Assessing and Treating ADHD

This article explores what ADHD is, how to identify its symptoms and diagnose it in your clients, and what some of the common treatment approaches are.

Related articles: ADHD vs Neurotypical Brains: Implications for Therapists, Harnessing ADHD Benefits with a Neurodivergent-affirmative Approach, The Importance of Early Diagnosis in Child ADHD, Comorbidities in Child ADHD.

Overview of ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterised by persistent symptoms of inattention and/or hyperactivity-impulsivity that interfere with functioning or development. The symptoms must be present before the age of 12 and impair functioning in at least two settings, such as at home and at school.

The symptoms of inattention include difficulty paying attention to details, difficulty with sustained attention, forgetfulness in daily activities, poor organisation, and poor time management. The symptoms of hyperactivity-impulsivity include fidgeting, restlessness, excessive talking, and interrupting others.

There are three subtypes of ADHD:

• Predominantly Inattentive Type: characterised by symptoms of inattention, but with few or no symptoms of hyperactivity-impulsivity
• Predominantly Hyperactive-Impulsive Type: characterised by symptoms of hyperactivity-impulsivity, but with few or no symptoms of inattention
• Combined Type: characterised by symptoms of both inattention and hyperactivity-impulsivity

It is important to note that ADHD is a chronic condition and many people with ADHD continue to experience symptoms throughout their lives, so ongoing management and support are typically needed.

What is ADHD?

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) defines Attention-Deficit/Hyperactivity Disorder (ADHD) as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. The diagnosis requires that symptoms must be present before the age of 12 years, and that these symptoms must be present in at least two settings, such as at home and at school.

The specific criteria for ADHD, as outlined in the DSM-5, include:

• Inattention. Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level.
• Hyperactivity and impulsivity. Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months, and they are inappropriate for developmental level.

What are the symptoms of ADHD?

The symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) can be grouped into two main categories: inattention and hyperactivity-impulsivity

Symptoms of inattention include:

• Difficulty paying attention to details or making careless mistakes
• Difficulty sustaining attention in tasks or activities
• Difficulty listening when spoken to directly
• Difficulty following through on instructions and completing tasks
• Difficulty with organisation and planning
• Avoiding tasks that require sustained mental effort
• Losing things necessary for tasks and activities
• Forgetfulness in daily activities

Symptoms of hyperactivity-impulsivity include:

• Fidgeting or squirming in seat
• Difficulty remaining seated
• Excessive talking
• Difficulty waiting one’s turn
• Interrupting or intruding on others
• Difficulty playing quietly or engaging in leisure activities
• Acting impulsively without thinking through the consequences

It’s worth mentioning that not all people with ADHD experience both sets of symptoms, and some may have primarily inattentive symptoms or primarily hyperactive-impulsive symptoms. The criteria for diagnosis as per DSM-5 specify that at least six symptoms of inattention or at least six symptoms of hyperactivity-impulsivity should be present for at least six months in at least two settings like school or home. These symptoms should be persistent and not just an occasional behaviour.

How to diagnose ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) is typically diagnosed by a mental health professional, such as a psychiatrist, psychologist, or clinical social worker. The process of diagnosis usually involves a comprehensive evaluation, which can include the following steps:

• Medical history. The professional will take a detailed history of the patient’s symptoms, development, and medical history, including any previous diagnoses or treatment for ADHD or other conditions.
• Behavioural assessments. The professional will use standardised rating scales and questionnaires to evaluate the patient’s symptoms and functional impairment related to ADHD. These can include the Connors’ Parent Rating Scale, the Behaviour Assessment System for Children, or the Adult ADHD Self-Report Scale.
• Physical examination. The professional will perform a physical examination to rule out any underlying medical conditions that may be causing symptoms similar to ADHD
• Diagnostic criteria. The diagnosis of ADHD is based on the criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). A diagnosis is made by a mental health professional who conducts a comprehensive evaluation that includes a medical history, physical examination, and behavioural assessments.
• Differential Diagnosis. The professional will consider other possible diagnoses that might mimic or co-occur with ADHD like depression, anxiety, or conduct disorder-related behavioural assessments.

It is important to note that the diagnosis of ADHD should not be based solely on a checklist of symptoms, and that a thorough evaluation by a qualified mental health professional is necessary to determine whether an individual has the disorder. Also, it is important to consider cultural, socioeconomic, and other factors that can impact the diagnosis and assessment of ADHD.

Common treatment approaches for ADHD

Treatment for Attention-Deficit/Hyperactivity Disorder (ADHD) typically involves a combination of medication and behavioural therapy. The goal of treatment is to reduce symptoms of inattention, hyperactivity, and impulsivity and to improve functioning in daily life.

• Medications: The most commonly used medications for ADHD are stimulants such as methylphenidate (Ritalin, Concerta, etc) and amphetamines (Adderall, etc). These medications work by increasing the levels of certain chemicals in the brain, such as dopamine and norepinephrine, which can improve attention and reduce impulsivity. Long-acting formulations can be taken once a day, minimising disruptions during the day. Other non-stimulant medications, such as atomoxetine (Strattera) may also be used.
• Behavioural therapy: Behavioural therapy can be an effective treatment for ADHD, particularly when used in combination with medication. Behavioural therapies can include parent training and behaviour modification, as well as social skills training and therapy. These therapies teach individuals strategies for managing symptoms and improving social and academic functioning.
• Occupational therapy: Occupational therapists can help children with ADHD by teaching them organisational and time management skills, as well as fine motor skills. This can help improve their ability to complete tasks and improve functional skills related to activities of daily living.
• Counselling or psychotherapy: A form of counselling or psychotherapy such as cognitive-behavioural therapy, can help people with ADHD learn coping strategies, develop better problem-solving skills and improve self-esteem, relationships and self-perception.
• Parenting and family-based interventions: Parenting interventions like parent-child interaction therapy, behavioural parent training can be effective in managing the behaviour of children with ADHD and improving family functioning.

Observing that at least three of the above approaches involve therapies, we can note that there are several types of therapy commonly used to treat Attention-Deficit/Hyperactivity Disorder (ADHD). These include:

• Behavioural therapy: Behavioural therapy is a treatment approach that focuses on teaching individuals with ADHD strategies for managing their symptoms and improving functioning in daily life. This can include parent training and behaviour modification, as well as social skills training and therapy. Behavioural therapy can help individuals with ADHD learn how to better regulate their behaviour, improve their ability to focus and sustain attention, and improve their social and academic functioning.
• Cognitive-behavioural therapy (CBT): This type of therapy aims to help people change negative thinking patterns, beliefs, and behaviours that contribute to poor emotional regulation, poor motivation, and poor self-esteem. CBT can help individuals with ADHD to learn better problem-solving skills, improve self-esteem, and develop positive relationships.
• Occupational therapy: Occupational therapy can be particularly helpful for individuals with ADHD, as it can teach them strategies for organising and managing their time, as well as improving fine motor skills. This can help to improve their ability to complete tasks and improve their functional skills related to activities of daily living.
• Parenting and family-based interventions: Parenting interventions, such as parent-child interaction therapy and behavioural parent training, can be effective in managing the behaviour of children with ADHD and improving family functioning. This can involve teaching parents and caregivers effective parenting techniques, and how to support their child in managing symptoms and building self-esteem.
• Neurofeedback or biofeedback therapy: This approach uses real-time displays of brain activity to help people with ADHD learn to regulate their own brain waves, in order to improve attention and reduce impulsivity.

It’s important to note that different people may respond differently to different treatment approaches, so it’s important to work closely with a mental health professional to find the most effective treatment plan. It is also important to keep in mind that ADHD is a chronic condition, so ongoing management and support may be needed.

ADHD courses and training

With ADHD being one of the most common neurodevelopmental disorders, it is crucial for therapists to be well-trained in its nuances. Following are some ADHD courses and training that you may be interested in:

• Working with ADHD in Children and Adolescents
• Working with ADHD in Adults
• OnTrac: A CBT Based Manualised Group Program for Adolescents with ADHD

Note: These courses are accessible (on-demand) through Mental Health Academy membership. If you are not currently a member, click here to learn more and join.

Key takeaways

• Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterised by persistent inattention and/or hyperactivity-impulsivity.
• The diagnosis of ADHD is based on the criteria specified in the DSM-5, and should be made by a mental health professional who conducts a comprehensive evaluation.
• Symptoms of inattention include difficulty paying attention to details, difficulty with sustained attention, forgetfulness, poor organisation, and poor time management. Symptoms of hyperactivity-impulsivity include fidgeting, restlessness, excessive talking, and interrupting others.
• Treatment for ADHD typically involves a combination of medication and behavioural therapy.
• Common types of therapy used to treat ADHD include behavioural therapy, cognitive-behavioural therapy, occupational therapy, parenting and family-based interventions, and neurofeedback/biofeedback therapy.