Lecture 3: Attention Deficit Hyperactivity Disorder

What is ADHD?

ADHD stands for Attention-Deficit/Hyperactivity Disorder. It is a psychological disorder involving developmentally inappropriate problems with attention, hyperactivity, and/or impulsivity that are severe enough to interfere with daily life. In school, it is one of the biggest disorders associated with disruptive behavior because it can affect focus, sitting still, waiting, following directions, and finishing work.

What five things are disorders?

Disorders are usually: statistically rare, severe, impairing, present for a long time, and not better explained by another condition.

What does it mean that disorders are “statistically rare”?

It means the behavior or symptom is outside what is typical for most people. Everyone gets distracted or restless sometimes, but ADHD becomes a disorder when the symptoms are much more extreme than what is normal for that age/developmental level.

What does it mean that disorders are “severe”?

Severe means the symptoms are strong enough to matter clinically. A child being energetic or forgetful sometimes is normal; ADHD symptoms are more intense, frequent, and difficult to control.

What does it mean that disorders are “impairing”?

Impairing means the symptoms cause real problems in functioning. For ADHD, this might mean low grades, family conflict, social problems, poor self-esteem, or emotional distress.

What does it mean that disorders are “present for a long while”?

It means the symptoms are persistent, not just a short phase or a bad week. ADHD requires a pattern over time, so clinicians look for symptoms that have lasted long enough to show this is a stable problem.

What does “not better explained by another condition” mean?

It means clinicians must rule out other causes. For example, trouble focusing could come from anxiety, trauma, sleep problems, depression, learning disabilities, substance use, or stress, not necessarily ADHD.

What is the continuous vs. categorical debate?

The debate is whether ADHD should be understood as a category you either have or do not have, or as symptoms that exist on a spectrum. The best answer: ADHD traits are continuous, because everyone has some level of distractibility or impulsivity, but diagnosis is categorical because clinicians use a cutoff to decide when symptoms become a disorder.

How does diabetes mellitus compare to ADHD?

Diabetes is easier to think of categorically because doctors can use blood sugar cutoffs to decide whether someone meets criteria. ADHD is more continuous because attention, activity level, and impulsivity vary across the whole population. The diagnosis is a category placed on top of a continuous range.

What does the overlap and comorbidity slide mean?

It means ADHD often overlaps with other disorders. A child can have ADHD and another condition at the same time, and some disorders share similar symptoms. So clinicians should not assume one diagnosis explains everything.

What is LD in relation to ADHD?

LD means learning disability. ADHD and learning disabilities can co-occur because attention problems can hurt learning, and learning struggles can make a child look inattentive or avoidant.

What are tics/Tourette’s in relation to ADHD?

Tics are sudden repeated movements or sounds. Tourette’s involves motor and vocal tics. ADHD can co-occur with tic disorders, so a child might have both attention/impulse problems and involuntary tics.

What is ASD in relation to ADHD?

ASD means Autism Spectrum Disorder. ADHD and ASD can overlap because both may involve social difficulties, rigid behavior, sensory issues, attention problems, or trouble with transitions, but they are not the same diagnosis.

What is DBD in relation to ADHD?

DBD means disruptive behavior disorders, such as ODD or conduct problems. ADHD can lead to conflict because impulsivity and poor self-control can look like defiance, and some kids truly have both ADHD and a disruptive behavior disorder.

What is anxiety in relation to ADHD?

Anxiety can co-occur with ADHD, especially with inattentive symptoms. Anxiety can also mimic ADHD because anxious kids may seem distracted, avoidant, forgetful, or unable to focus.

Why is ADHD included in the overlap diagram itself?

ADHD is the main disorder being discussed, and the diagram shows that ADHD is not isolated. It can overlap with LD, tics/Tourette’s, ASD, DBD, and anxiety.

What are the five ADHD diagnostic criteria on the slide?

Symptoms, impairment, setting, age, and rule out.

What does the “symptoms” criterion mean?

The child must have enough ADHD symptoms. These symptoms fall under inattention and/or hyperactivity-impulsivity. The diagnosis depends partly on how many symptoms are present.

What does the “impairment” criterion mean?

The symptoms must cause real problems in life, not just be noticeable. For example, ADHD symptoms might disrupt schoolwork, relationships, family life, self-esteem, or mood.

What does the “setting” criterion mean?

Symptoms and impairment must show up in more than one major setting. For example, a child cannot only struggle in one classroom with one teacher; ADHD usually affects school, home, afterschool, peers, sports, or other areas.

What does the “age” criterion mean?

ADHD symptoms must fit the developmental history. Clinicians look for symptoms beginning in childhood, not suddenly appearing for the first time due to another issue later on.

What does the “rule out” criterion mean?

Clinicians must make sure the symptoms are not better explained by another condition, like anxiety, depression, trauma, sleep problems, learning disability, or substance use.

What are the three ADHD symptom domains?

Hyperactivity, impulsivity, and inattention.

What is hyperactivity?

Hyperactivity means excessive movement or activity level. Examples from the slide include being fidgety, running or climbing when inappropriate, making noise, and seeming “driven by a motor.”

What is impulsivity?

Impulsivity means acting before thinking or having trouble stopping oneself. Examples include trouble waiting, interrupting, blurting things out, or butting into situations.

What is inattention?

Inattention means difficulty sustaining focus and organizing attention. Examples include trouble concentrating, being distractible, forgetful, and losing things.

What are the three ADHD presentations?

Combined presentation, predominantly inattentive presentation, and predominantly hyperactive/impulsive presentation.

What is combined presentation?

Combined presentation means the child has enough symptoms in both categories: at least 6 hyperactive/impulsive symptoms and at least 6 inattentive symptoms. Your slide notes this is most common in kids.

What is predominantly inattentive presentation?

Predominantly inattentive presentation means the person has at least 6 inattentive symptoms but fewer than 6 hyperactive/impulsive symptoms. This can be easier to miss because the child may seem quiet, dreamy, forgetful, or “under the radar.”

What is predominantly hyperactive/impulsive presentation?

Predominantly hyperactive/impulsive presentation means the person has at least 6 hyperactive/impulsive symptoms but fewer than 6 inattentive symptoms. Your slide notes this is the least common subtype and is more common in younger children.

What is the main idea of the impairment and setting slide?

ADHD is not diagnosed just because a child has symptoms. The symptoms must actually cause distress or disrupted functioning, and that impairment must appear in more than one setting.

What does impairment entail in ADHD?

Impairment means ADHD symptoms interfere with real life. The slide lists social skills deficits or relationship problems, regular family conflict, low grades, poor self-concept, and anxiety or mood issues.

How can ADHD disrupt social functioning?

ADHD can cause social problems because impulsivity, interrupting, emotional reactivity, or distractibility may make peer relationships harder. Other kids may see the child as annoying, rude, or unreliable even when the child does not mean harm.

How can ADHD disrupt family functioning?

ADHD can lead to regular family conflict because parents may constantly remind, correct, discipline, or argue with the child about routines, homework, chores, emotions, or behavior.

How can ADHD disrupt academic functioning?

ADHD can cause low grades because the child may miss instructions, forget assignments, lose materials, rush work, avoid sustained effort, or struggle to complete tasks even if they understand the content.

How can ADHD affect self-concept?

A child with ADHD may start to think they are lazy, bad, annoying, or stupid because they receive frequent criticism. Poor self-concept can develop from repeated failure or negative feedback.

How can ADHD relate to anxiety or mood issues?

ADHD can create stress from falling behind, being corrected often, or feeling out of control. Over time, this can contribute to anxiety, frustration, low mood, or emotional dysregulation.

What types of settings must impairment be present in?

Impairment must be present in more than one major setting, such as school, home, afterschool, peer interactions, or sports.

Why does ADHD impairment need to appear in more than one setting?

Because if the problem only happens in one setting, it may be caused by that specific environment instead of ADHD. For example, only struggling in one class might reflect teacher fit, class difficulty, bullying, or stress rather than a broad disorder.

What is an easy exam summary of ADHD diagnosis?

ADHD diagnosis requires enough symptoms, real impairment, symptoms across more than one setting, developmental history/age appropriateness, and ruling out other explanations. It is not just “a kid is distracted.”

What are the five most common points/peaks for ADHD diagnosis across development?

The slide’s curve shows common diagnosis peaks around preschool hyperactive/impulsive symptoms, 3rd–4th grade inattention, 5th–6th grade/middle school, high school, and college. The big idea is that ADHD may become noticeable at different ages depending on what demands the child is facing.

Why is preschool a common ADHD diagnosis peak?

Preschoolers may show hyperactive/impulsive symptoms first: running, climbing, interrupting, trouble waiting, and seeming constantly “on.” Inattention may be harder to notice because very young kids are not expected to sit and focus for long periods yet.

Why is 3rd–4th grade a common diagnosis peak?

Around 3rd–4th grade, school demands increase. Kids are expected to sit longer, follow multi-step directions, organize materials, complete work independently, and sustain attention, so inattentive symptoms become more obvious.

Why is 5th–6th grade/middle school a common diagnosis peak?

Middle school adds more teachers, more homework, transitions between classes, lockers, deadlines, and less adult structure. ADHD may become clearer because organization and self-management demands increase.

Why can high school be a diagnosis peak?

High school requires more independence, long-term planning, studying, emotional regulation, and time management. Some students who compensated earlier start struggling when structure decreases.

Why can college be a diagnosis peak?

College can reveal ADHD because students suddenly need to manage schedules, deadlines, studying, sleep, meals, and motivation without parents or teachers tracking everything. Inattentive ADHD especially may be missed until this stage.

What is the main idea of the age and rule-out slide?

ADHD must be developmental and not better explained by something else. Symptoms or impairment must have been present by age 12 or earlier, but the child does not need to have been officially diagnosed before age 12.

What does “symptoms or impairment must be present from age 12 or earlier” mean?

It means ADHD should show signs in childhood. A person can be diagnosed later, but clinicians look for evidence that attention, hyperactivity, or impulsivity problems existed before age 12.

What does “no diagnosis needed at or before age 12” mean?

It means someone does not need an official childhood diagnosis to qualify. They just need evidence that symptoms or impairment were present before age 12.

What does “prior cutoff: 7” mean?

Older diagnostic rules required symptoms before age 7. The cutoff changed to age 12 because many kids, especially inattentive kids, are not recognized that early.

What does the age criterion suggest about ADHD origins/causes?

It suggests ADHD is developmental and often brain-based. It usually begins early in life rather than suddenly appearing only in adulthood.

What is the first rule-out bullet?

Symptoms cannot be better explained by another psychiatric, medical, or developmental factor. For example, anxiety, depression, trauma, sleep problems, thyroid issues, learning disabilities, or autism may explain attention problems.

What is the second rule-out bullet?

ADHD can be comorbid with other conditions, but all symptoms cannot fit completely within another diagnosis. So a child can have ADHD and anxiety, but clinicians must decide whether ADHD symptoms are truly separate from anxiety symptoms.

When did ADHD first appear historically?

ADHD first appeared around the turn of the 20th century, though it was not called ADHD yet. It was historically described using terms like “minimal brain dysfunction,” because people thought the behavior came from subtle brain problems.

How did ADHD appear historically?

It appeared as adults began noticing children who struggled with sitting still, paying attention, controlling impulses, and functioning in school. The behaviors existed before, but schooling made them more visible.

How did child labor laws and compulsory education contribute to ADHD history?

Child labor laws kept more children out of work, and compulsory education required more children to attend school. Children who might previously have been working or at home were now sitting in classrooms, where attention and impulse-control problems stood out.

How was ADHD historically “discovered”?

ADHD was “discovered” when children who normally might not have been in school were required to enroll and then struggled with classroom expectations. It was not that school invented ADHD, but school made the symptoms easier to notice.

What was discovered with stimulant medication?

Stimulant medication was discovered somewhat accidentally during research comparing children with ADHD-like symptoms to children with traumatic brain injury. Researchers found that stimulants could improve attention and calm behavior in some children.

What is the “brain’s conductor” slide about?

The “brain’s conductor” refers to the prefrontal cortex. It helps coordinate attention, planning, impulse control, decision-making, working memory, and behavior regulation. ADHD involves differences in this control system.

How does the prefrontal cortex play a role in ADHD?

The prefrontal cortex helps you pause, focus, plan, organize, and control impulses. In ADHD, this region may show reduced or different activity, which can make attention, motivation, and self-control harder.

What is an fMRI?

An fMRI is a brain imaging method that shows changes in blood flow while the brain is working. Your professor described it like a “video” of brain activity because it shows which areas become active during tasks.

Why is fMRI significant for ADHD?

fMRI research shows that people with ADHD may have less activity in brain areas involved in attention and impulse control, especially the prefrontal cortex. It supports the idea that ADHD is brain-based, not just laziness.

What is the brain structure explanation for ADHD origins?

ADHD is associated with differences in brain volume and the structure of certain areas, especially the prefrontal cortex. Your slide notes that brain development may lag, which can affect attention and self-regulation.

What is the brain functioning explanation for ADHD origins?

Brain functioning in ADHD may involve reduced activity in the prefrontal cortex, cingulate gyrus, and caudate nucleus. These areas help with attention, motivation, behavior control, and impulse regulation.

What is the main neurotransmitter involved in ADHD?

Dopamine is the main neurotransmitter emphasized on the slide. It is involved in motivation, reward, focus, attention, and learning. Stimulant medications often work by increasing dopamine activity.

How do genetics contribute to ADHD origins?

ADHD is highly heritable, meaning it often runs in families and genes play a strong role. But genes are not the whole story; environment and brain development also matter.

What is the overall point of the genetics and ADHD slide?

ADHD has a strong genetic component, but there is no single ADHD gene. Many genes and environmental factors interact to influence whether ADHD symptoms appear and how severe they are.

What does “ADHD is heritable” mean?

Heritable means genetic differences help explain why ADHD tends to run in families. If close relatives have ADHD, risk is higher.

What does “high concordance in identical twins” mean?

Concordance means both twins have the same condition. Identical twins share nearly all their genes, so high ADHD concordance suggests genetics are important.

What does the “80% of MZ twins” bullet mean?

MZ means monozygotic, or identical twins. The slide says if one identical twin has ADHD, about 80% of the time the other twin also has ADHD, compared with about 5% in the general population.

What does “no single gene” mean?

ADHD is not caused by one gene. It is polygenic, meaning many genes each contribute a small amount. That is why a simple genetic test cannot diagnose or predict ADHD.

What does “genes and environment interact” mean?

A child may inherit vulnerability for ADHD, but environmental factors can influence whether symptoms appear, how severe they are, and how impairing they become.

What do environmental insults or trauma mean in ADHD?

Things affecting the developing brain, such as perinatal drug exposure, possible environmental exposures, or traumatic brain injury, may produce ADHD-like symptoms or activate genetic vulnerability.

How is ADHD diagnosed overall?

ADHD is diagnosed by combining several kinds of information: clinical assessment, developmental history, functional impairment, school/home reports, behavioral observation, and sometimes cognitive testing. There is no single simple test.

What is psychiatric/developmental/functional assessment?

This is the main clinical evaluation. It looks at symptoms, age of onset, development, school/work functioning, relationships, family history, and whether the symptoms cause real impairment.

What are neuropsychology evaluations?

Neuropsychological testing measures thinking skills that may be affected in ADHD, like working memory and processing speed. It can support diagnosis but does not diagnose ADHD by itself.

What is the SCAD profile?

SCAD is a cognitive pattern sometimes seen in attention problems. It can include weaknesses in areas like working memory or processing speed, but it is not a standalone ADHD diagnosis.

What is working memory?

Working memory is the ability to hold and use information in your mind. Example: remembering instructions long enough to follow them. ADHD can affect this.

What is processing speed?

Processing speed is how quickly someone can take in information and respond. Slower processing speed can make schoolwork take longer and can look like inattention.

What is structured behavioral observation?

Structured observation means watching and recording behavior in a systematic way, such as noting impulsivity, movement, distractibility, or time on task.

What is REDSOCS?

REDSOCS is a structured behavioral observation system mentioned on the slide. For exam purposes, know it means behavior is observed and coded systematically rather than judged casually.

What is neurological activity/fMRI in diagnosis?

fMRI can show brain activity patterns related to ADHD, but it is not commonly used in everyday diagnosis. ADHD is usually diagnosed through clinical and functional assessment, not brain scans.

Why is there no genetic test for ADHD yet?

Because ADHD is influenced by many genes and environmental factors. No single gene determines ADHD, so genetic testing cannot currently diagnose it.

What is the main idea of ADHD treatment?

The best-supported treatments are stimulant medication and behavioral interventions, especially when combined. Treatment should reduce symptoms and improve daily functioning, not just make the child easier for adults to manage.

What is the MTA study and why does it matter?

The Multimodal Treatment Study of ADHD is a major research study on ADHD treatment. It found strong evidence for stimulant medication, especially combined with behavioral treatment.

What is PATS and why does it matter?

PATS stands for Preschool ADHD Treatment Study. It studied ADHD treatment in younger children, showing that ADHD treatment also needs age-appropriate caution and monitoring in preschoolers.

Why is stimulant medication relevant for ADHD?

Stimulants can reduce core ADHD symptoms like inattention, impulsivity, and hyperactivity. They often work by increasing dopamine activity, which helps attention and learning.

Why is behavior therapy relevant for ADHD?

Behavior therapy helps build structure, routines, rewards, skills, and adult responses that support the child. It may not reduce core symptoms as strongly as medication, but it improves functioning.

Why is combined medication + behavior therapy often best?

Medication can help the brain focus and regulate, while behavior therapy teaches practical strategies and changes the environment. Together, they target both symptoms and daily functioning.

What does the slide warn about with neurofeedback/biofeedback, TMS, CogMed, or “snake oil”?

Some treatments are marketed as ADHD fixes without strong enough evidence. “Open label” means a study may not be blinded or tightly controlled, so results can be less reliable. The exam point: be cautious and prioritize evidence-based treatment. These therapies may lack scientific support and are often promoted without rigorous validation. It's important to be wary and focus on approaches backed by solid evidence.