Attention-Deficit/Hyperactivity Disorder (ADHD) is a diagnosis characterized by difficulty focusing one’s attention and controlling one’s impulses. In children, this often manifests as talking too much, difficulty sitting still, interrupting others, and difficulty waiting in lines. However, children with the “inattentive type” often present with less obvious symptoms. These can include difficulty staying on task or completing assignments due to “day dreaming” or being easily distracted by things their environment. It also can present with poor organization and avoidance of things that require sustained attention. Parents often tell me that they have to repeat things to their child numerous times before it “sinks in.” In my experience, children (especially girls) with the inattentive type often go undiagnosed until late high school or college. These individuals frequently come to their first appointment with issues related to depression and anxiety. However, when I dig deeper into the root of the problem, there is a universal sense that they have been under-performing their entire life, despite their best efforts. They often describe low self-esteem or anxiety, because frequently forgetting things or making careless mistakes has resulted in them doubting themselves. In these patients, their mood and anxiety often improve significantly once they are started on the proper medication.
Q1. What is it like to have ADHD?
A1. The metaphor I like to use is this: Imagine you’re in the electronics section of Best Buy (or Target, etc.) and you’re looking at that big wall of TV’s. You’re trying to watch what’s on just one of the TV’s, but all of them are on different channels and have the volume blasting. Anyone would have a hard time comprehending what they’re watching. With medication, it’s like you’re giving the person the remote control and allowing them to mute all of the other TV’s. And if they decide they want to watching something else, they can mute that one and turn the volume back up on another TV.
Q2. Do I have to take medication?
A2. Of course not. That’s a decision everyone has to make for themselves. There is some evidence that certain types of therapy can help people manage the symptoms. However, in my experience, even with therapy, people with ADHD still struggle to stay on task and to remember all of their day-to-day responsibilities. Often, people with ADHD gravitate toward jobs or hobbies that don’t require them to focus for long periods of time. If that’s the case, most often those individuals decide not to go on medication. However, I also know many professionals, including other doctors, who have ADHD and continue to take medication well into adulthood. There is also some flexibility with dosing. Since the benefits of the most common ADHD medications only last for 4-10 hours (immediate-release vs. extended-release), many people decide not to take it on the weekends, holidays, or days where they know they don’t have any important responsibilities.
Q3. Is the medication addictive?
A3. Medications like methylphenidate (Ritalin/Concerta), amphetamine salts (Adderall/Mydayis), and Vyvanse are in the class that we call stimulants. They are DEA controlled medications and do carry a risk of addiction. However, in my experience, I’ve never had a patient who I genuinely believed had ADHD who ended up becoming “addicted” to the medication or abused the medication. However, if someone were to repeatedly take more than is prescribed or took it via routes that are inappropriate (ex snorting), then I expect their risk of addiction would increase.
Q4. My kid has many of the symptoms you described, but they can sit for hours playing video games without moving. Does that mean they don’t have ADHD?
A4. It’s actually fairly common for parents to see this with ADHD. One of the areas of the brain that is affected in ADHD is the pleasure/reward center of the brain (aka nucleus accumbens). In these individuals, the threshold to experience joy/pleasure is somewhat higher than people without it. This is why it is difficult for them to delay gratification and why they are often thrill seeking and impulsive. When they play video games, they are rapidly defeating enemies, crossing gaps, or completing other small accomplishments, all of which activate that pleasure center. Because of this, video games are often one of the only thing that hold kids with ADHD’s attention. It’s also way many people with ADHD self-medicate with drugs and alcohol and describe feeling numb, apathetic, or bored when they don’t have much variation in their daily routine.
If you have any additional questions about ADHD or its treatment, feel free to comment below and I will add revisions to this blog post.