ADHD Awareness Month: Common questions, reliable answers

Most people know what ADHD is. And many people seem to have an opinion about ADHD. Whether it exists or not; what causes ADHD; how ADHD should be treated. But actually, most people don’t know a lot about ADHD. There are many myths, misconceptions and false beliefs out there. And that’s why every year in October it’s ADHD Awareness Month . With this year’s theme: Common Questions, Reliable Answers. In my work as research dissemination advisor, I collaborate with ADHD researchers and with ADHD patient organisations. I help to transfer the scientific evidence from the researchers to the patients, in order to get reliable answers to common questions. So what are these common questions that are often asked? I’ll share a couple with you. Does ADHD exist? Yes. ADHD stands for Attention Deficit Hyperactivity Disorder. It is a psychiatric condition that is defined in both the DSM and the ICD. These are manuals or classification systems that are used worldwide by psychiatrists and psychologists to determine whether someone’s symptoms and impairments fall under the definition of a certain disorder. For instance: to meet the DSM criteria for ADHD, a child must show at least 6 out of 9 symptoms of inattention, and/or 6 out of 9 symptoms of hyperactivity/impulsivity (for adults, this cut-off is at 5 symptoms). These symptoms must be present in two or more settings (i.e. both at home and in school) and must interfere with social, academic or occupational functioning. Does getting an ADHD diagnosis help? Yes, most of the time. Getting an ADHD diagnosis can be very helpful for a person, because it serves as recognition (“I’m not crazy, stupid or lazy, but I have a disorder that interferes with my daily functioning”) and it can help to receive adequate treatment, such as medication, psychotherapy and cognitive behavioural training. However, not everyone is happy to be ‘labelled’. Some don’t want to be treated differently, or as having a handicap. It greatly depends on the person, and also on the severity of their ADHD, whether the diagnosis can help them or not. Doesn’t everyone have a bit of ADHD? Yes and no. The downside of the psychiatric classification system is that it defines a clear-cut border between having ADHD and not having ADHD (which is very useful for, for instance to get a treatment insured, or approved by authorities). This classification does not do justice to the underlying biology. There is large variability between people in their ability to focus on a task, remember where they have left items, manage time, deal with emotions, and control impulses. People with ADHD are at the extreme end of this spectrum, showing behaviour (or symptoms) that seriously interferes with ‘normal’ everyday life. So perhaps you are not very good at concentrating or time management. But if this doesn’t result in serious impairments in your daily life, you probably don’t have ADHD. However, you do have some of the characteristics that are part of the disorder. Actually, more and more research is focussing on what we call ‘dimensional’ traits, such as the degree to which people are able to keep focussed on a boring task, instead of ‘categorical’ traits (i.e. good vs. bad at focussing). This is providing new insights into the biology of these traits. What causes ADHD? For a large part, genes, but that’s not the complete story. We know that ADHD is heritable; it runs in families. However, there’s not one gene that causes ADHD. Instead, many small variations in many different genes are thought to be involved in causing the disorder. If you have a lot of these genetic variants, then there’s a higher chance that you have ADHD. Next to genes, we know that environmental factors play a role as well. These are non-genetic factors that come from ‘outside’. For instance, smoking during pregnancy, or severe stress early in life, are linked to a higher chance of developing ADHD. Similar to the role of genetics, we still don’t know much about the role of these environmental factors in causing ADHD. But we do know that getting ADHD is a complex mix of inheriting certain genes from your parents, and early life environmental factors that no one really understands yet. Can brain scans be used to identify if someone has ADHD? No. We know that the many genetic and environmental factors influence brain development early in life (even before birth). However, these brain changes are not huge and they vary greatly between individuals with ADHD. For instance, research has identified that on average individuals with ADHD have a slightly smaller brain. But these differences are so small that you cannot just do a brain scan to identify whether someone has ADHD. For that, you need to go to a psychiatrist or psychologist. However, a lot of research is being done to better understand what happens in the brain of someone with ADHD. Want to know more? During the entire month of October experts will answer common questions about ADHD which will be posted on the website www.adhdwarenessmonth.org . To read more about research on ADHD, you can also follow this blog: http://mind-the-gap.live Dr. Jeanette Mostert is dissemination manager at the Radboudumc Nijmegen, The Netherlands. She obtained her PhD in 2016 on the topic of resting-state functional connectivity in adults with ADHD. She is also the communications officer of Pint of Science, The Netherlands .