ADHD in Children, Adults, and Seniors: A Deeper Look (Part 1 of 3)

You are probably familiar with the term ADHD (Attention Deficit and Hyperactivity Disorder). But not everyone with ADHD is hyperactive. In fact, ADHD can be a misleading term. Depending on which parts of the brain are affected, ADHD is currently diagnosed in three different forms:

1. The predominantly inattentive type, commonly referred to as ADD (Attention Deficit Disorder).
2. The predominantly hyperactive-impulsive type.
3. The combined inattentive and hyperactive/impulsive type.

ADHD in a Nutshell

ADHD is a condition that can affect children, adults and seniors. It is theorized to be anchored in a hypersensitive nature to exterior stimuli and an inability to efficiently differentiate between irrelevant and essential stimuli, which is necessary to complete tasks and engage with others in a relevant and productive manner (Blum et al. 2008). The effects of this faulty filtering system can usually be narrowed down to four aspects of cognitive ability:

1. Selective attention
2. Sustained attention
3. Impulse control
4. Psychomotor activity.

Selective attention allows us to direct our attention effectively. Poor selective attention, stemming from the brain’s inability to prioritize incoming information and zone in on relevant elements, can lead to lack of attention to detail, making careless mistakes, being easily distracted and forgetful, misplacing things, and getting distracted by inner thoughts when others are speaking.

Sustained attention allows us to concentrate for longer amounts of time and solve problems at hand. The inability to maintain focus due to being highly distractible may lead to difficulty completing long, and/or tedious tasks and reading for long periods of time.

Impulse control allows us to measure our reactions and their timing. Issues stemming from impulsivity can range from interrupting others and speaking too quickly to making rash decisions before all information has been collected and properly understood.

Psychomotor activity determines the speed at which we think and move, and an excess in psychomotor activity is often reflected by hyperactive speech or behaviors. Hyperactivity can lead to bouts of excessive talking, restlessness, and impatience as well as the inability to quiet the mind and/or partake in slower-paced activities, such as meditation.

Real-Life Challenges of ADHD

Issues with attention most often come to light when difficulties with schoolwork, work duties, or household chores arise. Symptoms include:

• Difficulty with organization, which can lead to feeling scattered and easily overwhelmed.
• Being easily distracted by internal thoughts or exterior stimuli to the point of frequently making careless mistakes when completing tasks.
• Getting lost in personal thoughts/daydreaming when being spoken to by teachers, colleagues or loved ones.
• Feeling forgetful.
• Difficulty maintaining attention on more lengthy activities (e.g., paying attention in the classroom, watching a movie).
• Having a tendency to procrastinate, to avoid, or to strongly dislike engaging in lengthy, tedious tasks that require sustained concentration (e.g., writing a long essay or a bibliography, counting inventory, filing taxes, folding and putting away laundry).
• Difficulty finishing projects due to getting side-tracked.
• Hyperactivity-impulsivity issues can occur independently, but often accompany and exacerbate issues with concentration; when both inattentive and hyperactivity-impulsivity symptoms are present, basic day-to-day functionality and the quality of relationships can be very severely impaired.

Symptoms of hyperactivity-impulsivity include:

• Feeling restless, which leads to fidgeting and not being able to remain seated when expected.
• Difficulty participating quietly in leisure activities (e.g., watching a movie) or playing more intricate games with others.
• Feeling “on the go,” as if “driven by a motor,” even when feeling drained.
• Bouts of excessive talking.
• Difficulty “waiting” in line or interrupting others, finishing other people’s sentences, or pre-emptively blurting out answers to questions being asked.

Diagnosing ADHD

It is important to note that the diagnosis of ADHD can only happen after many other disorders have carefully been ruled out, as several symptoms of ADHD, depression, anxiety, substance abuse and bipolar mania overlap. For instance, a person experiencing an episode of mania may also talk excessively, suffer from distractibility, be quick-tempered and impatient, impulsive and restless.  However, unlike a person with ADHD experiencing the same symptoms, the person experiencing the manic episode would not benefit from ADHD medication, which may worsen their condition. Similarly, someone who experiences bothersome anxiety may feel scattered, overwhelmed, fidgety, restless, and have difficulty making decisions, and persons experiencing depression may experience strong feelings of ambivalence, foggy thinking, forgetfulness, and difficulty initiating and completing tasks (ADHD conference 2017). Since persons affected by ADHD can also experience these conditions, a careful evaluation is crucial to determine the etiology of individual symptoms and proper treatment.

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 What’s next in our series on ADHD:

Part two: Neurobiology of ADHD and Comorbidities

Part three: ADHD Treatments

About the Center of Excellence in Co-Occurring Medicine:

The Center of Excellence in Co-Occurring Medicine is an outpatient clinic in Beaverton, Oregon, that offers expert, compassionate psychiatric care and substance abuse treatment.

About Esther Gabrielle Rosengarten, PMHNP-BC:

Ms. Rosengarten is Director of Clinical Operations at the Center of Excellence in Co-Occurring Medicine. She is a Psychiatric and Mental Health Nurse Practitioner with a long history of leadership in behavioral health and clinical practice, which reflects a deep commitment to the well-being of her patients. Prior to joining the Center of Excellence, Ms. Rosengarten served as Chief of Behavioral Health at Harvard Vanguard Medical Associates in the greater Boston area.