Dr. Streicher brings to MindWorks expertise in the diagnosis and treatment of ADHD across the span of development. Her comprehensive, empirically-supported approach to diagnosis follows the highest practice standards (referred to as “clinical practice guidelines”) that have been adopted by the American Academy of Pediatrics (AAP) and the American Academy of Child and Adolescent Psychiatry (AACAP). Furthermore, Dr. Streicher provides consultation on intervention strategies that are empirically-supported by the most current research.
The following summary highlights some key facts we know about ADHD from the extensive body of research that exists.
What is ADHD? Attention-Deficit/Hyperactivity Disorder (ADHD) is a highly prevalent disorder, affecting close to 10% of children/adolescents and 4% of adults in the United States. It is considered a “neurodevelopmental” disorder, meaning that it is a disorder of the development of the brain and is a chronic condition that often continues into adulthood. It affects specific brain areas and neural pathways that are related to one’s ability to self-regulate attention, impulse control, activity level, task initiation, persistence, effort, motivation, and frustration tolerance, as well as judgment/reasoning, working memory, processing speed, and planning/organizational skills. Over the hundred plus years that we have known about this disorder, ADHD has been referred to by a variety of different names (including “ADD” in the 1980’s), which has reflected the enormous amount of research on ADHD and our evolving understanding of this disorder. Current diagnostic classification systems (such as the DSM-IV and DSM-5) recognize three different subtypes of ADHD: ADHD Predominately Inattentive Type, ADHD Predominately Hyperactive-Impulsive Type, and ADHD Combined Type. ADHD is associated with higher risks for other co-occurring disorders. More specifically, research has shown that greater than two-thirds of children and adolescents with ADHD have at least one other learning or psychiatric disorder (such as learning disabilities, disruptive behavior disorders, mood and anxiety disorders, and tic disorders). Similarly, high rates of co-occurring disorders are also found in adults with ADHD (including mood and anxiety disorders, sleep disorders, and substance abuse disorders). Also recognized clinically in pediatric populations is the high prevalence of sleep disturbances/disorders, elimination disorders (wetting and soiling), fine motor coordination delays, and even Autism Spectrum Disorder with ADHD. Failure to recognize and treat such co-occurring disorders greatly affects the prognosis and long-term functioning of individuals with ADHD.
What causes ADHD? Scientists have not been able to identify one specific cause of ADHD, but we do know that several different factors appear to increase the likelihood of having this disorder, including genetics and family history, prenatal risks, and environmental toxins. Research has not supported that ADHD is caused by factors such as ineffective parenting, too much sugar intake, and food allergies.
What are the risks associated with ADHD? ADHD is not a benign disorder, particularly if left undiagnosed and untreated, and can lead to wide-ranging problems. A commonly seen negative consequence of ADHD is school under-achievement and failure and higher school drop-out rates. Students with ADHD enter college at significantly lower rates that their peers without ADHD, and those who do attend college tend to earn lower grades, take longer to finish their degrees, and are less likely to obtain their degrees. One often overlooked and under-appreciated area of functioning on which ADHD has a negative impact is social relationships. ADHD is associated with higher rates of strained parent-child relationships, peer rejection, and higher rates of divorce in adult patients with ADHD. Furthermore, in adults, ADHD can lead to poor job stability, under-employment, and financial problems. ADHD is associated with physical health and safety risks, including higher rates of overeating/obesity, sleep problems, accidents/injuries, alcohol/substance abuse, and unplanned pregnancies. ADHD left untreated also contributes to higher rates of driving-related citations (i.e., speeding tickets and motor vehicle accidents) and legal involvement/criminality.
What is involved in making a diagnosis of ADHD? Because of the complexity of the disorder, the evaluation of ADHD is a complex process. No single test or screening measure (such as the Vanderbilt Scales) can confirm whether or not a person has ADHD. Sometimes, typical childhood behaviors can be mistaken for symptoms of ADHD, and certain behavioral health and medical conditions have some of the same symptoms as ADHD (referred to as "ADHD look-alikes") , but require very different treatments. It is also important to recognize and understand gender differences that exist in ADHD and how the symptoms of ADHD evolve across different developmental stages from preschool age into adulthood. Furthermore, given the high rates of co-morbidity of ADHD with other disorders, a comprehensive evaluation is crucial in making an accurate diagnosis and identifying the full range of other potential issues present so that the most effective intervention plan can be developed. Consequently, only qualified health care providers with specialized training in ADHD should make this diagnosis. The components of an empirically-supported evaluation for ADHD includes use of a variety of assessment procedures, including: (1) evaluation for the presence of ADHD symptoms consistent with DSM-5 criteria, (2) obtaining a thorough developmental, medical, psychiatric, school, and social history, (3) standardized, norm-referenced behavioral assessment of the patient from multiple reporters across home/school/community settings, (4) clinical behavioral observations, (5) and other specific evaluations and testing to rule out certain psychological and learning problems, as well as medical conditions, that can look-like ADHD and/or co-occur with ADHD.
How is ADHD treated? Because ADHD is a complex, chronic condition, the most effective treatments involve a combination of interventions (referred to as “multi-modal” interventions). Treatments used in isolation tend not to be as effective for addressing the broad array of symptoms that may be occurring. There is not a cure for ADHD, and multi-modal interventions focus on reducing the symptoms of ADHD and improving the functioning of the patient. Multi-modal interventions with demonstrated effectiveness include: patient/family education on the condition, symptom management (through medication therapy, sleep hygiene practices, and exercise), behavior therapy, ADHD coaching, and school-based/educational interventions and accommodations. An individual’s prognosis (or expected response to treatment) is affected by numerous factors, and treatment components may need to be changed at different developmental stages of a patient’s life in order to maintain effectiveness. However, we know that individuals with ADHD can be happy, healthy, and highly successful when appropriately diagnosed and provided with the appropriate supports and interventions.
For more information on ADHD, please check out the following links:
Children & Adults with ADHD (CHADD) www.CHADD.org
National Resource Center for ADHD (NRC) www.Help4ADHD.org
Dr. Thomas Brown (internationally-recognized ADHD expert) www.DrThomasEBrown.com
Dr. Russell Barkley (internationally-recognized ADHD expert) www.RussellBarkley.com
For more information on ADHD Coaching and related resources, please check out the following links:
Impact ADHD (ADHD coaching for parents) www.impactadhd.com
Edge Foundation (ADHD coaching for parents, teens, & college students) www.edgefoundation.org