1. What is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is a medical condition and one of the commonest neuro-behavioural disorder in children and adolescents. ADHD also affects many adults. A person with ADHD has differences in brain development and brain activity. 

Symptoms of ADHD include inattention (not being able to keep focus), hyperactivity (excess movement that is not fitting to the setting) and impulsivity (hasty acts that occur in the moment without thought), that are disproportionately excessive for the child’s age and development. 

ADHD can affect a child at school, at home, and in friendships.

An estimated 8.4% of children and 2.5% of adults have ADHD. ADHD is often first identified in school-aged children when it leads to disruption in the classroom or problems with schoolwork. It is more commonly diagnosed among boys than girls.

The ICD-10 does not use the term “ADHD” but “hyperkinetic disorder”, which is equivalent to severe ADHD. DSM-5 distinguishes between three subtypes of the disorder: predominantly hyperactive/impulsive (ADHD), predominantly inattentive (ADD) and combined types. 

ADHD can’t be prevented or cured. But spotting it early, plus having a good treatment and education plan, can help a child or adult with ADHD manage their symptoms.

2. ADHD vs Behaviour disorders

• ADHD and disruptive behaviour disorders are not the same thing.

• ADHD can affect behaviour and other skills.

• Sometimes ADHD and disruptive behaviour disorders coexist.

Disruptive behaviour disorders and ADHD have some things in common, such as trouble keeping emotions in check and doing risky, impulsive things. But there are big differences between the two that can affect the strategies used to help a child.

2.1 What are disruptive behaviour disorders?

All children act up and act out from time to time. It is normal to test limits to see when no really means no. Most children have angry outbursts and sometimes use aggression to solve problems. These things are part of development and learning independence.

Most children learn that “negative” behaviour have consequences. But some children act angry, defiant and aggressive in spite of the consequences. If this behaviour is severe and continues for six months or more, it can be a sign of disruptive behaviour disorder.

There are two main disruptive behaviour disorders — conduct disorder (CD) and oppositional defiant disorder (ODD). They are different from each other, although children with CD may also have ODD. (To learn more about ODD and CD, please refer to our course, Understanding ODD.)

2.2 Is there a connection between ODD and ADHD?

Oppositional defiant disorder and ADHD have some similar symptoms. And some children may have both ADHD and ODD. Researchers are not sure what the connection is. Some think it may be tied into the fact that some children with ADHD have a hard time controlling impulsive behaviour and emotions . That can make it hard for children to take turns and think before acting. It may also contribute to the reflexive “No!” that often is part of ODD.

2.3 How are disruptive behaviour disorders and ADHD different?

Not all children who have ADHD have a disruptive behaviour disorder. And vice versa. Children with ADHD can have problems following the rules and may be easily frustrated and angry, but those are just some of many symptoms .

The way the brain works in children with ADHD makes it harder for them to stay still and to control impulsive behaviour. The brain matures more slowly in children with ADHD than in children without. Children with ADHD may also have lower levels of the brain chemicals (serotonin) that help regulate mood and movement.

The result of these differences in brain development may look like disruptive behaviour issues. But not all children with ADHD have an ongoing pattern of negative behaviour. Children with ADHD may react to their environment and get upset. But children with disruptive behaviour disorder seem to be looking for arguments and ways to break rules and rebel.

Although ADHD is not classified as a disruptive behaviour disorder it may have Disruptive behaviour problems (DBP). 

3. History of ADHD

Early 1900s

ADHD was first mentioned in 1902. British paediatrician Sir George Frederic Still described “an abnormal defect of moral control in children.” He found that some affected children could not control their behaviour the way a typical child would, but they were still intelligent.

The introduction of Benzedrine

The Food and Drug Administration (FDA) approved Benzedrine as a medication in 1936. Dr Charles Bradley stumbled across some unexpected side effects of this medication the next year. Young patients’ behaviour and performance in school improved when he gave it to them.

However, Bradley’s contemporaries largely ignored his findings. Many years later, doctors and researchers began to recognize the benefit of what Bradley had discovered.

No recognition – to recognition

The APA issued the first “Diagnostic and Statistical Manual of Mental Disorders (DSM)” in 1952. This manual listed all of the recognized mental disorders. It also included known causes, risk factors, and treatments for each condition. Doctors still use an updated version today.

The APA did not recognize ADHD in the first edition. A second DSM was published in 1968. This edition included hyperkinetic reaction of childhood for the first time.

The introduction of Ritalin

The FDA approved the psychostimulant methylphenidate (Ritalin) in 1955. It became more popular as an ADHD treatment as the disorder became better understood and diagnoses increased. The medication is still used to treat ADHD today.

An evolving definition

The APA released a third edition of the DSM (DSM-III) in 1980. They changed the name of the disorder from hyperkinetic reaction of childhood to attention deficit disorder (ADD). Scientists believed hyperactivity was not a common symptom of the disorder.

This listing created two subtypes of ADD: ADD with hyperactivity, and ADD without hyperactivity.

Better understanding

The APA released a revised version of the DSM-III in 1987. They removed the hyperactivity distinction and changed the name to attention deficit hyperactivity disorder (ADHD).

The APA included the three symptoms of inattentiveness, impulsivity, and hyperactivity into a single list of symptoms and did not identify subtypes of the disorder.

The APA released the fourth edition of the DSM in 2000. The fourth edition established the three subtypes of ADHD used by healthcare professionals today:

• combined type ADHD

• predominantly inattentive type ADHD

• predominantly hyperactive-impulsive type ADHD

A rise in diagnoses

ADHD cases began to climb significantly in the 1990s. There may be a few potential factors behind the rise in diagnoses:

• Doctors were able to diagnose ADHD more efficiently.

• More parents were aware of ADHD and were reporting their children’s symptoms.

• More children were actually developing ADHD.

More and more medications to treat the disorder became available as the number of ADHD cases rose. The medications also became more effective at treating ADHD. Many have long-acting benefits for people who need relief from symptoms for longer periods.

Today

Scientists are trying to identify the causes of ADHD as well as possible treatments. A 2020 review of studies points to a very strong genetic link [Chen Q, Brikell I, Lichtenstein P, et al.: Familial aggregation of attention-deficit/hyperactivity disorder. J Child Psychology Psychiatry 2017; 58:231–239]. Children who have biological parents or siblings with the disorder are more likely to have it.

It’s not currently clear what role environmental factors play in determining who develops ADHD. Researchers are dedicated to finding the underlying cause of the disorder. They’re aiming to make treatments more effective and to help find cures.

4. DSM 5

DSM-5 Diagnostic Criteria for ADHD

5. What ADHD is, and what it is not

5.1 What ADHD Is:

ADHD is a mental disorder
ADHD is an alternate way in which the brain develops
ADHD is a symptom spectrum disorder
ADHD is comprised of many symptoms
ADHD is diagnosed by its symptoms
ADHD is often genetically inherited
ADHD is disruptive to one’s life
ADHD is manageable
ADHD is frustrating
ADHD is context sensitive
ADHD is real

5.2 What ADHD Is Not:

ADHD is not caused by bad parenting
ADHD is not caused by diet, food additives, refined sugar
ADHD is not a gift
ADHD is not a curse
ADHD is not curable
ADHD is not in your head
ADHD is not imaginary
ADHD is not a disorder made up by pharmaceutical companies
ADHD is not strictly a childhood disorder
ADHD is not contagious
ADHD is not laziness
ADHD is not stupidity
ADHD is not easy to deal with
ADHD is not being unable to focus on anything
ADHD is not being able to hyper focus on anything
ADHD is not fake