between individuals.

While there is no one-size-fits-all diet, some general dietary strategies may be beneficial including having a balanced diet, including more protein and omega-3 fatty acids to your diet, reducing food additives, and staying hydrated is important for overall health and cognitive function.

Exercise and Physical Activity

Exercise can provide several benefits by addressing both physical and cognitive aspects of the condition.

These benefits include improved focus and attention, reduced hyperactivity and impulsivity, reduced stress and anxiety levels, improved mood, and better executive functioning skills.

It is important for individuals who have ADHD to find activities that are enjoyable and sustainable so they can stay engaged and motivated to incorporate these activities and exercises into their routines.

Sleep Managament

Managing sleep hygiene is crucial due to sleep difficulties being common among individuals with the condition. It is therefore important for individuals to establish a consistent sleep schedule, create a relaxing wind down sleep routine, limit screen time and use before bed, and manage any stimulant medication.

By implementing these strategies and prioritising healthy sleep habits, individuals with ADHD can improve their overall sleep quality and better manage symptoms during the day.

Technology and Its Impacts

Technology can have both positive and negative effects depending on how it is used and managed.

The positive aspects of technology include individuals using productivity apps and calendars to better manage their time and schedules, using mindfulness apps to calm their hyperactivity symptoms, and social media connections (for e.g., forums for individuals who have ADHD symptoms).

Conversely, the negative aspects of technology involve digital distractions, information overload, screen time hindering sleep hygiene, and potential impulsive risk-taking behaviours.

Therefore, overall, the impact of technology depends on how it is integrated into daily life and managed.

Complementary Therapies

Complementary therapies can be used alongside conventional treatments to help manage the symptoms and improve overall well-being.

These therapies may include behavioural therapy, mindfulness and meditation, exercise, and nutritional therapy.

It is important to note that the effectiveness of complementary therapies for Attention-Deficit/Hyperactivity Disorder can vary from person to person, and not all therapies may be suitable or beneficial for everyone.

Additionally, it’s essential to consult with a qualified healthcare provider before starting any complementary therapy to ensure safety and appropriateness, especially when combining them with conventional treatments.

ADHD in Different Life Stages

In School-Aged Children

It can present differently in school-aged children. Common characteristics may include inattention, hyperactivity, impulsivity, academic challenges, social and behavioural problems both inside and outside the classroom, low frustration tolerance, and variable academic performance.

Additionally, other factors, such as co-existing conditions (e.g., learning disabilities, anxiety, depression) and environmental influences, can impact the manifestation of ADHD symptoms in school-aged children.

It’s important to note that not all children will exhibit the same symptoms or severity of symptoms, and the presentation of the disorder can change over time as children develop and mature.

In Adults

In adults, it can manifest in various ways and may present differently compared to childhood. Common characteristics may include inattention, impulsivity, hyperactivity, executive dysfunction, difficulty with interpersonal relationships, and career challenges.

It is important to note that this condition can be underdiagnosed and undetected in adults, as symptoms may be attributed to other mental health conditions or life circumstances.

How can Parents help their Children with ADHD?

Parents can play a fundamental role in supporting their children by implementing effective strategies and providing consistent support.

Some of these strategies might include educating themselves about the condition and symptoms, establishing a consistent routine, and providing structure and emotional support for their child.

Further, parents can also encourage physical activity and promote better sleep hygiene and a healthier lifestyle in general for their children and themselves.

It is also important for parents to get involved with their children’s progress at school and to collaborate and communicate effectively with their teachers to ensure they are being academically supported.

Every child with ADHD is unique, so it may take time and patience to find the strategies and interventions that work best for your child.

With love, understanding, and consistent support, parents can help their children thrive and reach their full potential.

Conditions Coexisting With Attention-Deficit/Hyperactivity Disorder

Mood disorders

ADHD commonly coexists with several mood disorders, which can complicate diagnosis and treatment.

These may include anxiety, bipolar, disruptive mood dysregulation, oppositional defiant, and seasonal affective disorders.

It’s important to recognize and address coexisting mood disorders, as they can significantly impact functioning and quality of life.

Anxiety disorders

Anxiety disorders, including generalized anxiety disorder (GAD), social anxiety disorder, and panic disorder, often coexist.

The symptoms such as excessive worry, fearfulness, restlessness, and physical symptoms of anxiety, such as muscle tension and difficulty concentrating are shared with the disorders.

Depression

Depression is one of the most common mood disorders that coexists with ADHD.

Symptoms of depression include persistent sadness, feelings of hopelessness, loss of interest in activities, changes in appetite or sleep, and low energy.

These symptoms often overlap with symptoms of Attention-Deficit/Hyperactivity Disorder, making diagnosis and treatment challenging.

Learning disabilities

It can also often coexist with various learning disabilities, which can complicate academic performance and require specialised interventions.

These learning disabilities may include dyslexia, dyscalculia, dysgraphia, auditory processing disorder, nonverbal learning disability, and executive functioning deficits.

Psychiatric disorders

Attention deficit hyperactivity disorder often coexists with various psychiatric disorders, which can complicate diagnosis and treatment.

These may include personality disorders, sleep and substance use disorders, and autism spectrum disorder(ASD).

It’s important to recognize and address coexisting psychiatric disorders as they can significantly impact functioning, quality of life, and treatment outcomes.

A comprehensive evaluation by a qualified healthcare provider is essential for accurate diagnosis and development of a tailored treatment plan that addresses both ADHD and coexisting psychiatric disorders.

ADD vs. ADHD

The terms “ADD” (Attention Deficit Disorder) and “ADHD” (Attention-Deficit/Hyperactivity Disorder) are often used interchangeably, but they refer to slightly different presentations of the same disorder.

In summary, Attention-Deficit/Hyperactivity Disorder encompasses both inattentive and hyperactive/impulsive symptoms, while the term ADD historically referred specifically to the inattentive subtype.

Seek Professional Help at Psychology Blossom

At Psychology Blossom, we offer ADHD assessments for both adults and children.

Depending on which type of assessment you would prefer; we offer a variety of comprehensive assessment packages which you can choose from.

Please contact our clinic for additional information.

Message: +65 8800 0554

Phone: +65 8686 8592

[email protected]

ADHD FAQs