Psychology FAQ – AD_HD
FAQ – AD/HD
(Note that ALL FAQ are for general information only. These answers do not replace the need for qualified professional face-to-face or tele-health consultation)
Q: What is AD/HD?
A: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines AD/HD as a condition that is “…characterized by a persistent pattern of inattention and/or hyperactivity/impulsivity that interferes with functioning or development”. It must present with a number of the diagnostic criteria behaviours; be present before 12 years of age; present in two or more settings; interfere with functioning; and the presenting behaviours have to not be better explained by another “mental disorder”.
Q: What’s the difference between ADD and ADHD?
A: ADD (Attention Deficit Disorder) was a term formerly used to designate Attention
Deficit Disorder (ADD) distinct from Attention Deficit Disorder Hyperactivity Disorder (ADHD). Sometimes AD/HD will still be referred to in a shorthand fashion as “ADD”.
The terms ADD and ADHD have been replaced in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by the single term AD/HD. AD/HD as currently viewed is comprised of three sub-variants. One of these is AD/HD with predominantly inattention. This sub-variant is what was previously simply called “ADD”.
Q: Are there different types of AD/HD?
A: Yes. There are three types: Attention Deficit Disorder predominantly inattentive presentation; Attention Deficit Disorder predominantly hyperactive-impulsive presentation; and, Attention Deficit Disorder combined presentation (the former two types together).
Q: What are the diagnostic criteria for Attention Deficit Disorder Predominantly Inattentive Presentation?
A: The diagnostic criteria for Attention Deficit Disorder predominantly inattentive presentation for adults entail five or more of the following symptoms of inattention being present for at least 6 months, and these are inappropriate for developmental level:
Often fails to give close attention to details or makes careless mistakes, at work, or with other activities.
Often has trouble holding attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish chores, or duties in the workplace (e.g., loses focus, side-tracked).
Often has trouble organizing tasks and activities.
Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time.
Often loses things necessary for tasks and activities (e.g. pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
Often easily distracted
Often forgetful in daily activities.
Q: What are the diagnostic criteria for Attention Deficit Disorder Predominantly Hyperactive-Impulsive Presentation?
A: The diagnostic criteria for Attention Deficit Disorder Predominantly Hyperactive-Impulsive Presentation for adults entail five or more of the following symptoms of hyperactivity and impulsivity being present for at least 6 months, and these are inappropriate for developmental level:
Often fidgets with or taps hands or feet, or squirms in seat.
Often leaves seat in situations when remaining seated is expected.
Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
Often unable to play or take part in leisure activities quietly.
Is often “on the go” acting as if “driven by a motor”.
Often talks excessively.
Often blurts out an answer before a question has been completed.
Often has trouble waiting their turn.
Often interrupts or intrudes on others (e.g., butts into conversations or games)
Q: Are there essential conditions for a diagnosis of AD/HD?
A: Yes. In addition to displaying the required number of behaviours, a diagnosis of AD/HD has to ensure the AD/HD behaviours were present before 12 years of age; are present in two or more settings; significantly interfere with functioning; and, are not better explained by another “mental disorder”.
Q: Apart from the DSM-5 diagnostic criteria behaviours are there other experiences that occur for those who have AD/HD?
A: Yes. People with AD/HD will evidence cognitive differences. AD/HD is known as “executive functioning disorder”. This translates to a numerous range of experiences over which there has been considerable discussion. It is usually the case that people with AD/HD experience difficulties with working memory; emotions; motivation; time perception; and, self-regulation – being able to control one’s behaviour, emotions and thoughts in the interest of longer-term goals.
Q. I have a relative with AD/HD. Does this increase my chances of having AD/HD? Is it genetic?
A: Yes, AD/HD is a genetic condition. It has 70-80% heritability.
Q: What causes AD/HD?
A: Differences in the structure and neurochemical functioning (dopamine and norepinephrine) of the brain are seen to be causes of AD/HD.
Q: Can AD/HD have serious implications for my health?
A: Yes. The stress caused, or contributed to, by AD/HD especially with impulsivity and hyperactivity, can have serious health consequences. With the presence of AD/HD Combined presentation it is estimated that there is an associated reduction in anticipated life expectancy of 12.7 years. (Barkley R. and Fischer M. (2019). Hyperactive childhood syndrome and estimated life expectancy at young adult follow-up: The role of ADHD persistence and other potential predictors. Journal of Attention Disorders).
Q: I hear about AD/HD being “neurodiversity”. Can you tell me about this?
A: Neurodiversity is a term used to designate conditions that involve a person having a differently structured neurological system that functions differently. The concept of neurodiversity is that people experience and interact with their world in many different ways. The idea is that there is not a single “right” way of thinking, learning, and behaving. Rather than thinking in terms of “deficit”; “disorder”; or mental illness, differences are not seen as deficits per se but as differences.
Q: What is this “neurodiversity” I’m told ADHD is a form of?
A: Neurodiversity is a term originally coined by Australian sociologist, Judy Singer, in the late-1990s. There is no official definition of the term nor spokesperson for the movement. The term “neuro-diversity” is used by some thinkers to apply to a wide range of differences. A psychologist sees it as including a limited range of conditions. The aims of the Neuro-Diversity Movement seem to be to: change mainstream perceptions of the minority of people who are neuro-diverse; replace negative, deficit-based stereotypes of neuro-diverse people with a more balanced valuation of their abilities and needs; to find valued roles for neuro-diverse people; and, to demonstrate that society can benefit from the contribution of neuro-diverse people.
Q: What might be strengths that persons with AD/HD might exhibit?
A: People with ADHD might be hyper-focused; exhibit higher levels of creativity and curiosity; be innovative and inventive; have leadership abilities; exhibit high energy, spontaneity and productivity.
Q: When might a “difference” in neurodiversity thinking be a difficulty?
A: Difficulty or disability can be thought of as to whether a person’s behaviour is functional in the interaction between the person, their context, and their task. “Functional” is seen as accomplishing tasks as required, meeting one’s needs without harm to self or others. This is the same for neurodivergent and neurotypical persons. Neurodiversity can be a difficulty in the majority neurotypical world if reasonable accommodations are not made.
Q: Are there other types of neurodivergence apart from AD/HD?
A: Yes. ADHD, Autism, Dyspraxia, Dyslexia, Dyscalculia, Dysgraphia, and Tourette’s syndrome are all neurodiverse conditions. These are diagnostic terms used to explain diverse ways of thinking; learning; processing information; and, behaving. Neurodivergence necessitates a neurological difference – it is not simply a difference of opinions or lifestyle.
Q: Can you develop AD/HD? As, for example, you can become depressed – develop depression?
A: AD/HD is a neuro-developmental condition. This means you are born with it. If it seems a person seems to have “developed” AD/HD it is that they and/or others have just become aware of it. Or, it may be the behaviours that appear are due to reasons other than AD/HD. There can be a number of reasons why AD/HD-like behaviours appear.
Q: What is the prevalence rate in the population for AD/HD?
A: The prevalence rate in the population for AD/HD is estimated to be 5%.
Q: What percentage of people are estimated to have AD/HD but are undiagnosed?
A: The percentage of people are estimated to have AD/HD but are undiagnosed is estimated to be 4% of the population of the 5% estimated to have AD/HD. (Bruno C, Havard A, Gillies MB, et al. (2023). Patterns of attention deficit hyperactivity disorder medicine use in the era of new non-stimulant medicines: A population-based study among Australian children and adults (2013–2020). Australian & New Zealand Journal of Psychiatry. 2023;57(5):675-685. doi: 10.1177/00048674221114782)
Q: Is AD/HD over-diagnosed?
A: On the contrary, AD/HD is actually under- diagnosed. It is estimated that up to 80% of those who have AD/HD are undiagnosed.
Q: Isn’t AD/HD simply poor parenting; poor socialisation; poor self-control?
A: No. Not at all. AD/HD is a neurodevelopmental condition people are born with.
Their brains are different.
Q: Are the AD/HD behaviours just “boys will be boys” behaviours? Active, outgoing boys?
A: No. Girls can also have AD/HD. The “boys will be boys” thinking is outdated and sexist. The hyperactive and impulsive behaviours dismissed by “boys will be boys” thinking can have serious damaging impacts.
Q: Is AD/HD only a condition that children have? Can adults have it too?
A: No. It is not only a childhood condition. AD/HD is not “cured”. However, it can be managed. Those who are diagnosed as having AD/HD in childhood continue to have it as adults.
Q: Does medication assist with managing AD/HD?
A: Most people with ADHD benefit from taking medication. Medications do not “cure” (it isn’t an illness to be cured) ADHD, but can help a person control their symptoms on the day that the medication is taken.
Q: Can AD/HD be managed without medication?
A: A minority of people may think this is possible. However, the majority of professionals and most of those with AD/HD will note AD/HD is a neurological difference and managing it successfully requires psychopharmacological treatment as well as behavioural interventions. Many, perhaps most, professionals dealing with those with AD/HD will observe that significant, sustained and reliable management will only occur with medication.
Q: Can my GP prescribe medication for AD/HD?
A: No. To get a prescription for AD/HD you will need a referral to a psychiatrist or neurologist treating ADHD. GPs can be given prescribing rights for repeat prescriptions for limited time periods once a paediatrician or psychiatrist has initially diagnosed the condition.
Q: Are there different medications for AD/HD?
A: Yes, there are. AD/HD medications may be either stimulant or non-stimulant and can be short acting or sustained release. There are also several types of medication.
Q: Can you have ADHD and experience other conditions? Such as anxiety?
A: Yes. When you experience more than one condition the other conditions are called “comorbid” conditions. Anxiety can occur in its own right, but it is almost always present as a comorbid condition when a person experiences almost all other mental health conditions.
Q: Does having AD/HD also mean you have to have a learning difficulty?
A: No. However, learning difficulties are very common comorbid conditions when you have AD/HD.
Q: Can a person have ADHD and also be on the Autism spectrum?
A: It could be said that we are all at least a little on the Autism spectrum. Yes, a person can have both of these conditions.
Q: Can other conditions be the cause of a person’s AD/HD behaviours?
A: Yes. Part of the diagnostic process is, in as much as is possible, other explanations are ruled out. Part of the diagnostic criteria required for a diagnosis of AD/HD is to rule out more salient alternative explanations i.e. other conditions being the cause of problem behaviours. Conditions to be ruled out are spelt out in the DSM-5 ADHD criteria – “The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder”.
Q: My GP thinks I may have ADHD. What would they have taken into account in deciding this?
A: Your GP has probably read the DSM-5 criteria for AD/HD. Different GPs may be more experienced in diagnosing AD/HD than others. Behaviours they may have considered might include: Some of the behavioural symptoms your doctor will observe may include: anger management difficulties; difficulties coping with stress; difficulties following through and completing tasks; difficulties maintaining a focus; difficulties multi-tasking; difficulties planning; disorganization and problems prioritizing; excessive activity or restlessness; frequent mood swings; impulsivity; low frustration tolerance; and, time management difficulties. Your GP may have observed a difficulty in sitting still; fidgeting; a rapid speed of speech and non-stop talking.
Q: My GP referred me to a psychologist asking them to assess me to see if I have ADHD. Why is this?
A: Your GP was aware that a psychologist experienced in ADHD assessment is a professional who can undertake a comprehensive assessment to best assist you.
Q: Does Chapman Marques Psychology offer AD/HD assessments?
A. Yes. Chapman Marques Psychology offers AD/HD assessments. Gregg Chapman has had extensive experience assessing AD/HD.
Q: What does an assessment of Adult ADHD involve?
A: Ideally an assessment of Adult ADHD will involve a clinical interview asking questions about your childhood and adolescent history; family history; school experiences; current functioning in your workplace, relationship, leisure time, any education you may be undertaking and a range of experiences e.g sleep habit, overall health, moods etc. You will also be asked to complete some self-rating scales. If possible a close friend, partner or relative may be asked, with your permission to also complete a questionnaire about their observations of your behaviours.
Q: Some professionals don’t use the term “symptoms” referring to ADHD behaviours. Why is this?
A: Professionals who see ADHD as a neuro-atypicality rather than a “mental illness” will refer to the behaviours characteristic of ADHD as “behaviours”. Their viewpoint is that ADHD is not a “mental illness”. They see it as a difference – as neuro-atypicality. As a minority experience for approximately 5% of the population. They believe that behaviour can be viewed and measured via its dimensions. They note that we all behave and behaviour has to be in a context and relating to a task. Behaviour can be analysed by looking at its frequency; duration; intensity; latency; topography; context – and in some cases, developmental appropriateness. When assessing a behaviour the dimensions can be analysed with respect to how often it occurs – too much, too little, ought not to occur, needs to be learnt; how long it occurs – too long; not long enough; not at all; not intense enough, too intensely; too immediately, taking too long; what it is experienced as – the “shape” of it; the situation in which it occurs. Developmental appropriateness is generally not pertinent to adult ADHD – it is usually relevant to children, adolescents and elders.
Q: Is ADHD a mental illness?
A: No. It is a neuro-developmental condition of neuro-atypicality. Although listed in the DSM-5 it is a neurological condition and experience.
Q: Is ADHD a disability?
A: An experience of disability must be viewed in terms of a person’s abilities; the task/activity they are engaging in; and, the context. In some situations, AD/HD can be an advantage. In terms of a school student being eligible for reasonable accommodations, being diagnosed as experiencing a disability can assist. This can apply to an adult in the workplace. AD/HD is recognised ass a disability. If it is unable to be managed, AD/HD can be a disability. AD/HD is classified as a disability under the 1992 Disability Discrimination Act.
Q: What if ADHD is untreated? What can be the consequences?
A: If ADHD is untreated, the consequences are different for a child or adolescent. Here we’ll address the consequences for an adult. The consequences will vary depending on the sub-type of ADHD you experience, your social setting and your underlying personality. Many people with ADHD report they experience physical and/or emotional exhaustion from fighting your physiology to control your distracted and/or “over the top” behaviours on the job and in an intimate relationship. If you are undertaking a course of study, you will possibly always be late submitting assignments. You will likely procrastinate starting assignments and create stress. You may unintentionally miss classes or turn up at the wrong time. You will always be losing things. You may experience trouble with friendships if others find you always interrupt them, or you are seen as too talkative – you “never shut up”. You may experience successive unsuitable relationships due to impulsivity. Family life may also suffer. Untreated ADHD can increase tensions between partners and between parents and children. You may be at increased risk of driving accidents and accidents during high-risk thrill-seeking activities. We know that untreated ADHD results in higher rates of divorce and job loss, compared with the general population.
Q: I’ve been told I “mask” my ADHD behaviours. What does this mean?
A: Masking refers, for those able to do so, to managing the neuro-divergence of ADHD so your ADHD inattention; impulsivity; and, hyperactivity appear within the average range displayed by the neuro-typical majority. It comes at the price of exhausting vigilance and effort.
Q: Can I have ADHD but appear not to from the viewpoint of others?
A: This can be possible. Generally, it would be if you have mild ADHD and have put in effort over time to manage some of your behaviours. Perceptions of ADHD vary in some segments of society or with respect to activities (e.g. high risk sports or activities) such that your ADHD behaviours are not seen as(or are not) distinct from other neuro-typical persons engaging in the same behaviour.
Q: What are some of the common strengths of people with AD/HD?
A: Some of the common strengths of people with AD/HD include: composure in a crisis;
empathy and compassion; being at ease with risk and change; being open to change; hyper-focus; rapid generation of ideas; and, seeing situations differently.
Q: How can I make an appointment to be assessed for AD/HD?
A: Assessment of AD/HD can be arranged by contacting Chapman Marques Psychology and Relationship Counselling at Belconnen Specialist Centre. Phone: 6251 1880. email: belconnenspecialistcentre.com.