Recognize ADHD early for the best treatment outcomes

Does your child--or do you--have trouble staying focused, sitting still, or organizing tasks for school or work? If so, then you might want to consult a mental health specialist about attention-deficit/hyperactivity disorder, or ADHD.

ADHD is one of the most common neurodevelopmental disorders in children and also affects many adults, according to psychiatric nurse practitioner Matthew James Tirelli, MSN. “ADHD affects about 11% of school-age children and is more commonly diagnosed in biologically male than biologically female children,” Tirelli says. “The current U.S. prevalence for adults with ADHD is between 2.5% and 4.4%, depending on the study.”

Because many ADHD symptoms--difficulty staying still for long periods of time, short attention span, and disruptiveness in the classroom--are common in young children, and because the term ‘ADHD’ is casually used to describe anyone who has some inattention or hyperactivity, many people assume that the condition is over- or inappropriately diagnosed, Tirelli says. “To meet a diagnosis of ADHD, a person must have impairment in two or more domains of their life, such as school, home or community setting,” he explains. “Recently, a lot of adults have found videos describing symptoms of ADHD on Tiktok and have used this to inquire about a possible diagnosis in themselves,” he adds. “While Tiktok has increased both valuable information and misinformation, I always encourage my patients to bring their concerns to me for verification or validation.”

Symptoms of ADHD may include:

• Frequent daydreaming
• Forgetting or losing things often
• Squirming or fidgeting
• Talking too much
• Making careless mistakes
• Taking unnecessary risks
• Inability to resist temptation
• Trouble taking turns
• Difficulty getting along with others

Although ADHD in children can develop into a lifelong condition, research suggests that adequately treating it with psychiatric medication can decrease the likelihood that it will persist into adulthood, Tirelli says. “In general, we see that about 50% of people ‘grow out’ of ADHD, while another 25% might have symptoms but don’t necessarily need treatment into adulthood,” he says.

Categories of ADHD

ADHD falls into three categories: inattentive, hyperactive-impulsive, and combined. Individuals with inattentive ADHD have trouble organizing or finishing tasks, paying attention to details, or following instructions or conversations. They are easily distracted or forget details of daily routines.

Those with hyperactive-impulsive ADHD fidget with or tap their hands or feet, squirm in their seat, and talk a lot, often out of turn. They can’t sit still for meals or homework. Smaller children may constantly run, jump, or climb. People with hyperactive-impulsive ADHD feel restless and behave impulsively, sometimes interrupting or grabbing things from others. They have trouble waiting their turn or listening to directions. Not surprisingly, they are more prone than others to accidents and injuries. People with combined ADHD have equal amounts of both types of symptoms, whose presentation may change over time.

Because other disorders — including anxiety disorder, depression, oppositional defiant disorder, and learning disorders — can mimic ADHD, recognizing and treating the condition early are key to positive outcomes.

Causes of ADHD

Studies have yet to identify the specific causes of ADHD. There is no evidence that eating too much sugar, watching too much television, poor parenting, or social and environmental factors such as poverty or family chaos cause it, although they might make it worse.

Genetics may play a role, however. “ADHD is one of the most heritable psychiatric conditions and often runs in families,” Tirelli says. “Siblings have twice the risk of having ADHD than the general population, (e.g., if one sibling has ADHD, then chances are good that another sibling will have it too).

Indeed, without identification and treatment, ADHD may lead to substance abuse, delinquency, anxiety, depression, and academic and job-related problems. “ADHD symptoms can be exacerbated by not taking care of oneself (good sleep, appetite, not exercising, substance use),” Tirelli says. “Symptoms can also be more impactful when people are in environments that are not well-suited for their individual needs.”

Treatments for ADHD

The best treatments include a combination of behavior therapy and medication. “Behavioral modification techniques can include organizational and time management skills,” Tirelli says. Extra time on tests and assignments, working in a quiet and distraction-free location, and using mindfulness skills in moments of distraction can also help, he adds. “Psychostimulant medication can be extremely helpful for individuals with ADHD, and studies show that adequately treating it decreases teenager impulsivity (not wearing seatbelts or reckless driving for example) and substance use.”

The Weill Cornell Psychiatry Specialty Center has faculty who specialize in the diagnosis and evidence-based treatment of ADHD. Its clinicians tailor treatment to the unique needs of each individual child and family following a comprehensive evaluation, which contains a careful history and clinical assessment of an individual’s academic, social, and emotional functioning, and developmental level. Treatments may include pharmacotherapy, behavioral therapy, and parent education and support. Says Tirelli, “As providers, we work with our clients to figure out a treatment plan that aligns best with their individual values and needs.”