ADHD 101: What (actually) is ADHD?

[This is the first in a three-part series about ADHD in the modern child.]

Welcome! You’re here with a question that every parent has probably pondered about their child(ren). When they haven’t put their socks on after 20 minutes of reminding, when he can’t seem to focus on schoolwork, when she fiddles constantly, or even the infamous “bouncing off the walls” scenario. Children are little balls of energy and curiosity that seem to drive us to our wit’s end. (Hey, I get it, I’m a parent.) It’s good thing we love these tiny humans so much!

It seems you’re taking this question pretty seriously since you turned to some research for help. Good for you! Here’s the thing, ADHD is simultaneously over-diagnosed but also truly on the rise. Thanks, complex world. The CDC reports that in 2016, “about 9.4% of children ages 2-17 had ever been diagnosed with ADHD.” (almost ONE in TEN?!) and yet the number of children diagnosed with it at any one time is closer to 5%, which means about half of these kids receive a diagnosis of ADHD, only to have it abandoned later! What?! 

Well let me take you to a neurology class for moment. (Not really, but kind of. I promise it’ll help!) ADHD is an under-functioning of the prefrontal cortex, the part of your brain you are punishing when you literally facepalm. It is responsible for “executive function” which means logic, impulse control, focus, reflection, and complex cause and effect analysis. But here’s the thing, that part of the brain is the last to develop (it doesn’t finish until your 20s!) AND is the highest order of functioning. That’s a fancy way of saying that all other conditions of development, physical safety, and relational security have to be met before this thing starts firing on all cylinders! That’s why it’s so hard to focus when you’re under a lot of stress.

Okay, so let’s talk diagnosis. ADHD is diagnosed as one of 3 core types:

ADHD- inattentive type

ADHD- hyperactive/impulsive type

ADHD- combined type

So whether your child has difficulty focusing only, constant movement/lack of judgement only, or both, there’s an app category for that. So, what are the criterion?

Essentially the diagnostic manual (DSM5) says that a child must demonstrate at least 6 of the given criteria to be diagnosed. The criterion can be found here, but suffice to say that for inattentive type, it asks if the child struggles to listen to directions and/or complete tasks in 9 similar ways. For hyperactive/impulsive type, it lists 9 different examples of constantly moving and acting out whatever comes to their mind. I paraphrased, obviously. In fairness, it’s not hard to see why a doctor will ask a simple series of questions and quickly arrive at a diagnosis; it’s not a complex set of criterion. Thus many children receive the label rather haphazardly. But diagnosing any child with any disorder should be more than a few simple questions. Many factors shape who we are, so these factors need to be taken into account. So that’s where we are headed next.

Way to go! You have a good foundation for understanding ADHD and brain function. Keep reading to understand what could be masquerading as ADHD, a process of discovery we call “differential diagnosis” here.