ADHD

Attention Defecit Hyperactivity Disorder

ADHD is generally characterized as a psychiatric disorder which includes inattentiveness, low impulse control and hyperactivity. Symptoms of ADHD are usually present before the age of six, and so subsequently ADHD is defined as a developmental disorder (Centers for Disease Control and Prevention, 2023). The causes of ADHD are not fully known; however, it is plausible that genetics plays a role (Rivas-Vazques et al., 2023). For instance, research has shown that parents and siblings of a person with ADHD have an increased likelihood of having ADHD themselves. Still, the heritability of ADHD is complex and likely interacts with various other factors. (National Health Service, 2021). Some studies have suggested that the neurotransmitters dopamine (DA) and norepinephrine (NE) might not work properly for people with ADHD, or that there is an imbalance in the level of these chemicals in their brain. Other studies involving brain scans suggest that specific areas of the brain may be smaller or larger in people with ADHD. (Rivas-Vazques et al., 2023). Some data indicates that people with ADHD have abnormalities in their fronto-striatal circuits (neural pathways connecting the frontal lobe with the basal ganglia that control motor, cognitive and behavioral functions). (Rivas-Vazques et al., 2023)

Since one emblem of ADHD is low levels of dopamine, people with ADHD are chemically wired to seek more of this pleasure-producing neurotransmitter, making people with ADHD susceptible to eating disorders (Blum et al., 2008). This is exemplified by a study that demonstrates an increased dopamine release in binge-eaters in comparison to non-binge eaters when presented with food stimuli.

Individuals with eating disorders are up to five times likelier to abuse alcohol or illicit drugs, and those who abuse alcohol or illicit drugs are up to 11 times likelier to have eating disorders (The National Center on Addiction and Substance Abuse at Columbia University, 2003). Since one emblem of ADHD is low levels of dopamine, people such as Russell are chemically wired to seek more of this pleasure-producing neurotransmitter, making people with ADHD susceptible to eating disorders. This is exemplified by a study that demonstrates an increased dopamine release in binge-eaters in comparison to non-binge eaters when presented with food stimuli.

Underdiagnosis

Why ADHD is Underdiagnosed in Adults

The underdiagnosis of ADHD in adults is the result of the fact that research and understanding of the condition has been relatively recent. The DSM-4, published in 1994, classified ADHD as a neurodevelopmental disorder – something people grow out of. It was not until the DSM-5, released in 2013, that researchers recognized that although many adolescents outgrow ADHD symptoms, many do not. This led the Diagnostic and Statistical Manual to recognize the probable long-term course of the syndrome. (Lovett et al., 2021)

Still, adult ADHD continues to be widely overlooked, since hyperactivity itself usually declines with age and the symptoms of inattentive ADHD tend to be less noticeable. In addition, the strict criteria that an adult diagnosis cannot be made unless symptoms were present in childhood makes confirmation more challenging. As a result, less than 20% of adults with ADHD are properly diagnosed and treated (Barkley & Brown, 2008; Ginsberg et al., 2014). Unfortunately, these individuals are at an increased risk of developing comorbid depression, anxiety and substance abuse.(Rivas-Vazquez et al., 2023).

Why ADHD is Underdiagnosed in Girls

A 2007 study by Biederman et al. discovered that a higher male-to-female diagnosis ratio is present in clinical samples. Many differences are noted between girls and boys with ADHD. Girls are more likely to have Inattentive ADHD, which does not involve hyperactivity or disruptive behavior. As a result, females are often under- and misdiagnosed. In fact, girls with ADHD are frequently solely diagnosed with Anxiety Disorder, which may be due to the tendency to pathologize female emotional distress (Quinn et al., 2014).

Less than 20% of adults with ADHD are properly diagnosed and treated

ADD vs ADHD

ADD is a subtype of ADHD and is not formally listed within the DSM-V (American Psychiatric Association, 2013).

Earlier literature prior to the DSM-V suggests that ADD consists of attention deficit and is rooted in the posterior cortex or back of the brain, while ADHD is a cognitive deficit based in the front of the brain, where cognitive and behavioral functions are controlled (Arnsten et al., 2009). Approximately two thirds of people with ADHD have problems concentrating or focusing but do not experience hyperactivity or impulsiveness, meaning they fall within the ADD subtype. (NHS et al. 2021).

(Broadimage/Shutterstock)

Hilary Duff

Hilary Duff is an American actress, author and singer. She became famous at a young age as the main character in the Disney Channel show Lizzie McGuire from 2001 to 2004 and The Lizzie McGuire Movie. Duff successfully transitioned from teen idol and has appeared in numerous movies and TV series. She has also released five albums, topping the Billboard 200 Chart, with Metamorphosis. Additionally, she has co-authored a trilogy of New York Times best-selling novels and is involved in various businesses, including fashion lines, cosmetics, eye glasses, and children’s products. Duff’s awards include 7 Nickelodeon Kids’ Choice Awards, 4 Teen Choice Awards, and 2 Young Artist Awards.

Duff has said that her childhood was quite difficult due to her dyslexia and ADHD, which includes hyperactivity and with which she was diagnosed in the 1st grade. She continues to take medications for ADHD as an adult. (HoodMWR, 2023) Duff has also struggled with anorexia. She has stated that towards the end of the run of Lizzie McGuire, at 17 years old, she weighed only 96 lbs and was obsessed with food and being skinny. (People Magazine, 2022) Duff now has three children and says she has learned to embrace her naturally athletic frame.

Diagnostic Criteria

Adults

Typically, general practitioners refer adults with possible ADHD for an assessment if:

Symptoms began during adolescence and continue
A mental health condition does not explain the symptoms
Symptoms significantly affect daily life (Centers for Disease Control and Prevention, 2023)

Children

In order to be diagnosed with ADHD, a child must exhibit 6 or more symptoms of hyperactivity and impulsiveness, or 6 or more symptoms of inattentiveness (Cabral et al., 2020).

For hyperactivity/impulsivity these are:

Fidgets excessively
Cannot stay seated
Feels restless
Cannot play quietly
Always “on the go”
Talks excessively
Impatiently blurts out answers
Cannot await turn, interrupts

For inattention, they include:

Fails to pay attention to details
Cannot sustain attention
Does not seem to listen when spoken to
Cannot follow instructions/fails to complete work
Cannot organize tasks
Avoids tasks that require concentration
Loses things
Is easily distracted
Is forgetful in daily activities

Additional criteria (Center for Disease Control, 2023)

Symptoms are:

Present before the age of 12
Continue for at least 6 months
Occur in at least 2 different environments, for example both home and school
Are considered to significantly interfere with functioning socially or academically
Cannot be better explained by a mental health condition, another developmental disorder or a phase of adolescence