What Is Attention Deficit Hyperactivity Disorder & How Can ADHD Be Treated?

There is a lot of confusion and misinformation about ADHD.

Some of the most common online claims aim to discredit the condition. They diminish the impact it has on those diagnosed with ADHD, saying it creates inconvenience but nothing life-threatening. 

Others go even further, sharing suspicions that ADHD is not a real condition but a temporary impairment created by social media addiction or just an excuse for people's laziness, irresponsibility, recklessness, and lack of discipline. 

This couldn't be further from the truth.

ADHD is a very real and serious serious mental health disorder with symptoms that significantly impact the everyday lives of people who have the condition. This is not an opinion but a factual statement supported by hundreds of studies.

The symptoms are even more severe for those who remain undiagnosed because they lack therapy, medical guidance, and clarity on what coping mechanisms to use. This is why getting an official diagnosis and receiving more information about ADHD is essential.

If you have even a faint suspicion of having ADHD, then it is worth listening to your hunch and considering the possibility. To help with that, below, you will receive a comprehensive review of ADHD, the most common symptoms, and how to evaluate them.

Undiagnosed ADHD - Feeling Different But Unable To Explain How 

Undiagnosed ADHD feels like you have to constantly mask and compensate for a problem you don't understand. This problem is often attributed to a personality defect, like laziness or intellectual inferiority to other people. 

It feels as if there is something fundamentally wrong with you that you can't change, no matter what. It's an enigma that makes you feel different in ways you can't describe. Even if you are successful, you are still very likely to feel like an imposter. 

How else can you explain the fact that one day, you focus for 8 hours straight on a project, and the next, you can't get started? Why do you forget important upcoming events or crucial information others give you? What makes you sit down to do work at the very last moment even though you know you must start earlier? 

Maybe you are an alien hidden in human flesh. How you connect with others, formulate your thoughts, come up with solutions, find motivation, or build systems feels totally different. No matter how much success you have, it doesn't feel right. No matter how well you fit, it doesn't feel like you fit the way you are supposed to fit. 

Perhaps you are not an alien. You are just a human who struggles a lot. You can never put your finger on it, but it seems it takes you three times more effort and energy to do certain tasks than your friends. If life is a video game, then someone switched your settings to 'hard mode' and shoved you in the simulation. 

If any of this sounds relatable and your intuition about a hidden problem has grown ever stronger, then read on as we explore what ADHD actually looks like.

What Is ADHD?

ADHD, or attention deficit hyperactivity disorder, is a mental health condition that disrupts the ability to pay attention, reduces control of impulses and emotions, and impairs cognitive function in various ways (1)

The condition is almost entirely genetic. The person is born into it and remains with ADHD for the rest of their life. It runs in the family, which means if one or two parents have ADHD, then the chance for their child to have it is significantly higher. 

However, there are cases where new genetic mutations occur spontaneously in the sperm and egg cells of your parents (de novo cases). The latter is a minority of cases and hasn’t been explored fully yet. 

Another small minority of cases happens due to brain injuries that create permanent brain damage or disruption in the typical growth of various brain regions, like the prefrontal cortex. Physical injury, or poisoning from lead, alcohol, and other neurotoxic chemicals are common examples of causes for brain damage.

This damage can happen before birth, very early in childhood, or even into adulthood. Those cases are called acquired ADHD because the person wasn’t genetically predisposed enough for ADHD, or genes alone were not enough to have symptoms without the injury. 

Since most cases of ADHD have a very strong genetic component,  the brain differences are permanent and irreversible. Contrary to popular belief, children can't outgrow ADHD. Still, people diagnosed as children may experience changes in how intense and persistent certain symptoms become compared to others when they grow into adults. 

For example, as a child, you may struggle with external hyperactivity, which comes with physical restlessness. However, in adulthood, you may find it more challenging to cope with internal hyperactivity, like racing thoughts, anxiety, and inability to shut off your brain. 

ADHD Symptoms 

Having ADHD can feel like you are always carrying a huge backpack because many of the symptoms you experience can create challenges and problems. 

ADHD symptoms:

1. Intense craving for stimulation - People with ADHD crave stimulation more than neurotypical people. As a result, ADHD brains struggle with discipline, willpower, and mental persistence. Even if you rationally know what ought to be done, the brain inevitably drifts toward what creates the most quick and intense dopamine spikes, making boring tasks without an immediate benefit hard to begin and sustain (5)

2. Executive dysfunction - Executive function deficits affect a person's ability to get started, organize, prioritize the right tasks, self-regulate, have an awareness of time, and sustain effort on a task. It's not a lack of intelligence, ability, and resources but the lack of mental skills required to take productive action that turns potential into actual results in the real world (6)

3. Inattention & Distractability - ADHD brains have an issue with attention regulation and consistency. People with ADHD can not resist the urge to pay attention to something else that they suddenly see, hear, or think of, which distracts them from what they should be doing. Zoning out and drifting to other activities is much more likely if what you should be focusing on is boring and not stimulating (7)

4. Hyperactivity - This can be both external and internal. External hyperactivity means constantly fidgeting, tapping, talking, or moving around due to restlessness. Internal hyperactivity can mean anxiety and feeling overwhelmed, multiple racing thoughts at once, and a lack of ability to shut off your brain when you need to focus on a task (7)

5.  Impulsivity - There's no moment of delay between an event and the response that follows. When something happens, ADHD brains don't consider the pros and cons of a decision but just act based on impulse. You don't choose freely and think of the implications but are left to observe the consequences after acting automatically (7)

6. Emotional dysregulation - People with ADHD struggle to stop and moderate powerful emotions and substitute them with emotions that are milder and more controlled. The ADHD brain also struggles to re-interpret emotions to better cope with intense feelings and to effectively acknowledge and let go of painful emotions that may be weighing you down.

7.  Decision-making dominated by intrinsic motivation - ADHD brains don't work based on importance, rewards, and consequences. Intrinsically fulfilling experiences - urgent, done as a selfless duty toward someone else, intellectually stimulating, emotionally engaging, novel, interesting, exciting, and done in a competitive environment - are much more desirable. The desire for enjoyment often overrides the ability to prioritize based on actual importance (8) 

The Negative Impact of ADHD

Having ADHD is not a joke.

Don't be fooled by trends for romanticization of mental health disorders, claims that give you quirky personality traits, or misleading information about the ADHD "superpowers" you may have. 

Here are a few startling statistics to remember as we dive deeper into the symptoms of the condition:

1. ADHD can reduce total lifespan - According to research by Columbia University, having ADHD increases the risk of self-reported vehicle crashes by up to 74 percent. Furthermore, studies by Russell Barkley suggest that ADHD symptoms, like lack of self-control, impulsivity, forgetfulness, and under-stimulation, can reduce the average lifespan by as much as 13 years, making it a bigger health hazard than high cholesterol, tobacco, alcohol abuse, or obesity (2)

2. ADHD increases the chance for co-occurring mental health disorders - Studies show that adults with ADHD have a much higher chance of developing mood disorders, anxiety disorders, and various types of depressive disorders (3)

3. ADHD can lead to a higher risk of substance abuse - The constant craving for stimulation pushes many people with ADHD towards substance abuse in a dire bid for pleasure, thrill, and novelty. People with ADHD have a much higher chance than neurotypical people of developing substance abuse disorders with alcohol, nicotine, marijuana, cocaine, and other substances (4)

4. ADHD can cause difficulties in your career - Issues with time management, concentration, discipline, organization, and other common symptoms can make you less productive, making you make careless mistakes, fall behind, and struggle to keep up with peers. If you are a higher-risk asset than other employees, you are first on the chopping block during layoffs.

5. ADHD increases the chance for conflict and issues in relationships - Being highly impulsive, forgetful, and all over the place doesn't always go well in a relationship. Furthermore, ADHD often comes with emotional baggage and issues with emotional control and regulation, which can lead to or exacerbate tension and conflict. 

I know that looking at all those negative statistics can be a lot to swallow at once, but it’s better to know just how severe ADHD can be and take it seriously instead of falling into the trap of downplaying its effect on your life. 

ADHD And Common Comorbidities

We briefly touched on the connection between ADHD and other mental illnesses, but let’s get more specific because this is a very underlooked issue. 

A staggering 60% of children diagnosed with ADHD have a co-existing diagnosis of another mental health disorder. Among this group, 33% of children have one co-existing condition, 16% have two, and 18% have three or more. Common among those co-occurring mental health disorders are:

1. Anxiety disorders - Anxiety and ADHD feed off one another. Struggling to fit in can make you question what’s wrong with you and what you can do better. Being hyperactive makes anxiety worse because you have countless racing thoughts overwhelming you at any given moment. Getting anxious and stressed is often necessary to get work done because you can only get started at the very last moments while riding a wave of adrenaline and cortisol. For any ADHD symptom that can make life harder, you can make a plausible connection with increased anxiety levels.

2. Autism - Between 40 and 70 percent of people diagnosed with autism have comorbid ADHD. Inversely, around 20 percent of people diagnosed with ADHD have autism. Both conditions share common symptoms, like executive dysfunction, hyperfocus on special interests and highly stimulating activities, emotional dysregulation, etc. Even if there is some overlap in the symptoms, both neurodevelopmental conditions have characteristics that can make you feel like your brain is constantly fighting itself. For example, your ADHD makes you suffocated in structures, but your ASD needs it to function (thrives on order but rebels against routine), you are excited to go outside for novel experiences, but ASD leads to sensory overload and overwhelms whenever you go into unfamiliar environments, or you feel simultaneously under-stimulated and over-stimulated in certain environments. Both conditions can also “cancel out” some symptoms. For instance, ASD makes you more socially anxious and awkward, but your ADHD makes it easier to be chatty about your interests, impulsively approach people, or quickly make bonds through over-sharing. 

3. OCPD - Obsessive-Compulsive Personality Disorder is a condition characterized by an obsession for control, proper organization, perfectionism, and a desire to see things "the way they should be”. It commonly overlaps with ADHD, but the underlying cause is not clear yet. It’s possible that struggling to organize yourself and keep everything together creates an extreme need for perfectionism or adverse experiences in your childhood tied to ADHD trigger OCPD.

4. Bipolar - A bipolar diagnosis is 11 times more likely for a person diagnosed with ADHD and 30 times more likely for a person who has both ADHD and an anxiety disorder. Although the exact cause for the connection remains unclear, common issues with emotional dysregulation could be the reason for the overlap since both conditions have symptoms that lead to mood swings, large fluctuations in energy levels, and impulsivity.

5. Substance abuse and addiction - Numerous studies have shown a clear connection between having ADHD and using various dangerous substances (alcohol, weed, nicotine, hard drugs, etc) as a coping mechanism. Taking substances can temporarily compensate for inattention, under-stimulation, anxiety, and other painful ADHD symptoms. Since ADHD’ers struggle with time blindness (hard to calculate long-term consequences), differences in motivation (feeling stimulated at the moment takes priority over importance), and impaired impulse control, experimenting can quickly turn into dependence or serious addiction.

6. Complex Trauma - Sometimes, clinicians find it hard to tell the difference between ADHD and complex trauma because they affect similar brain regions and lead to similar symptoms. It’s especially hard to say what causes what when you are diagnosed with both conditions. One potential difference is that ADHD appears very early in childhood before any traumatic experiences, but complex trauma due to childhood abuse and negligence can make your ADHD symptoms worse. In some cases, having ADHD early in life can lead to highly stressful situations that cause complex trauma because you feel chronic guilt and shame, along with an intense sense of alienation and isolation.

Common Misconceptions And Misinformation About ADHD 

ADHD is a neurodevelopmental condition that leads to a very specific subset of symptoms. Unfortunately, despite the scientific literature being very clear on the existence of ADHD, there are many misguided and unscientific theories that seek to discreet its existence. 

For example, certain nutrient deficiencies may exacerbate ADHD symptoms, but fixing your diet won't cure your condition. 

ADHD is not a sign of a magnesium, zinc, iron, or B12 deficiency. Severe malnourishment, movement, and adequate sleep can mimic ADHD symptoms, but that doesn’t explain why there are millions of people with stellar blood work and healthy lifestyle habits who continue to have ADHD.

Furthermore, spending a lot of time on social media and the internet can worsen the symptoms of ADHD, but the condition has been reported in scientific journals way before modern technologies became an issue. Similar to the previous myth, those who spread such theories make the logical fallacy of assuming that a factor contributing to worse ADHD symptoms is the root cause behind the condition. 

Those examples are some of the most extreme ways of avoiding what science says. However, sometimes people get genuinely confused because they suffer from PTSD, severe depression, and crippling anxiety and have many symptoms that feel similar to having attention deficit and hyperactivity syndrome. 

This happens because many other mental health disorders have some symptoms that are similar to those of ADHD. Still, that doesn’t mean they are the same. It’s just that many mental health disorders impair and disturb the same brain regions, so symptoms overlap. 

It can seem tempting to believe that “ADHD is just a trauma response,” but that’s a gross over-simplification that’s simply not true. In a small fraction of instances, ADHD symptoms may actually be a response to severe and unprocessed trauma. However, this is the exception, not the rule. 

In some people, it’s not one condition (PTSD) or the other (ADHD). Those cases happen due to co-occurring mental health disorders. The problem is that ADHD symptoms could be significantly contributing to the formation of a second mental health disorder, which ends up being easier to diagnose. So, the physicians treat the symptoms but not the root cause. 

In ideal circumstances, this dual diagnosis (comorbidity) dilemma is usually resolved through trial and error in treatment that ends with the mental health professionals reaching the conclusion that it could be nothing else but ADHD. 

For example, if you have a patient who suffers from extreme anxiety that brings overwhelming racing thoughts, you’d administer anxiety medications, therapy, and other science-based treatments. 

However, if they remain resistant to all treatments, you can explore other hidden conditions, like undiagnosed ADHD. As you will see below, ADHD impairs emotional control and increases internal hyperactivity (racing thoughts), so those two symptoms can appear as a classic case of anxiety on the surface. When an anxiety disorder is not seen as the root cause anymore, the patient can get diagnosed with ADHD and get the right treatment. 

This illustration may seem like a very rare exception, but cases where ADHD symptoms are misdiagnosed as side effects of another mental health disorder are very common. For instance, many women who suffer from both depression and ADHD but get treated only for depression don’t see significant improvements because their ADHD remains unaddressed.

This is why there is a whole term called “the lost generation” that describes several generations of women who had symptoms of ADHD but got treated for anxiety, depression, and trauma because back then, the research and diagnosis for ADHD were almost entirely centered on men.

How Symptoms Differ - The Different ADHD Presentations

For far too long, when people thought of ADHD, they envisioned images of hyperactive boys driving teachers mad in school and drawing huge crowds due to their jester tricks and mischief. 

However, the loudest and most visible instances of ADHD don’t tell the full picture of the condition. They hide the girls staring through the window while zoning out, and the boys with social anxiety who bring out their impulsive urges by biting their nails and picking at their skin. 

Not all people with ADHD experience the same symptoms to the same degree. ADHD has sub-types, which are divided based on which core symptoms dominate. To be even more accurate, those are presentations because your dominant symptoms in one phase of life may differ from another.

The three presentations are inattentive, hyperactive-impulsive, or a combination of both, with combined being the most common at around 75% of cases (9)

A person with inattentive ADHD is more likely to struggle with zoning out, excessive daydreaming, spacing out, procrastination, and inability to concentrate and find motivation. It feels as though you are permanently out of tune with the world and somewhat detached from yourself and others. 

In contrast, a person with hyperactive ADHD will likely struggle more with an inability to stay in one place, constant fidgeting, highly spontaneous and impulsive decisions, etc. 

Hyperactivity can also be internal, meaning you struggle with anxiety and chronic stress because your thoughts are always racing in your mind, and you can't stop thinking, feeling, and craving to do something. Staying still, physically and mentally, feels not only boring but painful.

Both can and will most likely experience all symptoms of ADHD, but some symptoms will be much more severe and noticeable than others based on which type of condition they have.

How to Evaluate ADHD Symptoms

You probably see a few obvious problems with the DSM-5 testing. 

First, the wording is heavily focused on children, including environments (school) that are totally unrelatable to adults. Second, the DSM-5 focuses too much on one set of symptoms (hyperactivity) and pays very little attention to properly wording other major symptoms (impulsivity, motivation differences, lack of emotional self-control, and others). Third, many of the symptoms were worded with boys in mind, not girls. 

If you decide to get officially tested, alongside an assessment of symptoms, you may also be asked to give documentation of past adverse events that may be related to your ADHD. The clinician will also try to reach out to family and friends to get multiple perspectives on how you present yourself in everyday life. 

There are other evaluations for ADHD as well, like IQ testing and executive function testing. The problem is that such tests have a very high rate of giving false results. This is because many people with ADHD have average or above-average intelligence, and a basic executive function test is nothing like the mental skills you need to use in your everyday life. 

If you are curious to learn more about the current flaws in the DSM-5 symptom list and popular methods of testing (IQ and EF testing), then the best place to start is this lecture. It’s given by Russell Barkley, the leading expert on ADHD in the US and one of the best in the world. He’s a retired clinical neuropsychologist who has been studying ADHD for 50+ years. 

In the meantime, let’s examine the way you should evaluate your symptoms. No matter the exact wording and phrasing, ADHD symptoms must fit within a set of criteria before you can get a clinical diagnosis.    

The Intensity of Symptoms

Everyone gets bored, procrastinates, and can't focus on a task from time to time. However, ADHD is a disorder, which means the person with the condition experiences the symptoms so intensely that it causes chaos and disrupts their daily life.

There is a difference between procrastinating a task for an hour and having paralysis for days, no matter what you try. In much the same way, getting bored after 3 hours of studying is different from being unable to start at all, zoning out after 5 minutes, or feeling psychological pain from the effort you have to put in. 

A helpful way of understanding the difference is to think about the line we draw between clinical depression and symptoms of depression. A person could feel dejected, miserable, and nihilistic, but it's only when the feelings get severe enough to stop them from getting out of bed, eating, working, and interacting with others that we know for sure it's a mental health disorder. 

The Number of Symptoms

As per requirements for official testing on ADHD, it's not enough to show some signs of inattention, hyperactivity, or impulsivity. Multiple ways in which those symptoms can manifest must be observable.

The logic is that the more symptoms are present, the higher the likelihood that the total disruption they place upon a person is severe enough to warrant an official diagnosis. For example, ADHD tests usually require between 5–6 sub-symptoms of inattention or hyperactivity/impulsivity to be present to be fully certain.

Persistence of Symptoms

ADHD is a permanent and irreversible condition, suggesting that symptoms related to the disorder must be present over a very long period. Persistence also suggests that the symptoms continue to be present, to varying degrees, across multiple contexts — at home, in school, when out with friends, at work, etc.

This is also why ADHD tests require evidence that the symptoms were present before a person was 12. 

The logic is that a sufficiently long time rules out other potential explanations for those symptoms. For example, having issues with attention regulation could be explained by being chronically sleep-deprived for the past three years because you are balancing a 9/5 with the university. 

No Other Plausible Cause For The Symptoms 

There can be an overlap between symptoms of ADHD and other mental health disorders. People with autism spectrum disorder (ASD) also experience executive dysfunction symptoms. A person with depression can suffer from a lack of motivation and lack of focus. Bipolar can cause mood swings, uncontrollable emotional episodes, and burnout similar to the emotional dysregulation felt with ADHD.  

There can also be lifestyle choices that can lead to ADHD symptoms. For example, chronic lack of sleep and severe deficiencies in vitamins and minerals can significantly disrupt cognitive function.

This is why an official diagnosis requires that symptoms of ADHD continue to exist independently, even when other diagnoses have been ruled out or treated. For instance, the person isn't severely deprived of basic physiological needs.

Current Medical Treatments for ADHD

There are many options for the treatment of ADHD. 

Therapy can help you untangle unhealthy coping mechanisms you’ve developed over the years and teach you how to create new ones. Coaching can give you a clear action plan, motivation, and accountability. Improving lifestyle habits and accommodations can make symptoms less severe and painful.

Other than social support and behavioral training, prescription drugs are one of the most popular treatments. 

This is because hundreds of studies have shown that various ADHD medications are highly effective in compensating for the disruptions in neurotransmitter activity that ADHD causes. Multiple meta-analyses (summary of multiple studies) have found stimulants to be highly effective in improving ADHD symptoms without causing any life-threatening side effects (10, 11,12, 13)

There are many different kinds of meds under the umbrella term of “ADHD medications.” Some are stimulants that directly ramp up neurotransmitter production, like Adderall. Others are new medications called “non-stimulants” that encourage neurotransmitter production through other means, like Strattera. Since stimulants have been around for much longer, there is a lot more research supporting their effectiveness and safety.

All ADHD medications work to improve brain chemistry and address the root cause of ADHD symptoms. However, they can improve your symptoms through different mechanisms. Some are “fast-acting” medications that offer immediate relief, like a bright fire that’s very bright but runs out after a while. Other types are “slow-acting” since they are designed to be gradually absorbed so they can keep a consistent effect for the whole day. 

The right ADHD medication taken in the optimal dosage can reduce hyperactivity and improve alertness, motivation, and memory retention without risking dependence or addiction in any way. 

However, the result really depends on how your body responds to the medicine you are given. Current research suggests that up to 80% of children and adults trying ADHD medications will experience a positive effect on their symptoms (14, 15) 

How you personally respond will be very different from how someone else feels after taking ADHD medications.

In some hyper-responders (10% of cases), ADHD medications produce life-changing results where symptoms are significantly reduced. In such cases, ADHD medications feel as essential as insulin is for diabetics. 

However, there is a large percentage of people who experience a positive impact in the beginning but see benefits diminish over time because they develop partial or full tolerance to the medications. In other cases, you may not experience many benefits at all, even in the beginning. Sometimes, the benefits are there, but they are not enough to justify other negative side effects you may be experiencing, like nausea, insomnia, headaches, stomachaches, etc (16, 17)

Even if medications give you promising results, it’s important to remember stimulant medications are not a solution to your ADHD. They can alleviate the intensity of symptoms, help you better cope, and help you stay on top of your tasks and responsibilities. However, they only get your mind in the right headspace for work; they are not enough to get work done automatically.

So, even if you take medications, you’d still need to work on improving behavioral skills and building up habits and routines. Think of medications as one of many tools in your toolbox of options, not a magical pill that can fix your condition. 

If you want to try ADHD medications, you should talk with a psychiatrist, primary care physician, or any other mental health professional who is qualified to prescribe stimulants. It’s not only the dosage and medication that matter, but the need to see if your health condition will allow you to take medications. 

While trying medications yourself is the best way to see if they work for you, educating yourself as much as possible in the meantime can help you make a fully informed choice. I would recommend watching this deep dive into everything you need to know about ADHD stimulants from Russell Barkley, a retired neuropsychologist and psychiatrist who’s the leading international authority on ADHD. 

Many people don’t take ADHD medications and live healthy, happy, and productive lives while relying on therapy, social support, coaching, personalized accommodations, and systems to manage their symptoms. Sometimes, medications are not financially accessible, or you don’t feel comfortable being dependent on them long-term, which is valid, especially if your country has a limited supply and is prone to shortages.

At the end of the day, the choice rests entirely on you. 

Key Takeaways

ADHD is a mental health disorder that can significantly reduce your well-being. Symptoms, like inattention and hyperactivity, can make it much harder to work, spend quality time with loved ones, and navigate everyday life. 

The condition's origins remain contested, but the consensus is that it is very much real and clearly different from other conditions, even if there is a partial overlap in symptoms. Don't ever allow other people to gaslight you into believing otherwise.