Child & Adolescent Psychiatry

ADHD (Attention Deficit Hyperactivity Disorder)

ADHD is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning and development. ADHD begins in childhood but often persists into adulthood. It is not caused by poor parenting or laziness — it is a brain-based condition involving differences in dopamine and norepinephrine neurotransmission.

Symptoms

Difficulty sustaining attention in tasks or play

Frequently makes careless mistakes in schoolwork or work

Does not seem to listen when spoken to directly

Fails to follow through on instructions or finish tasks

Difficulty organizing tasks and managing time

Avoids tasks requiring sustained mental effort

Frequently loses things necessary for tasks

Easily distracted by extraneous stimuli

Fidgets, squirms, or leaves seat when expected to sit

Runs or climbs in inappropriate situations

Talks excessively or blurts out answers

Difficulty waiting turns

Interrupts or intrudes on others

Causes

Neurobiological: differences in brain structure and function (prefrontal cortex, dopamine pathways)
Genetic factors (ADHD is highly heritable, 70-80%)
Prenatal factors (maternal smoking, alcohol use, preterm birth)
Environmental toxins (lead exposure)
NOT caused by sugar, bad parenting, or too much screen time

Diagnosis

Diagnosis requires comprehensive evaluation including detailed developmental and behavioral history from parents and teachers, standardized rating scales (Conners, Vanderbilt), behavioral observation, and ruling out other conditions. Symptoms must be present before age 12, occur in multiple settings, and cause significant impairment. Neuropsychological testing may be helpful but is not required.

Treatment Options

Stimulant medications: Methylphenidate (Ritalin, Concerta), Amphetamine-based (Adderall)

Non-stimulant medications: Atomoxetine (Strattera), Clonidine, Guanfacine

Behavioral therapy and parent training (essential for children)

Classroom accommodations and educational support

Organizational skills training

Combined medication + behavioral approach (most effective)

Diet optimization and exercise programs

When to Seek Help

Seek evaluation if your child consistently struggles with attention, organization, or impulse control across multiple settings (home and school), if academic performance is significantly below potential, if behaviors cause social difficulties or family conflict, or if you're an adult who has always struggled with focus and organization.

Your Action Plan

1.Step 1: Get a proper evaluation — ADHD assessment involves rating scales from multiple sources (parents, teachers, self)

2.Step 2: Understand this is neurological — your brain processes dopamine differently, affecting attention and impulse control

3.Step 3: Try medication if recommended — stimulants work within 30-60 minutes and can be transformative

4.Step 4: Build external structure: use calendars, alarms, to-do lists, timers — compensate for weak internal organization

5.Step 5: Exercise daily — this naturally boosts dopamine and norepinephrine in your prefrontal cortex

6.Step 6: Sleep consistently — sleep deprivation dramatically worsens ADHD symptoms

7.Step 7: For adults: consider coaching — ADHD coaches specialize in building practical systems

8.Step 8: Leverage hyperfocus — structure your life to spend more time in areas of genuine interest

9.Step 9: Manage time blindness: set alarms for EVERYTHING, overestimate how long tasks take by 50%