What Is ADHD? Symptoms, Causes, and How It Is Diagnosed

All over the internet, there are splashy posts and videos proclaiming that “if you do __, you might have ADHD!”  While I think most of these come from a place of caring, such as people with ADHD trying to educate others, these posts do leave many confused about what is and is not a symptom of ADHD.  Let’s clear up what ADHD is, how different people might experience ADHD, different diagnoses that might look like ADHD but are not, and what a Bodhi ADHD assessment looks like.

What is ADHD?

For many of us, we have only a vague impression of what ADHD is.  I know that before becoming a clinician, my idea of ADHD was my high school classmates being hyper and not paying attention.  This simplistic view, while common, does not tell the whole story, and it completely leaves out adult experiences with ADHD.  

Starting with the basics and language, ADHD stands for Attention-Deficit/Hyperactivity Disorder.  Some people colloquially refer to it as ADD (attention deficit disorder), but this is actually an older term that has been out of use clinically since the 1980s.  ADHD has three types of presentations: predominantly inattentive, predominantly hyperactive/impulsive, and combined.  As a clinician who does ADHD assessments, I am looking for both symptoms of inattention (difficulty regulating attention) and symptoms of hyperactivity/impulsivity.  Some people with ADHD have symptoms of one type or the other, while some have both.  

Executive Functioning

What helped me best understand ADHD was learning about executive functioning, aka all the self-management skills that are not usually explicitly taught in school but are essential for success.  Executive functioning refers to one’s ability to plan, manage their time, hold information in their mind temporarily/while working with it, stay organized, inhibit impulses, and manage emotions.  In essence, ADHD is a delay in the development of executive functioning skills.  My favorite metaphor for how executive functioning works for folks with ADHD can be found in this YouTube video by How To ADHD (which also is a very good explanation of ADHD in general).  Basically, having ADHD and struggling with executive functioning skills is like being a CEO in a meeting with a secretary who lets everyone (aka potential distractions) into your office regardless of how it will impact your ability to do the tasks you need to do.  Talk about overwhelming!  

https://www.youtube.com/watch?v=jhcn1_qsYmg

Executive functioning skills develop slower for people with ADHD compared to neurotypical (non-ADHD) people, and folks with ADHD have a deficit in certain brain chemicals that allow for their executive functioning systems to function properly.  This means that even if someone with ADHD knows what task they need to do and intends to do it, they might not be able to follow through.  This does not mean that folks with ADHD will never develop executive functioning skills, but it does mean that they might need extra support in managing their time, staying on task, and regulating their behavior.  For some people, this looks like medication, while others might opt for lifestyle changes or external support.  People with ADHD struggling with executive functioning are not lazy, and they are likely just as frustrated by their struggles to focus as the people around them.  

Why a Diagnosis Might be Missed in Childhood

A key feature of ADHD that is essential for diagnosis is that the symptoms begin before the age of 12.  ADHD is a neurodevelopmental disorder, meaning that it begins in childhood and has a strong genetic component.  Symptoms do not suddenly emerge later in life, although it is possible that symptoms become more noticeable later once demand exceeds capacity and a person is no longer able to manage their symptoms without support.  However, not everyone with ADHD is diagnosed during childhood, which is why so many adults seek an ADHD diagnosis.  Given that ADHD symptoms start in childhood, when I am doing an ADHD assessment with an adult, I am asking them a lot of questions about both internal and external symptoms they experienced when they were a kid in addition to their current experiences.  Since my background is in the American K-12 special education system, I know that the kids most likely to be identified as having ADHD by the schools are those who display external behaviors that are disruptive.  The kids who struggle with impulse control and hyperactivity are going to cause problems for a K-12 teacher, so they are more likely to be referred to special education and identified as having ADHD.  Coincidentally, this might be why our stereotypical picture of ADHD is a little kid (most likely a boy) bouncing off the walls and not paying attention.  

This leaves out all the kids whose ADHD presents differently.  Remember, there are multiple types of ADHD.  Some people are predominantly inattentive, some are predominantly hyperactive/impulsive, and some have combined symptoms.  Kids who are predominantly inattentive likely will not be as disruptive to the adults around them.  In the context of school, these kids may or may not be noticed depending on the severity of the symptoms and if the symptoms are negatively impacting the child’s education.  An inattentive child who receives a large amount of organizational and time management support from parents, for example, might not be identified by the school as having any problems.  Many children develop compensatory strategies to help them manage their ADHD symptoms, or the external support they have from parents or the school structure itself minimize the impact of their symptoms.  

For girls in particular, ADHD can present differently and be harder to recognize, leading to later diagnoses.  This is because girls tend to more often exhibit inattention, which can look like being easily distracted, having difficulty remaining focused, or having trouble staying organized.  While girls can and do experience the hyperactive/impulsive type of ADHD, it can show up differently (i.e. excessive talking) or the child might experience more social pressure to mask or hide their symptoms.  A quick article summarizing the gender differences in ADHD diagnoses in children can be found HERE. 

Other Conditions

What are some other mental health conditions that might look like ADHD but are not?  The biggest one that I personally run into with clients is post-traumatic stress disorder, or PTSD.  When someone has experienced trauma, it is more difficult for them to use their executive functioning skills.  Their threat response system is constantly scanning their environment for danger, which makes things like attention, focus, impulse control, and emotional regulation more difficult.  This can be even more of a struggle for folks who have experienced complex trauma, meaning trauma that was ongoing, especially if the complex trauma occurred in childhood.  When I am doing an ADHD assessment with people, I ask a lot of questions about when ADHD symptoms began in order to determine if they started before the traumatic event or only started after the traumatic event.  For clients with complex trauma from childhood, this is difficult to determine and requires a more detailed assessment.  Working with a skilled clinician can help people with trauma in their backgrounds to determine if they have ADHD or not.  

It is worth noting that there are certain medical conditions that can cause symptoms that resemble ADHD symptoms.  Some of these include hypothyroidism, insomnia, and certain types of seizures.  Talking with your doctor about possible ADHD symptoms is a good place to start, especially if you struggle with any of the listed conditions.  

Bodhi ADHD Assessments

What does an ADHD assessment at Bodhi look like?  I typically start by doing a free, virtual consultation with clients to get an idea of what symptoms they are experiencing.  The assessment itself includes a rating scale, a diagnostic interview, and taking the client’s history.  This can take a few sessions to complete and must be done in-person.  I also like to get information from other people in the client’s life (with their permission of course).  If the client has previous evaluations or school reports, they are encouraged to share those as well.  I want to be as thorough as possible since an ADHD assessment is complicated.  If you are interested in learning more, please reach out to schedule a free consultation today!