ADHD & Autism
Attention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder which is largely characterized by challenges with inattention, lack of focus, emotion dysregulation, and impulsivity.
There are three subtypes of ADHD: Inattentive, Hyperactive, and Combined type (which is comprised of characteristics of both inattentive and hyperactive types). In the current literature, there has been an emergence of data indicating that inattentive type may be more prevalent in women, hyperactive type more prevalent in men, and combined type becoming more equally distributed between the genders.
The areas of the brain which are typically impacted by ADHD are the limbic system (which may include the hippocampus [memory] and amygdala [survival response]) as well as the prefrontal cortex which houses the processes largely responsible for our executive functions (eg. Working memory and response inhibition).
People with ADHD (or ADHDer’s as they are called in activist communities) often experience other phenomena associated with executive functioning challenges such as sensory processing disorders (eg. Sensory Defensiveness which may impact response inhibition and emotion control; Hyperphasia [extremely vivid imagination]; and Synaesthesia [eg. Tasting colours or experiencing sounds as touch]) as well as alexythymia (which impacts an ADHDer’s interoception or ability to know how they are feeling internally) which ultimately can have an impact on their ability to relate to others, possibly resulting in a negative impact on their relationships, employment opportunities, and ultimately, their self-esteem.
Common Presentation
The prevalence rates of ADHD in youth ages 12-17 are estimated as being 13% of the population, with boys being more commonly diagnosed than girls (13% vs 6%). Race data indicates that ADHD is more commonly diagnosed in African American (12%), Caucasian (10%), and less commonly diagnosed in Hispanic (8%) and Asian (3%) youth. Also, there are a number of co-occurring disorders which are commonly diagnosed with ADHD such as behavioural/conduct disorders (52%), Anxiety (33%), Depression (17%), Autism (14%), and Tourettes (1%).
However, it is important to note that there has been an increasing call in the neurodiversity community to re-examine the race-based data given that the medical model has been historically discriminatory against BIPOC people, and given that a number of the assessment tools used for assessing ADHD have been tested and validated using white male study participants which may not accurately reflect the experiences of BIPOC ADHDers. In addition, the neurodiversity community has raised concerns regarding over-diagnosis of co-occurring disorders, and is calling for further analysis and study. For instance, is the criteria for generalized anxiety being met, or is there a presence of anxious feeling due to sensory processing concerns? Is it conduct disorder, or is the behaviour rooted in impaired response inhibition? These questions highlight the importance of accessing diagnostic and treatment services which are not only culturally competent, but also specialized.
Myths About ADHD
There are several myths regarding ADHD which can delay diagnosis and treatment. Some examples are presented below:
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There was a prevalent belief that ADHD was mostly a childhood disorder which is why the data on adults is so scant and even non-existent. Recent research has discovered that ADHD can, in fact, be present in adults. However, the fact that it is still largely believed to be a childhood disorder may impact and adult’s access to diagnosis.
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New research suggests that this may not be the case, and the COVID pandemic saw women and girls being diagnosed at unprecedented rates. Given that ADHD was previously believed to be a mostly “male” disorder, and hyperactivity is on average more prevalent in male ADHDers, many women, who are on average more likely to have the inattentive subtype, may be missed (largely because inattention is an internal experience which may not be caught by teachers, family, or partners). The research has also noted that women, due to how they are socialized, are more likely to be more successful with masking behaviours which may also delay diagnosis and treatment.
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ADHD, sadly, has been equated to a disorder of morality, meaning that many people close to the ADHDer often think that they just need to “try harder” and they can overcome it, or worse, that they are just lazy.
ADHD is a disorder of executive functioning and limbic system control; these impairments are legitimate, challenging, and can be quite damaging to life of the ADHDer. Treatment, support, and coping skills can be highly effective in providing an ADHDer what they need to live a fulfilling life.
What causes ADHD?
Currently, the research is scant as to the actual causes of ADHD. The research that is available has determined that there appears to be genetic factors which contribute to ADHD developing. For instance, children of parents who have ADHD are more likely to be diagnosed with ADHD. However, researchers are currently exploring a number of potential causal factors such as brain injury, exposure to lead, exposure to substances before birth, premature delivery, and low birth weight.
How is it diagnosed?
Currently, in Ontario, ADHD can be diagnosed in a number of different ways. The most common methods of diagnosis are by seeking a psychological assessment by a registered clinical psychologist or neuropsychologist. The psychologist will assess you by using a clinical interview and various diagnostic tools to determine the level of impairment. In addition, they will likely review report cards, and speak with collateral contacts which may include other allied health professionals and family or friends. Psychological assessments are not covered by OHIP and may cost anywhere from $3000-$4000, depending on the level of assessment needed.
In addition, diagnosis of ADHD may be rendered by family physicians or psychiatrists. The assessment may consist of a clinical interview, collateral contact, and in some cases diagnostic measurement tools. At Lotus, our consulting psychiatrist has many years of experience diagnosing and treating ADHD. These services are covered by OHIP.
A number of factors must be present for a diagnosis of ADHD to be rendered. Symptoms must cause impairment in functioning, must have been present since before the age of 12, and must not be attributable to other causes such as medications, substances, or other psychiatric and neurocognitive conditions.
How is it treated?
There is a saying in the neurodivergence community that, “when you’ve met one person with ADHD, you’ve met one person with ADHD.” At first glance, this may be confusing, but what is expressed here is that the presentation, and symptoms of ADHD, vary from person-to-person. For instance, not all ADHDers struggle with sensory issues, and some may be fairly organized. Therefore, treatments must be tailored to the individual ADHDer.
During the clinical diagnostic interview, our psychiatrist may speak about lifestyle and medication changes which may alleviate symptoms. Common medications include stimulants such as adderall, or dexadrine, or if depressive symptoms are present, wellbutrin may be prescribed as it has shown to be effective with both depression and ADHD. Our psychiatrist can review medication options with you to ensure that you find one that works best for you and your life!
In addition, we offer clinical counselling at Lotus for ADHD. The therapist will conduct a clinical interview with you, and speak about challenges in your life, as well as your treatment goals. Typically, ADHD is treated using eclectic approaches, and depending on what an ADHDer’s goals are, treatment could include psychoeducation on ADHD (and why this brain is so awesome!!), lifestyle coaching, treatment for alexithymia, executive function assessment and skills building, coping strategies, schema therapy, CBT, attachment-based therapy, polyvagal work, strengths-based therapy, and SSP (safe and sound protocol) for certain sensory needs.
Strengths
There is a myth out there that a diagnosis of ADHD means that the person who has it may struggle their whole lives, and won’t be successful. This could not be further from the truth! While it is true that some people do struggle and have greater impairment to their level of functioning, a diagnosis of ADHD does not guarantee negative outcomes. In fact, ADHDers are often very creative, emotionally in tune, with a laser focus on their passions. Treatment interventions have been shown to be highly effective in supporting ADHDers to manage their symptoms. Recently, the general public has become more open about discussing the gifts of ADHD. There are many executives, business owners, artists, and actors who have leveraged the superpowers inherent with this type of mind. In fact, Microsoft and Google both value ADHD so much, they created ADHD working groups whose purpose is to give input on leveraging the strengths of ADHD and to provide input on improvements to the company to support employees with ADHD.
Should you wish to connect with a therapist who is passionate about supporting clients with ADHD, please reach out to Natalia to book a consult or initial appointment.
