Introduction to the Neuro-Diverse Family - ADHD

The next video explores the experiences of Sam, shedding light on how ADHD influences his behaviour and the importance of understanding and support.

Watch: That's Me, I Have ADHD! (9:29 minutes)

Pre-watch question

What do you think might be some common misconceptions about ADHD?

Post-watch Task

Note down five characteristics and indicators of ADHD you identified during this video.

ADHD is characterised by common traits related to inattention, hyperactivity, and impulsivity, which collectively determine the specific type of ADHD a person may have. It is important to note that individuals with ADHD may experience challenges in one or more of these areas, and the presentation of symptoms can evolve as children grow older.

Inattention

Inattention is characterised by having trouble concentrating or staying focused on tasks, especially when those tasks are perceived as dull and lacking in mental stimulation. Activities like doing homework or sitting quietly can be challenging for individuals with ADHD.

Common indicators of inattention include:

• Difficulty maintaining focus on a single task.
• Frequently shifting from one task to another without completing any.
• Being easily distracted by various sights and sounds.
• Forgetting instructions or struggling to follow them.
• Making careless mistakes.
• Facing challenges with organising tasks.
• Frequent daydreaming.
• Not paying attention when directly addressed.
• Appearing forgetful and often misplacing items.

Despite having a low tolerance for boredom, people with ADHD can hyper-focus on tasks of interest, sometimes at the expense of crucial activities like sleep and social interaction. However, this hyper-focus can also be advantageous when directed toward a specific task. 

Impulsivity

Impulsivity is a common trait in individuals with ADHD that can express itself in multiple ways:   

• Talking over people in conversations
• Frequently interrupting or 'butting in' when others are speaking.
• Struggling to wait for their turn, in conversations or activities.
• Easily lose control of their emotions, leading to outbursts or mood swings.
• Acting without considering the consequences.
• Displaying little or no sense of danger, taking risks without hesitation.
• Being accident-prone due to acting without thinking.

Impulsivity in ADHD can make it challenging to maintain appropriate social interactions and adhere to expected behavioural norms. Individuals often find themselves in situations where their actions have unintended consequences due to their impulsive tendencies.

Hyperactivity

Hyperactivity is another characteristic symptom associated with ADHD that can present itself in various forms:

• Being in constant motion, as if driven by an internal motor.
• Frequently fidgeting or moving to help maintain focus.
• Difficulty sitting still or remaining seated, especially in situations where it is expected.
• Always having something to say, talking quickly, interrupting others, or dominating conversations. 
• Excessive verbal or internal monologue overactivity.

People with ADHD who display hyperactivity traits may have a constant need for stimulation, which can lead to restlessness and difficulties with activities that require stillness or silence.

Presentations of ADHD

There are three different ways ADHD presents itself, depending on which traits (inattention, hyperactivity, and impulsivity) are strongest in the individual:

Predominantly Inattentive Presentation

This type is characterised by challenges in organising tasks, paying attention to details, and following instructions or conversations. People with this presentation are easily distracted and often forget daily routine details. It's often noticed more in girls, those who've had a head injury affecting the frontal lobe, and individuals with Autism Spectrum Disorder (ASD). Importantly, they are not usually hyperactive and generally don't cause disruptions in the classroom.

Predominantly Hyperactive-Impulsive Presentation

This presentation involves restlessness, like fidgeting, talking a lot, or not being able to sit still. People with this presentation find it hard to control their impulses, leading to impulsive actions. In kids, it might show as always running, jumping, or climbing. They struggle to wait their turn, interrupt others, and might be more accident-prone. As they grow up, hyperactivity often becomes more subtle, showing as restlessness and fidgeting.

Combined Presentation

This is the most common type of ADHD, where both inattentive and hyperactive-impulsive symptoms are present equally. People with this combined type face challenges with attention, behaviour, activity, and impulse control, with symptoms from both categories being equally noticeable. It's important to know that ADHD symptoms can change over time, and so can the presentation.

This video demonstrates the difficult level of concentration when someone has ADD/ADHD.

Watch: ADD/ADHD Simulator (3:48 minutes)

Pre-watch question

What challenges do you think people with ADHD/ADD might face when it comes to concentration?

Post-watch question

What impact did the video have on your understanding of ADHD? Did it increase your empathy for individuals with ADHD?

ADHD Presentation in Adults

ADHD traits often change in adulthood. While hyperactivity lessens, adults may still feel restless despite outward calmness. Inattentive traits tend to remain steady, yet adults can adapt their lives to their ADHD subtype.

Every adult with ADHD had it as a child. Some were diagnosed early, while others discovered it later.

Learning Activity - Teariki’s Journey with Adult ADHD

Instructions:

Create a Character

1. Make up an adult character named Teariki who has ADHD. 
2. Share basic details like age, background, family, education, and job. 
3. Ensure Teariki's traits and experiences match what's known about adult ADHD.

Characteristics

1. Describe Teariki's ADHD traits and symptoms.
2. Explain how these traits affect his daily life, relationships, work, and routines.
3. Research real ADHD characteristics for an authentic case study.

Challenges

1. Talk about Teariki's difficulties due to ADHD. 
2. Explore how his condition affects his personal and professional life. 
3. Use actual examples and scenarios that match challenges faced by adults with ADHD.

Presentation and Discussion

1. Share your well-researched case study on the class forum, choosing a presentation format like a report, PowerPoint, or video. 

Sharing your presentation - Step-by-step guidance:

Follow these steps to upload your presentation.

1. Go to the forum - ‘Share Your Work'.
2. Click ‘New thread’.
3. In the ‘Subject’ field, type the name of this activity and your name, e.g. 'Teariki's Journey with Adult ADHD'.
4. In the ‘Message’ field, write a brief summary about what you learned from this activity.
5. In the ‘Attachment’ box, you can either drag and drop your presentation file or you can search for it.
6. Click ‘Post to forum’.

The exact cause of ADHD is unknown, but it is believed to result from a mix of various factors. While we don't have all the answers about the causes and risk factors, recent research indicates the important role of genetics in ADHD. (NIH, 2021)

Let’s look more closely at some of the suspected causes:

Genetics and ADHD

Research indicates that genes play a substantial role in the development of ADHD, with studies revealing a strong genetic link between family members. If a person has parents, siblings, or close relatives with ADHD, their risk of having ADHD increases significantly (NIH, 2021). Children with siblings having ADHD are nine times more likely to have ADHD themselves and around 40% of parents with ADHD have children who also meet the criteria for an ADHD diagnosis (Uchida et al., 2020).

It's worth noting that ADHD isn't only about genes. Environmental factors also play a role in whether someone develops ADHD. Studies on twins show that if one twin has ADHD, it doesn't automatically mean the other twin will (Warren et al., 2023).

While ADHD's genetic connection is clear, it's not caused by just one gene, and how it is inherited is likely to be complex.

Brain Function, Structure and Chemistry

The ADHD brain may differ from the non-ADHD brain in three different ways: function, structure, and chemistry.

Brain Function

Recent ADHD research has highlighted differences in how the ADHD brain works compared to non-ADHD brains. Scientists using tools like functional Magnetic Resonance Imaging have found that in people with ADHD, certain parts of the brain linked to attention and impulse control often show irregular activity. This makes it challenging for them to stay focused, control impulses, and organise tasks effectively.

One interesting aspect of brain function involves what's called the 'default mode network', which handles activities like daydreaming and memory recall. Normally, this network is active when the brain is at rest and not focused on a specific task. But in people with ADHD, this brain network might stay overly active, making it harder to concentrate and pay attention to the task they need to do. (Rubia, 2018)

Brain Structure

New research has revealed differences in the structure of the ADHD brain. MRI scans have found changes in the size of certain parts of the brain, especially in areas deep inside. These differences are linked to the networks in the brain responsible for functions like attention, emotional control, and movement. The findings emphasise that ADHD isn't just about behaviour; it's also about how the brain is built.

Studies reveal that children with ADHD tend to have slightly smaller brains than those without ADHD. The brains of people with ADHD may also mature a bit slower. Certain parts of the brain, like the amygdala and hippocampus, seem to be smaller in people with ADHD, affecting how they process and regulate emotions. Other areas, like the frontal lobe, may also be smaller, causing challenges with attention, controlling impulses, and social interactions.

(Hoogman, Bralten, Hibar, et al. 2017).

The following video suggests ADHD occurs because the front part of the brain, called the prefrontal cortex, grows slower than normal. This slow growth in the prefrontal cortex makes it harder to control attention, behaviours, and emotions automatically.

Watch: Sarah on "What's ADHD?" (7:16 minutes)

The video uses brain imaging studies to show that ADHD is a real condition related to how the brain develops, encouraging us to accept and understand ADHD as part of our diverse ways of thinking and being.

Pre-watch question 

Are there any myths or misconceptions about ADHD that you've come across, and how have these influenced your perception of the condition?

Post-watch Task

Make your own notes explaining how the MRI and EEG studies in the video challenge common misconceptions about ADHD and reinforce the idea that it is a neurodevelopmental condition.

Brain Chemistry

Brain chemistry is about the balance of chemicals in the brain that affect mood and how the nervous system works. Recent research has been studying chemicals like dopamine and norepinephrine, which help with attention, focus, and controlling impulses. Dopamine is also connected to feeling pleasure, being motivated, getting rewards, moving, remembering things, and thinking.

People with ADHD often have less dopamine in their brains than those without ADHD. This might be because there are more dopamine transporters in people with ADHD, and this can make dopamine levels lower. When the pathways for dopamine don't work well in the ADHD brain, it can affect motivation and how they feel rewards. This could be why adults with ADHD find it hard to stay motivated. Despite extensive research, there are still many questions about how the ADHD brain is different from a non-ADHD brain.

The image shows that in people with ADHD, brain chemicals called neurotransmitters are less active in areas of the brain that control attention.  

Brain Injuries

Research has shown that traumatic brain injuries (TBIs), whether occurring in the womb or later in life, can affect the brain's functioning and lead to an increased risk of ADHD, particularly when the injuries are severe. A study involving children aged 3 to 7 years who were hospitalised overnight for TBIs found that approximately 62% of those with severe TBIs developed ADHD in the years following the injury, a condition known as secondary ADHD. (Narad et al., 2018)

Pre-Natal and Early Life Factors

ADHD has been associated with several prenatal and early life factors that may increase the risk of its development, although a direct cause-effect relationship is not proven. Some of these factors include:

Prenatal Complications

Alcohol consumption and maternal smoking during pregnancy have been linked to a higher likelihood of ADHD in children. Additionally, exposure to neurotoxins like lead and certain pesticides may contribute to ADHD. Low birth weight is another risk factor, with babies weighing under 3.3 pounds (1.5kg) having an increased chance of developing ADHD. (Franz, Bolat, Bolat et al., 2018).

Birth Complications

Certain factors during pregnancy and birth, like oxygen deprivation, caesarean delivery, and premature birth, have been linked to ADHD, although these complications don't directly cause ADHD, and more research is needed to understand the exact connections. 

Other pregnancy-related factors, such as maternal stress, health problems, trauma, and substance use, might also influence ADHD development. (Lingasubramanian et al., 2022)

ADHD often comes with other medical and psychiatric conditions, which we call co-morbidities. These additional challenges can complicate diagnosis and treatment. 

Imagine ADHD like an iceberg (Matthews, 2020). The visible tip represents the typical ADHD symptoms, while the submerged portion embodies various related challenges. About 75% of individuals with ADHD meet diagnostic criteria for another disorder and, on average, have three coexisting conditions alongside ADHD. These additional conditions may involve depression, anxiety, personality disorders, learning difficulties, substance abuse, and impulse control difficulties. 

There are three primary categories of ADHD co-morbidities, each varying in severity and having different causes:

Cortical Wiring Problems

These stem from structural issues in the cerebral cortex, which is responsible for higher-level brain functions. Examples include learning disabilities, language disabilities, motor difficulties, and executive function issues.

Emotion Regulation Issues

These encompass conditions like depression, anxiety disorders, anger-control problems, obsessive-compulsive disorder (OCD), and bipolar disorder. 

Tic Disorders

Tic disorders involve sudden, uncontrollable muscle movements. They can range from motor tics (like eye blinking or head jerking) to vocal tics (like grunting). In some cases, Tourette's syndrome, characterised by multiple, persistent motor and vocal tics, may be present.

Co-morbidity Statistics

Consider the following statistics for coexisting conditions in both children and adults. (CHADD, 2023)

Learning Activity - Coexisting Conditions in Both Children and Adults

In your own notes, complete the following:

1. Choose one comorbid condition (e.g., learning disability, anxiety, substance abuse) from the provided statistics. 
2. Explain why you find this condition interesting or significant. 
3. Select one age group (children or adults) to focus on. 
4. Analyse the prevalence of your chosen comorbid condition within this age group and provide possible reasons or factors that might contribute to the observed statistics. 
5. Discuss the potential implications of these findings for individuals affected by ADHD.

Diagnosing ADHD is a comprehensive process involving clinical evaluations, assessments, and psychological testing. There is no straightforward test to tell if you have ADHD, and many other issues can have similar symptoms.

Assessment Process

A complete ADHD evaluation has two main goals: first, to confirm if someone has ADHD and not some other cause for their symptoms, and second, to find any extra challenges like depression, dyslexia, autism, etc., that might be making things harder for them.

Only certain medical experts like a paediatrician, psychiatrist, neurologist, or clinical psychologist are qualified to assess and diagnose ADHD.

The assessment process for ADHD uses different kinds of evaluations to get a full picture of the person's symptoms and overall thinking and emotional profile. Here's a breakdown of the different assessment types:

• Clinical Evaluation: Gathering information from various sources to confirm ADHD symptoms and understand the individual's history.
• Screening Tools: Questionnaires like the Vanderbilt Assessment Scales and Conners' Rating Scales are used to assess and quantify ADHD symptoms.
• ADHD Rating Questionnaires: Assessing the severity of symptoms in the initial stages.
• Observation: Behavioural observations in various settings to confirm symptom consistency and severity.
• Mental Health Broad Screener Questionnaires: Identifying areas of focus for specialists, such as co-morbid conditions.
• Cognitive and Psychological Assessments: Evaluations to understand an individual's cognitive profile and rule out other conditions.
• Neuropsychological Assessment: Functional tests to explore specific cognitive aspects related to ADHD.
• Medical Examination: To rule out underlying medical conditions contributing to symptoms.
• DSM-5 Criteria: Diagnostic guidelines used for diagnosing ADHD, providing a comprehensive understanding of symptoms and behaviour.

Each assessment serves a specific purpose and may be administered at different stages of the evaluation process, depending on the person's needs and the clinician's judgment. 

Initial assessments help confirm ADHD is present, while further assessments, like cognitive testing and neuropsychological assessments, provide a deeper understanding of cognitive functioning and rule out other potential causes.  

Dr. Garth Smith discusses the challenges of diagnosing ADHD in this video, highlighting the vagueness of its symptoms and introducing a potential computer-based diagnostic tool that could provide earlier and more objective ADHD diagnosis.

Watch: Wondered why ADHD is a challenge to diagnose? (11:29 minutes)

Pre-Watch Question 

What do you already know about the challenges associated with diagnosing ADHD, and what makes the diagnosis process complex?

Post-watch task

Complete the ‘Three Takeaways’ task in the class forum.

Learning Activity - Wondered why ADHD is a challenge to diagnose? Three Takeaways

1. After watching the video, think about the three most important takeaways you gained from the video.
2. Express these takeaways in a concise and creative format. Some options include:
   1. Three-Sentence Summary: Write a three-sentence summary of your main takeaways.
   2. Visual Infographic: Create a simple visual infographic with icons or symbols representing your takeaways.
   3. Acrostic: Spell out the word "VIDEO" or "SMITH" and provide one takeaway for each letter. (You will need five takeaways.)
   4. Three Keywords: Choose three keywords or phrases that capture your takeaways and provide a brief explanation for each.
3. Share your 'Three Takeaways' with the class through the forum platform.

An ADHD diagnosis often brings relief and a pathway to managing the condition. While no cure exists for ADHD, various strategies can be adapted to address individual needs.  

Management plans will typically encompass:

Therapies and Behavioural Interventions

Ways to manage ADHD symptoms without using medication involve working with professionals like psychologists, therapists, ADHD coaches, or other experts. Here are some strategies:

• Behaviour Therapy: This includes training parents in managing behaviour, therapy for children, interventions in the classroom, peer support, and teaching organisational skills.
• Psychoeducation: Learn about ADHD, recognise when support is needed, and be kind to yourself.
• Cognitive Behavioural Therapy (CBT): Change thought patterns, feelings, and behaviours related to mood or concerns like anxiety or low mood.
• Executive Functioning Skills Training: Find the best ways to use your environment and tools for support.
• Occupational Therapy: Improve abilities like motor control, coordination, visual-spatial relationships, and self-concept.
• Speech Therapy: Useful for children with ADHD who have speech delays or advanced language skills.
• Nutritional Changes: Explore dietary changes, like reducing processed foods and adding nutrient-rich whole foods, to manage ADHD symptoms.
• Exercise: Regular physical activity can improve cognitive function, reduce hyperactivity, and promote healthy sleep.
• Chemical Sensitivity, Toxicity, Allergies: Be aware of exposure to chemicals and toxic metals, which can contribute to managing ADHD.

Parent Education and Support

Parents can adopt various management strategies to help manage their child's ADHD. Complete the following activity to view creative and fun activities that parents and children could do together to make each strategy an exciting adventure.

Learning Activity - Parent Management Strategies

Medication Considerations

Medication is a crucial component of ADHD treatment, with different options available according to the person’s age, symptom severity, and the level of impact on day-to-day functioning. 

In Aotearoa New Zealand, the medications used for treating ADHD differ slightly between children and adults, but the overall approach remains similar. 

The primary medications utilised include:

• Methylphenidate (Concerta, Ritalin, Ritalin LA, Rubifen) 
• Dexamphetamine (Dexamfetamine)   
• Atomoxetine (Strattera)

Methylphenidate usually stands as the preferred first-choice medication. (Healthify He Puna Waiora, 2023)

It is important to note that ADHD medications might not be suitable for individuals with specific medical conditions. In such cases, alternative treatment options will need to be explored.

Medications may not work for all ADHD symptoms or affect everyone the same way. A combination of medication, therapy, behaviour changes, and skills training is often the most effective treatment.  

The video highlights the limitations of ADHD medication in addressing all aspects of executive function, emphasises the importance of self-acceptance, and suggests that individuals with ADHD can improve executive function through various strategies, underscoring the need for a multifaceted approach to manage ADHD effectively.

Watch: What ADHD Medication Won't Fix (5:54 minutes)

Pre-watch question

Can you name some of the challenges associated with a deficit in executive function?

Post-watch task

The video talks about the importance of acceptance and understanding in managing ADHD. Do you agree with this perspective? Why or why not?

ADHD is not caused by factors such as sugar intake, excessive television watching, specific parenting styles, poverty, or family chaos. Research has debunked these common misconceptions and shown that while these factors may influence symptom severity, they are not the primary causes of ADHD.

Individuals with ADHD have varying levels of intelligence, just like the general population. The presence of ADHD does not imply a fixed level of intelligence, and people with ADHD can have a wide range of cognitive abilities. While ADHD is associated with developmental delays primarily in the prefrontal cortex of the brain, these delays do not affect overall intelligence, as your intelligence is determined by a combination of genetic factors and environmental influences.  

Vaccines and allergies are also not causes of ADHD. Research has not shown any direct link between getting vaccines or having allergies and developing ADHD. ADHD is a neurodevelopmental condition, and its causes are more related to genetics and brain development than to vaccines or allergies. It's essential to rely on scientific evidence when discussing the causes of medical conditions like ADHD.

The following videos follow the experiences of Katie and Brando in dealing with their ADHD. After watching both videos, complete the table comparing their experiences. 

Watch: Katie Harris Journalist. Sharing her personal ADHD story (4:03 minutes)

Katie, a journalist, surfer, and musician with ADHD, shares her journey of understanding and embracing her diagnosis, highlighting the challenges of diagnosis and the need to dispel stereotypes about ADHD to create a more accepting and supportive society.

Watch: Brando using his ADHD hyperfocus to achieve his goals (16:52 minutes)

Brando Yelavich shares his journey of living with ADHD, discussing his diagnosis, struggles with substance abuse, and how he turned his life around through nature, exploration, and embracing his ADHD as a superpower.

Learning Activity - Comparing Two Personal ADHD Stories

Compare the experiences of Katie and Brando in dealing with their ADHD by completing this table: Comparing Two Personal ADHD Stories - Worksheet. Use bullet points to make concise comparisons between Katie and Brando's experiences.

• ADHD is a neurological condition impacting attention, behaviour, and emotions.
• Types include inattention, impulsivity, and hyperactivity, with varied presentations.
• Causes involve genetic factors, brain function, structure, chemistry, and early-life influences.
• ADHD often coexists with other conditions, including mood disorders and learning disabilities.
• ADHD diagnosis involves comprehensive assessments by qualified experts, lacking a simple test due to symptom overlaps with other issues.
• Confirming ADHD presence and identifying additional challenges are the dual goals of the assessment process, employing various tools guided by DSM-5 criteria.
• Assessment Tools range from clinical evaluations to neuropsychological assessments, administered in stages for a comprehensive understanding.
• Collaboration with professionals for interventions like behaviour therapy, psychoeducation, and exercise is used to address ADHD symptoms.
• Medications like Methylphenidate are common, but a holistic approach, combining medication, therapy, and behaviour changes, is often more effective for comprehensive ADHD management.
• Common misconceptions include links to sugar, TV, parenting styles, and vaccines, all debunked by research.