The Clinicians’ Guide to Differential Diagnosis of ADHD is a clinical compendium from Medscape, MDEdge, and ADDitude designed to guide health care providers through the difficult, important decisions they face when evaluating pediatric and adult patients for ADHD and its comorbid conditions. This guided email course will cover the following topics:

• DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
• DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
• DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
• DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
• DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
• DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
• DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

NOTE: This resource is for personal use only.

Like most moms, I can clearly recall the moment my baby was first placed into my arms. It was real… She was here! Ten fingers, ten toes, bright eyes, and a cute little mouth with pink, bowed lips. She was perfect. My urge to protect her and offer her the happiest life possible was immediate.

Looking back, almost 15 years later, I can see I was brimming with the idealism innate to most all new parents. Our babies often represent a fresh start, a clean and bright beginning. The hopes we project onto them are inevitable. But life almost always has other plans.

Releasing the Myth of the Perfect Childhood

When my daughter was 2, I realized that I needed to leave my marriage. I left with no savings, assets, or job. When she was 4, my mother had a massive brain hemorrhage. After my mother died, my stepfather was in an accident and required care before eventually also dying. I battled through graduate school during this time.

I noticed that my daughter was unique as she reached school age. She was brilliant, verbose, and creative, but also different in her behaviors. She began to have massive meltdowns after school every day — tears, tantrums on the floor, and generally losing her shit, especially if homework was on the table.

Though she was extremely bright and an early reader, tearing through Harry Potter books in second grade, she also struggled in the classroom. It was hard for her stay on task, and she got out of her seat during lessons. I struggled to reconcile how my child, who was reading at an adult level and had unusually mature social insights, could also be so messy, irritable, disruptive, and so often unable to focus. As I searched myself and the world for an answer, I took the road we so often do as mothers. I blamed myself. Even my experience as a therapist and years of studying child psychology couldn’t help with the huge blind spot I had when it came to my own kid.

[Read: Why ADHD in Girls Is Often Overlooked]

Maybe it was because of the divorce — or because of my grief. Maybe I had spent too much time studying. I read to her every night, but maybe if I had focused more on math, she would be doing better with it. Essentially, I blamed myself for everything.

Consulting the Experts

As I tried to gather more info from “the experts,” I felt even worse. Seasoned parents told me that my daughter was disrespectful and needed a firm hand. School meetings, where I faced a row of teachers telling me about behavioral issues, left me feeling as though I was on trial. Even meeting with child therapists for consults confused me, since they’d only tell me that my daughter was precocious and creative and seemed to have a high IQ, but they did not otherwise offer any concrete help.

I pushed my daughter into martial arts, amped up her nutrition, discussed her ongoing issues with my mental health colleagues, and tried different therapists. Deep down, I saw her struggles as my own shortcomings. I was exhausted — and it didn’t help that she slept erratically.

Without answers, my daughter’s struggles worsened. Things had spiraled into a hatred for school, difficulty with activity transitions, trouble with organizational tasks, panic attacks, and even thoughts of self-harm.

[Read: 5 Things Every Doctor (and Parent) Should Know about Girls and ADHD]

It was our pediatric primary care provider who finally brought up ADHD. Could it really be that my daughter’s brain just needed some extra dopamine? ADHD ran in my family and in her father’s family as well. I began to wonder what a pediatric ADHD prescription would do.

As it turned out, it did a lot. Once we found the right medication and dose, the world opened up for my daughter. Her anxiety quieted. Her focus improved. Thoughts of self-harm and panic attacks receded. What’s more, she he was having fun. Life wasn’t a constantly overwhelming battle. We could both breathe.

Advocating for Girls with ADHD

I wondered why my daughter’s diagnosis had been so hard to arrive at and why it had taken so long, even for me, a mom and a trauma-informed therapist with a clinical degree. As I reviewed research on ADHD, things became clearer.

We often think of wild and unruly boys when we picture ADHD. The reality is that many girls are also silently suffering with ADHD without any understanding or support. That’s why ADHD is more commonly diagnosed in boys and is often underdiagnosed in girls. Educator and medical provider bias may also contribute to this.

Girls are more often misdiagnosed (or only diagnosed) with depression or anxiety. Socialization patterns may also be a factor. Some researchers theorize that girls are more likely to “mask” ADHD symptoms. This is particularly concerning, because research indicates that ADHD in girls is correlated with more severe pathologies such as self-harm and major depression. These unique risks mean that our girls are in danger if an ADHD diagnosis is missed or delayed.

Today, my daughter is thriving. In my clinical work, I now advocate for girls to be automatically screened for ADHD if they are struggling with what seems like anxiety or mood dysregulation. I wish I had the information I have now when my daughter was in her early grade school years. I’m grateful, however, that I now have the awareness to fight for her and for other girls.

Girls’ Mental Health and ADHD: Next Steps

• Self-Test: ADHD Symptoms in Women and Girls
• Read: Stop the Cycle of Shame for Girls with ADHD
• Read: I Searched So Hard for ADHD That I Missed All the Signs

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Half of all women with ADHD receive a misdiagnosis or an incomplete diagnosis before finally identifying and treating their attention deficit disorder. This staggering statistic, revealed in a recent ADDitude survey of 2,760 women, confirms the anecdotal reports we hear often of medical gaslighting, distrust of self, unnecessary suffering, delayed treatment — and the grave consequences of each.

“I was misdiagnosed and received treatment that did not help me,” wrote one survey respondent misdiagnosed with depression and anxiety. “This led to me never getting better and ending up having a mental breakdown before I got my proper ADHD diagnosis 10 years later.”

“I believe if, instead of being diagnosed with bipolar 2 (cyclothymia), anxiety, and depression, I had been appropriately diagnosed with ADHD and given coping skills and treatment for that, my life would be completely different,” wrote another ADDitude reader.

“Antidepressants worked for a while, but my anger and frustration flare-ups were still an issue,” wrote a woman diagnosed with ADHD in her 50s. “Eventually, the antidepressants didn’t work anymore and I hit bottom… By the time I was diagnosed with ADHD, I was on long-term disability and felt I had no control over my life.”

The reasons for incomplete or inaccurate diagnosis range from outdated ADHD and gender stereotypes to low self-esteem and self-trust, seeded by years of criticism for unrecognized and untreated symptoms of ADHD, according to ADDitude‘s Women’s Health Month survey.

“Not being able to verbalize my emotions well continues to be a difficulty, likely due to not being able to trust my own emotions, whether they are valid or an under or over reaction,” wrote an ADDitude reader misdiagnosed with bipolar disorder. “In my opinion, this led to being misdiagnosed.”

This prevalent and debilitating roadblock to an ADHD diagnosis was a topic of discussion with Olympic marathon medalist Molly Seidel during her recent conversation with WebMD about barriers to mental health care for women.

“I wish that I had been more vocal about exactly how I was feeling earlier, because we might have gotten to the solution a lot earlier,” said Seidel, a world-class professional runner who was diagnosed with obsessive compulsive disorder and eating disorders before finally receiving an ADHD diagnosis a few years ago. “Especially as women, a lot of us are willing to almost gaslight ourselves by saying, ‘Oh it’s not really that bad.’ And then you look objectively at it, and you’re like, ‘No, this is objectively pretty bad and there has to be a better way to live than this.’”

For Seidel, an ADHD diagnosis was nothing short of life changing.

“My diagnosis came with such a sense of relief from knowing, Oh my God, there is a reason why I feel the way I feel. Maybe I’m not just thoroughly messed up and thoroughly a terrible person. My brain just works a little bit differently,” said Seidel, who earned the bronze medal in the Olympic marathon in Japan. “That diagnosis was the most freeing thing and the thing that has gotten me to the place that I am now.”

“What it took me years to figure out is that, if you are just trying to treat the symptoms and not addressing the underlying causes, it will just tend to jump from diagnosis to diagnosis to diagnosis,” said Seidel, who reported that she’s “in a much better and more stable place than I’ve been in a long time.”

Seidel’s ADHD treatment plan today includes mindful meditation, fine-tuned nutrition, miles upon miles of exercise, and therapy.

“Ultimately, the point of therapy is learning to have a better relationship with your own brain and understanding the mechanisms by which your brain works,”she said. “That has been the biggest thing in becoming more confident and trusting myself.”

ADHD Diagnosis in Women: Next Steps

• Self-Test: ADHD Symptoms in Women and Girls
• Read: Why ADHD in Girls Is Often Overlooked
• Read: Why Women with ADHD Feel Disempowered — And What We Can Do About It

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Physical activity can significantly reduce depressive symptoms in children and adolescents, according to a recent study published in JAMA Pediatrics. ¹

The meta-analysis of 21 studies involving 2,441 participants (47% boys and 53% girls) between the ages of 11-19 found that physical activity may help alleviate depressive symptoms in young patients. Twelve of the studies also demonstrated the benefits of physical activity for participants with a somatic or psychiatric disorder such as depression, obesity, ADHD, and diabetes.

The findings revealed that physically active teenagers experienced more notable reductions in depressive symptoms than did younger participants. “It is possible that younger children are sufficiently active to be desensitized to additional physical activity, whereas their older and more sedentary counterparts might be more responsive to the intervention,” researchers said.

After analyzing the frequency and duration of physical activity, researchers determined that engaging in three sessions of physical activity lasting at least 30 minutes yielded the greatest improvement in depressive symptoms.

“Depression is the second most prevalent mental disorder among children and adolescents, yet only a small proportion seeks or receives disorder-specific treatment,” researchers said. “Physical activity interventions hold promise as an alternative or adjunctive approach to clinical treatment for depression.” ²

Benefits of Physical Activity for Comorbid Conditions

The study suggests that physical activity may also alleviate comorbid symptoms of anxiety and ADHD, which impact 75% and 57% of children with depression, respectively.³,⁴

This finding echoes that of a 2017 ADDitude survey, which found that 37% of children with ADHD manage their symptoms with daily exercise. Roughly half of the respondents rated exercise as an “extremely” or “very” effective treatment — the highest rating of any ADHD treatment included in the survey.

“Any aerobic activity, especially outdoors, helps our daughter,” said one ADDitude reader recently surveyed on the impact of exercise. “Within a day or two of not doing anything, she gets depressed.”

“We see great improvements in our son after physical activity,” said another parent. “The depression can really take hold, even though he is only 10. We homeschool, so our son and I both have YMCA memberships and attend at least three times per week. He enjoys the elliptical, rower, spin bikes, automatic stepper, and treadmill.”

Most ADDitude reader panelists called exercise an effective form of treatment, but many said that inducing their children to participate in physical activity is challenging.

“My teenage daughter has depressive symptoms, and we see her mood improve when she is active, but it took her a long time to start exercising,” said one parent. “She used to play tennis and soccer and ski, but when she went to college, she stopped exercising.”

Physical activities must be regular and consistent to maintain their mental-health benefits, according to ADDitude readers. “In just a few short months, I see the absence of physical activity in his life magnifying all his depressive symptoms,” one parent said.

“I see an improvement in her behavior with more physical activity, but I could not say I’ve noticed any direct correlation with her mood,” said another parent. “However, I notice that her mood and behavior deteriorate when she’s less active or getting too much screen time. She does martial arts once a week and seasonally participates in soccer or t-ball. We’re adding family yoga in a few weeks.”

“My son always does better when he moves but, unfortunately, it is very difficult to get him going,” wrote another parent. “I notice after shooting hoops he is much calmer and in a better mood, so I try to encourage him to get out and do it.”

However, exercise is not a universal cure. Of ADDitude survey respondents, 5% found exercise “not very” or “not at all affective” in addressing ADHD symptoms.

“Physical activity does not have a sustained effect on his depression or intense feelings,” said one ADDitude reader panelist. Said another, “The positive results of physical activity last as long as the activity occurs, then fade fast.”

One parent explained that physical activity negatively impacted her child’s symptoms. “Physical activity does not help her — it actually makes it worse. She needs more mental activities to help her, such as puzzles, card games, or workbooks. Those are things that help regulate and reduce her symptoms.”

Sources

¹Recchia F., Bernal J.D.K., Fong D.Y., et al. (2023). Physical Activity Interventions to Alleviate Depressive Symptoms in Children and Adolescents: A Systematic Review and Meta-analysis. JAMA Pediatr. https//doi.org/10.1001/jamapediatrics.2022.5090

²Erskine H.E., Baxter A.J., Patton G., et al. (2017 ). The Global Coverage of Prevalence Data for Mental Disorders in Children and Adolescents. Epidemiol Psychiatr Sci. 26(4):395-402. https://doi.org/10.1017/S2045796015001158

³Angold, A., Costello, E.J. (1993). Depressive Comorbidity in Children and Adolescents: Empirical, Theoretical, and Methodological Issues. Am J Psychiatry. 150(12):1779-1791. https://doi.org/10.1176/ajp.150.12.1779

⁴Birmaher, B., Brent, D., Bernet, W.,  et al. (2007). AACAP Work Group on Quality Issues. Practice  Parameter for the Assessment and Treatment of Children and Adolescents with Depressive Disorders.  J Am Acad Child Adolesc Psychiatry. 46(11):1503-1526. https://doi.org/10.1097/chi.0b013e318145ae1

Virtual reality (VR) games may be used to accurately and objectively diagnose ADHD symptoms in children, according to a team of Finland-based researchers. Their newly developed VR game, Executive Performance in Everyday LIving (EPELI), performed better than standard behavioral tests in distinguishing children with ADHD from those without ADHD in a small study of 76 subjects. According to the study, “EPELI showed predictive validity as the ADHD group exhibited higher percentage of irrelevant actions reflecting lower attentional-executive efficacy and more controller movements and total game actions, both indicative of hyperactivity-impulsivity.”¹

Unlike the questionnaires, interviews, and clinical observations commonly used to assess ADHD, EPELI simulates tasks that occur in everyday life. Players are asked to remember to engage in simple tasks like brushing their teeth or eating a banana despite distractions in the environment.

“The game measures everything: how much the child clicks on the controls and how efficiently they perform the tasks,” says Topi Siro, the developer of EPELI. “Efficiency correlates with everyday functioning, where children with ADHD often have challenges.²

How EPELI Gauges ADHD

EPELI presents 13 task scenarios to players over 25 to 35 minutes. Each scenario includes one general topic (e.g. morning routines) and 4 to 6 subtasks (e.g. wash hands). Participants engage in an instruction phase and execution phase for each scenario. The execution phase must be completed within 90 seconds.

A previous study of EPELI successfully distinguished children with ADHD from a neurotypical control group.¹  That research was recently replicated in a study published by Nature, but with an added behavioral marker: visual attention.³ Children played EPELI followed by a second VR game called Shoot the Target. The latter tracked eye movement by asking participants to “shoot” virtual objects with their gaze.

Liya Merzon, a doctoral researcher at Aalto University, said this proved to be “an effective way of detecting ADHD symptoms.”

“The ADHD children’s gaze paused longer on different objects in the environment, and their gaze jumped faster and more often from one spot to another. This might indicate a delay in visual system development and poorer information processing than other children.”²

Practical Applications of VR for ADHD

In a recent ADHD Experts webinar on this topic, Randy Kulman, founder of LearningWorks for Kids, explained why VR games may offer a more comprehensive and useful way to measure ADHD behaviors.

“As somebody who does assessments on a regular basis, I know that the tools I use — like the Continuous Performance Test, tests from the NEPSY, the Auditory Attention and Response Subtest — are only capturing certain kinds of things from the kids. And some of it involves observation and hand-scoring,” Kulman said. “Whereas when you are using VR to assess kids with ADHD, you’re picking up on everything. You’re picking up on their eye movement. You’re seeing how quickly they actually respond. You’re seeing what they do when there are transitions. You’re seeing how much they’re actually looking or paying attention to distractors.”

Erik Seesjärvi, a doctoral researcher at the University of Helsinki and clinical neuropsychologist at Helsinki University Hospital, said EPELI is available for professionals to use in their clinical work and that “the experience has been very positive.”

“All of the neuropsychologists who answered a feedback survey after the first pilot said they had benefited from using virtual reality methods as a complementary tool in their work.”²

Its creators say EPELI could be used to understand and assess other conditions including age-related diseases, autism, language problems, brain trauma, adult ADHD, and cerebral palsy.

VR is being used more commonly today in ADHD treatment. Companies like XRHealth and Amelia Virtual Care are using VR in their mental health treatment practices, and several research centers are now investigating the efficacy of VR treatments in improving ADHD symptoms such as working memory, executive function, and cognitive processes. Though further research is needed, initial analyses conclude that “this technology, by simulating and providing a virtual environment for diagnosis, training, monitoring, assessment and treatment, is effective in providing optimal rehabilitation of children with ADHD.”⁴

Virtual Reality Games for ADHD: Next Steps

• Download: Free Guide to Brain-Boosting Video Games
• Download: Expert Overview of Common ADHD Diagnosis Mistakes
• Read: FDA Approves First-Ever Game-Based Therapy for Attention
• Read: Akili Expands Prescription Digital Therapeutics Portfolio with TALi Partnership

Sources

¹Seesjärvi, E. et al. (2021). Quantifying ADHD symptoms in open-ended everyday life contexts with a new virtual reality task. J. Atten. Disord. https://doi.org/10.1177/10870547211044214

²Salmitaival, J. P. S., Merzon, L., & Seesjärvi, E. (2022, December 20). Virtual reality game to objectively detect ADHD. Aalto University. https://www.aalto.fi/en/news/virtual-reality-game-to-objectively-detect-adhd

³Merzon, L., Pettersson, K., Aronen, E.T. et al. (2022). Eye movement behavior in a real-world virtual reality task reveals ADHD in children. Sci Rep 12, 20308. https://doi.org/10.1038/s41598-022-24552-4

⁴Bashiri, A., Ghazisaeedi, M., & Shahmoradi, L. (2017). The opportunities of virtual reality in the rehabilitation of children with attention deficit hyperactivity disorder: a literature review. Korean journal of pediatrics, 60(11), 337–343. https://doi.org/10.3345/kjp.2017.60.11.337

ADHD medications — both stimulants and non-stimulants — do not place patients of any age at greater risk for cardiovascular events such as heart failure and hypertension. This groundbreaking finding comes from a new meta-analysis of 19 observational studies, including 3.9 million participants, that found no statistically significant association between ADHD medications and cardiovascular disease (CVD), even among middle-aged and older adults.¹

The analysis, published November 23 in JAMA Network Open, is the most comprehensive systematic review and meta-analysis of longitudinal observational studies to date on the association between ADHD medication use and the risk of CVD. It included patients from the United States, South Korea, Canada, Denmark, Spain, and Hong Kong. It found no associations between ADHD medication use and a higher incidence of CVD, however, it did recommend further research on the risk of cardiac arrest and tachyarrhythmias among female patients and patients with pre-existing CVD.

“The results of this meta-analysis suggested no statistically significant association between ADHD medication use and the risk of any cardiovascular events across age groups, although a modest risk increase could not be excluded, especially for the risk of cardiac arrest or tachyarrhythmias,” the study authors wrote. “Therefore, clinicians should discuss with their patients and families the possible cardiovascular risk of ADHD medication in light of the latest evidence, and they should rigorously follow clinical guidelines that suggest monitoring of blood pressure and heart rate at baseline and each medication review.”

Clinicians should not outright disallow ADHD medication for adult patients, according to the JAMA findings. This represents a stark change to the status quo for many medical practitioners who have ruled out stimulants and non-stimulants due to fear of cardiovascular side effects, said William Dodson, M.D.

“Since I have been in the ADHD field, I’ve had to battle the false belief perpetuated by the FDA that the stimulant medications were somehow cardiotoxic despite not having the slightest evidence that they were toxic at all,” said Dodson, who led an ADDitude webinar in April 2022 titled, “Why Adults with ADHD Abandon Medication.” “The only effect that these medications have on the cardiovascular system is that if the dose is too high or you’ve added a stimulant on top of a finely tuned dose, it’s going to increase the blood pressure and increase the heart rate. That’s it.”

In recent correspondence with ADDitude, Dodson called the JAMA meta-analysis “the most important article in the last decade” in ADHD medicine and heralded it as a “turning point,” particularly for older adults who have been unable to treat their ADHD with medication due to fears of cardiovascular side effects.

“This is probably the single biggest false belief about ADHD medications… Taking stimulant medications does not increase your cardiovascular risk at all, zero, nothing,” Dodson said. “Cardiologists know that these medications are not dangerous and that there is lots of research to support that.”

However, in a JAMA editorial published alongside the recent finding, Roy C. Ziegelstein, M.D., advised clinicians to proceed with caution. He expressed the need for further research into elderly patients, as well as women and individuals with pre-existing CVA. He also sought data broken out by race and ethnicity, and comorbidities.

“Although the study by Zhang et al. is reassuring in many ways,” wrote Ziegelstein, a cardiovascular disease expert at Johns Hopkins University School of Medicine, “health care professionals must carefully weigh these factors when prescribing ADHD medications, especially to older adults, individuals with established CVD, and those with other comorbidities that increase CVD risk.”

Sources

¹Zhang L, Yao H, Li L, et al. (2022). Risk of Cardiovascular Diseases Associated with Medications Used in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis. JAMA Netw Open. https://doi.org/10.1001/jamanetworkopen.2022.43597

The benefits of ADHD medication are well-documented: Children with ADHD are more likely to improve their focus and academic performance when receiving proper ADHD treatment. Effective treatment can also help boost a child’s self-esteem and enhance their ability to form long-lasting friendships.

Many parents can identify the most common medications used to treat ADHD, but they might be surprised to learn that more than 40 medications have been shown to effectively treat ADHD. How do you choose the best treatment option for your child, with all these options available? A healthcare provider who understands ADHD will recognize the unique characteristics of each medication and use that knowledge to recommend a treatment strategy tailored to your child’s specific needs. But even caregivers with the best treatment teams should understand their options.

In this webinar, you will learn about:

• Research into the efficacy of ADHD medication for treating the core symptoms of ADHD, including inattention, distractibility, hyperactivity, and impulsivity
• Why there are so many medications available to treat ADHD and how they differ
• How your child’s health care provider determines which medication may serve them best
• ADHD medication side effects and how they can be mitigated
• The findings of 20 years of research involving the effects of medication on the ADHD brain from childhood into adulthood

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How to Treat ADHD in Children: Next Questions

1. 1. What ADHD medications are used to treat children?
      • What are all of my ADHD medication options?
      • What are the most popular ADHD medications?
      • How does ADHD medication work?
      • How do ADHD medication formulations and delivery systems differ?
      • What are the benefits and risks of ADHD medication?
   2. Is ADHD medication right for my child?
   3. What are common side effects associated with ADHD medication?
   4. What natural treatments help kids with ADHD?
   5. How can I find an ADHD specialist near me?

Obtain a Certificate of Attendance

If you attended the live webinar on January 19, 2023, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker:

Walt Karniski, M.D., is a developmental pediatrician, trained at Boston Children’s Hospital. He was director of the Division of Developmental Pediatrics at the University of South Florida in Tampa, Florida, for fifteen years. He then opened a private practice and for twenty years, evaluated and treated children with ADHD, autism, anxiety, learning disabilities, and other developmental difficulties. During that time, he developed and operated three private schools for children with ADHD, anxiety, and learning disabilities. Over the forty years he has been practicing, he has evaluated and treated close to ten thousand children, conducted numerous studies of brain activity in children, and has been director of a child abuse program and a program for enhancing development in children born prematurely. Dr. Karniski approaches each child as a unique individual, with distinctive strengths and weaknesses, where the diagnosis does not matter as much as understanding the specific needs of that child. His new book is ADHD Medication: Does It Work and Is It Safe? (#CommissionsEarned) (Roman & Littlefield, May 15, 2022).

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

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The scene is raw, heart-wrenching, and relatable to parents of children with attention deficit hyperactivity disorder (ADHD) — including Emmy-nominated executive producer Nancy Armstrong, who drew inspiration for the film from raising her children with ADHD.

The Disruptors follows five households affected by ADHD, throwing into plain view the daily realities of parenting neurodivergent children. Viewers meet Emily, a mother who was “super-offended” when a teacher suggested that her son might have ADHD, and Briana, who recognized ADHD symptoms in her six-year-old son after receiving her own ADHD diagnosis.

[Self-Test: Does My Child Have ADHD? Symptom Test for Kids]

“ADHD is the number one searched term on the Internet,” says Dale Archer, M.D., author of The ADHD Advantage: What You Thought Was a Diagnosis May Be Your Greatest Strength(#CommissionsEarned), but misinformation prevails. The Disruptors dispels many ADHD misconceptions and explains the brain chemistry of ADHD through easy-to-understand animated segments and interviews with ADHD experts and ADDitude contributors like Russell A. Barkley, Ph.D.; Thomas E. Brown, Ph.D.; Ellen Littman, Ph.D.; Edward (Ned) Hallowell, M.D.; and others.

But this is not a doom-and-gloom ADHD documentary. The film successfully strikes a balance between hardship and hope by carefully reframing ADHD symptoms as “superpowers.” (For example, Hallowell says, “Impulsivity done right is creativity” and “Distractibility is curiosity.”)

The Disrupters highlights some of the most creative innovators of our time who had ADHD symptoms (e.g., Thomas Edison, Albert Einstein, Andrew Carnegie). Snippets of interviews with celebrities, athletes, and business owners with ADHD — including Paris Hilton, Scott Kelly (former NASA Astronaut), Howie Mandel, David Neeleman (JetBlue and Breeze Airways founder), Michelle Carter (three-time Olympian), and NFL legend Terry Bradshaw — demonstrate how real-life role models overcame ADHD-related adversity to achieve success.

However, the biggest takeaway from the film is this: the importance of unconditional love. “The way forward for families with ADHD is don’t lose sight of the relationship,” Barkley says. “Stop longing for the child you thought you wanted when you were pregnant and accept the child you have. Take it as your mission as their shepherd to help them develop those talents and focus on your relationship with them over everything else because that will sustain them and you.”

The Disruptors is available on iTunes/Apple TV, Amazon Prime, and Google Play.

The Disruptors ADHD Documentary: Next Steps

• Free Download: Guide to Debunking Annoying ADHD Myths
• Read: What Is ADHD? Symptoms Explained
• Watch: “Is ADHD Real?”7 Myths (and Truths) About ADHD

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

A rush of energy, frenetic action, and then a crash — the hyperactive ADHD cycle. Though more commonly associated with the inattentive subtype, women do experience ADHD hyperactivity — as well as related stereotypes and sexism. Here, ADDitude readers tell us their stories as women with ADHD hyperactivity, from rush to crash.

“Growing up, being undiagnosed in the ‘70s meant I learned to fidget in place. Getting up and moving wasn’t allowed. Disrupting a meeting wasn’t allowed. People say I’m not hyperactive, but if they watch me for five minutes they’ll see my feet wiggling or bouncing, my hands fiddling with something, and me changing positions constantly. I cannot be still. Ever. It’s exhausting sometimes.” — An ADDitude Reader

“As a child, my symptoms were talking loud, talking a lot, coming alive at night, and needing very little rest. At about 18, my ADHD turned inward and now it feels like this constant knot in my stomach, like I have stage fright every day. I still talk loud, and a lot, but I need a lot of rest these days.” — Emma, Australia

“The activity in my head is constant, so my body jumps from one task to another, adding more tasks to the list as I go. As I’ve gotten older, I force myself to sit down in the evenings with my husband and watch television. When he’s not around, I continue on doing — keeping busy until I drop at bedtime. Then I’m dead to the world and nothing can wake me.” — Anna, Ireland

“As a child the hyperactivity manifested mostly through impatience, the inability to sit still, and fidgeting with everything around me. I often had this ‘excited’ type of feeling inside my chest. I just couldn’t contain it and it was impossible to not move. Once I transitioned to adulthood, the hyperactivity definitely got more subtle. At times, I still have that excited feeling in my chest that forces me to abruptly walk away mid-conversation.” — An ADDitude Reader

[Free Download: Secrets of the ADHD Brain]

“ADHD feels like energy. It affects my mind, thoughts, actions, and activity level all at once. It has urgency and makes me feel anxious. I need to do things right away. It is sporadic and unorganized at the same time. I’ve always had a very active mind, and I am easily excitable. I need to do things very quickly, in bursts. The energy will fade out once I’ve hit a wall or have to go to bed. Sometimes I wish I didn’t have to sleep.” — Amy, North Carolina

“For me, hyperactivity impacts both my actions and thoughts. The morning can be a double-edged sword because I have boundless energy and intentions to get everything done, but I find it hard to settle myself down to do the things that have to be done. Much of the time that causes anxiety.” — Toni, Canada

“My hyperactivity feels like I had too much caffeine — racing heart, alertness, and an inability to say no when presented with any opportunity. I feel like I just have this internal tank that never runs out of gas. I am constantly needing to go somewhere or do something.” — An ADDitude Reader

“I want to sprint. I want to do all the things and so I do. I chat. I worry. I run. I smash out a boxing bag. I take on too much, which helps me keep all the balls in the air until I drop them all at once and need a holiday.” — An ADDitude Reader

“I was extremely hyperactive as both a child and an adult. A brain injury stopped much of my physical activity for years, and my hyperactivity became much more mental after that — I have a mind that literally never shuts off. I need to do something like reading or crosswords even while watching a TV show. Doing two things at once is a necessity.” — An ADDitude Reader

ADHD Hyperactivity in Women: Next Steps

• Read: What Happens When Hyperactivity is Trapped Inside
• Watch: How ADHD Shapes Your Perceptions, Emotions, and Motivation
• Download: Get a Grip on Tough ADHD Emotions

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A new electronic health records (EHR) algorithm, which can differentiate attention deficit hyperactivity disorder (ADHD) from comorbid conditions in children, may lead to more accurate diagnoses and treatment interventions. According to findings published in the journal Neurodevelopmental Disorders, more than half of children with ADHD have one comorbidity or more. This has confounded clinicians who’ve had trouble discerning whether a patient’s symptoms were caused by ADHD or comorbidity.¹

Given the prevalence of ADHD comorbidities, researchers from the Center for Applied Genomics (CAG) at Children’s Hospital of Philadelphia (CHOP) developed a multi-source EHR rule-based algorithm with natural language processing (NLP) test mining to provide a comprehensive view of a patient’s medical record. Using electronic health records and data from CHOP, and data from the CAG between 2009 and 2016, the research team performed a retrospective case-control study on a total of 51,293 patients aged eight and older. Of those, 5,840 were diagnosed with ADHD; among those cases, 46.1% had ADHD alone, and 53.9% had ADHD along with at least one comorbidity.

The algorithm had a positive predictive value of 95% for ADHD and 93% for controls, and it had a positive predictive value ranging from 60% to 100% for comorbid conditions. The higher number of patients with comorbidities, such as anxiety (27.1% of ADHD cases) and autism spectrum disorder (15.1% of cases), yielded more accurate results. Other comorbidities observed in the cohort included learning disorders (11.8%), conduct disorder (10.1%), and oppositional defiant disorder (9.1%).¹

ADHD keywords did not significantly help distinguish patients. However, ADHD-specific medications on EHRs did — it increased identified cases by 21%.

Although the algorithm is in the early stages of development, researchers recommend implementing it in genomics and discovery-based studies. “With the high positive predictive values achieved by this algorithm, we believe we have developed a robust and useful tool for identifying appropriate datasets and successfully distinguishing between groups of patients,” said Hakon Hakonarson, M.D., Ph.D., director of the Center for Applied Genomics at CHOP and senior author of the study. “It’s possible that these groups with or without comorbidities may respond differently to medication, which could help us design better and more effective methods for therapeutic interventions.”

Source

¹Slaby, I., Hain, H. S., Abrams, D., Mentch, F. D., Glessner, J. T., Sleiman, P., & Hakonarson, H. (2022). An electronic health record (EHR) phenotype algorithm to identify patients with attention deficit hyperactivity disorders (ADHD) and psychiatric comorbidities. Journal of neurodevelopmental disorders, 14(1), 37.
https://doi.org/10.1186/s11689-022-09447-9

In truth, considerable overlap exists between dyslexia and ADHD – from reading challenges to heritability – and both conditions frequently co-occur. ADHD and dyslexia are both linked to problems in school and with learning, but for different reasons. Ultimately, these overlapping traits complicate evaluations for ADHD and dyslexia, especially when both conditions are present. Nonetheless, a thorough evaluation that carefully considers each symptom cluster is critical to receive appropriate supports.

ADHD and Dyslexia: Similarities

Inattention

ADHD and dyslexia both may bring difficulties with focusing and paying attention. For an individual with ADHD, these challenges are persistent across settings and circumstances. For someone with dyslexia, these secondary signs tend to appear when reading and language demands spike.

A student with dyslexia might tune out and look off-task – visibly similar to a student with ADHD – as they struggle to follow the teacher’s lecture or complete a reading or writing task. (Dyslexia is not just print-based, after all, but a broad language-processing issue.) What’s more, students with dyslexia often experience mental fatigue – which may manifest as inattention – as they read, write, and listen to teachers over the course of the school day.

These challenges explain why ADHD and dyslexia – individually and combined – are associated with underachievement in school. Reading is effortful, and symptoms of both conditions compound that effort and discourage many students from engaging in reading. A student who is less likely to read is also less likely to develop vocabulary and acquire knowledge across many subjects.

[Get This Free Download: Signs of Dyslexia at Every Age]

Reading Challenges

• Reading comprehension: Individuals with dyslexia can exhibit poor reading comprehension if they inaccurately or ineffectively read words due to poor phonological processing and fluency.But ADHD might also cause reading comprehension issues. Working memory is essential for reading, but deficits linked to ADHD make it difficult to hold information and connect it to other parts of a text. Impulsivity and inattention could also cause readers to skip over words, miss punctuation, or lose their place on the page.

• Guessing at words: Individuals with ADHD might impulsively and impatiently guess at words on the page to quickly advance their reading, but dyslexic individuals will guess because they struggle to “unlock the code” of reading. The differences come through during assessment as evaluators ask patients to break a word down or describe its sounds. (A student with dyslexia will struggle with the task.)

• Avoidance: Difficulty with tasks that require sustained mental effort — such as reading —  is a DSM-5 symptom of ADHD. Similarly, someone with dyslexia will avoid reading because of inherent difficulties.

Writing Challenges

From organizing thoughts to proofreading, the writing process is complicated by both dyslexia and ADHD. Dyslexia, however, brings more spelling problems than does ADHD. (Spelling difficulties are a common feature of dyslexia.) Writing samples often help evaluators clarify the source of these challenges.

[Read: The Defining Signs of Dyslexia Too Often Ignored]

Resistance During Evaluations

A child with ADHD might struggle to comply during a dyslexia evaluation due to symptoms of inattention, impulsivity, and hyperactivity. Dyslexia could be present, but difficulty gathering meaningful data during testing will complicate the evaluator’s interpretation.

Similarly, a dyslexic child with undiagnosed ADHD might shut down or become oppositional during executive function testing and other parts of an ADHD evaluation. A lack of data will also muddle this interpretation.

There is information in resistance. More opposition during a reading activity compared to a computational activity, for instance, could indicate dyslexia. A child who struggles to focus across all activities could be showing signs of ADHD.

Heritability and Comorbidity of ADHD and Dyslexia

Separately, dyslexia and ADHD tend to run in families. The heritability of dyslexia is 40% to 60%.¹For ADHD, it’s 77% to 88%.² At the same time, 25% to 40% of individuals with ADHD also have dyslexia.³ That means individuals, families, schools, and even evaluators might inaccurately attribute signs of one condition for the other, or miss the presence of a comorbid condition entirely.

ADD and Dyslexia Evaluation: Considerations

With so much overlap between ADHD and dyslexia, an effective evaluation must consider both symptom clusters. The following elements comprise a strong, comprehensive evaluation for ADHD and dyslexia:

• An evaluator knowledgeable about ADHD and dyslexia. Look for evaluators who are members of organizations like the International Dyslexia Association (IDA), the Learning Disabilities Association (LDA), and/or CHADD. Be upfront with the evaluator – ask about their experience diagnosing ADHD and co-occurring dyslexia. If you or your child is already diagnosed with one condition, but your suspect more is going on (especially reading difficulties), don’t delay on seeking further evaluation.

• Phonological processing testing, not just reading comprehension assessments. Deficits in phonological processing, which includes the ability to distinguish sound structures in language (like the difference between “cat,” “hat,” and “mat”), are definitive markers of dyslexia and can greatly speed up evaluations. One such test is the Comprehensive Test of Phonological Processing (CTOPP), but there are others. Rapid naming, another potential indicator of dyslexia, should also be assessed.

• Testing over several sessions, especially for children exhibiting signs of inattention and impulsivity. Aim to schedule evaluations before midday, when the brain is typically at its sharpest. If you or your child take ADHD medication, the examiner will probably want you medicated on testing day, but be sure to ask ahead of time.

Dyslexia Evaluation and ADHD: Next Steps

• Self-Test: Does My Child Have Dyslexia?
• Free Download: 19 Symptoms of Adult Dyslexia
• Read: Learning Disabilities Overview ⁠— Reading, Writing & Math Disorders

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “When Dyslexia and ADHD Overlap: Symptoms, Misconceptions, and Interventions [Video Replay & Podcast #403],” with Cheryl Chase, Ph.D., which was broadcast on June 1, 2022.

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Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Gialluisi, A., Andlauer, T., Mirza-Schreiber, N., Moll, K., et al. (2021). Genome-wide association study reveals new insights into the heritability and genetic correlates of developmental dyslexia. Molecular Psychiatry, 26(7), 3004–3017. https://doi.org/10.1038/s41380-020-00898-x

² Faraone, S. V., & Larsson, H. (2019). Genetics of attention deficit hyperactivity disorder. Molecular Psychiatry, 24(4), 562–575. https://doi.org/10.1038/s41380-018-0070-0

³ DuPaul, G. J., Gormley, M. J., & Laracy, S. D. (2013). Comorbidity of LD and ADHD: Implications of DSM-5 for assessment and treatment. Journal of Learning Disabilities, 46(1), 43–51. https://doi.org/10.1177/0022219412464351

Though this approach has produced improved outcomes for patients and clinicians, it is still largely underutilized. Following a recent ADHD Experts webinar titled “Integrated Care for Children with ADHD: How to Form a Cross-Functional Care Team,” ADDitude editors provided answers (and relevant resources) to commonly asked questions on collaborative care. Find those responses below.

Q1: “Why center integrated ADHD care around primary care doctors when you have access to mental health professionals?”

A primary care provider (PCP) is one of few medical professionals with a whole-person approach to care. In many cases, the PCP has already established an in-depth, trusting relationship with the patient and family. They also act as an opportune gateway to additional healthcare services.

Rather than starting from scratch elsewhere, involving a PCP when seeking ADHD diagnosis and treatment options may save families time (and money). PCPs can initiate diagnostic assessments using validated screeners, exams, and patient history. In an integrated care model, they can also collaborate with psychiatrists and behavioral health care managers to develop, implement, and adjust treatment plans.

Next Steps:

• Download: Who Can Treat ADHD?
• Read: Care Coordination: Forming an ADHD Treatment Team for Children
• Read: How Pediatricians Can Help School-Age Kids

Q2: “Does integrated care include help for children who experience social challenges associated with their ADHD? If so, who leads that effort?”

Both the physical and behavioral needs of patients are addressed in an integrated care approach. Addressing social struggles in children with ADHD might fall first on the behavioral health care manager (BHCM), who acts as a linchpin between the medical care team and the child’s daily life. The BHCM partners with parents to outline goals and develop a plan while networking with schools and community agencies to provide accommodations and evidence-based treatment. Throughout this process, the BHCM is routinely updating the care team and monitoring patient progress.

Next Steps:

• eBook: The ADHD Guide to Making & Keeping Friends
• Read: The Social Executive Function Skills That Elude Kids with ADHD
• Read: “Collaborative Care” Improves ADHD Symptoms in Children

Q3: “How do I find an integrated care practice in my area?”

Integrated care models are not standard, but they are becoming more common around large children’s hospitals and academic centers. If you live near a large children’s hospital, approach the primary care practice and ask if behavioral health is embedded in their pediatric clinics. Otherwise, talk to your pediatrician’s office to determine potential opportunities for collaborative care.

Next Steps:

• Search: The ADDitude Directory
• Research: ADDitude’s Top ADHD Clinics
• Read: Picking ADHD Professionals to Treat Your Child

Q4: “Are there specific, evidence-based training programs available for parents?”

BHCMs may provide brief, evidence-based training for parents with the goal of teaching skills and reducing barriers to care. Check out these resources available through Seattle Children’s Hospital and its First Approach Skills Training (FAST) Program.

Next Steps:

• Understand: Is Parent Training a Key to ADHD Symptom Control?
• Read: Behavioral Parent Training for ADHD: Strategies That Work
• Sign Up: ADDitude’s Free Parenting Class

Q5: “How does the billing process work in an integrated care model?”

Though billing varies by state and by insurance plan, CPT codes are available to collaborative care practices. Watch this video for information on effective billing and coding strategies. Visit the AIMS Center online to learn more.

The content for this article was based on questions submitted by live attendees during the ADDitude ADHD Experts webinar titled, “Integrated Care for Children with ADHD: How to Form a Cross-Functional Care Team” [Video Replay & Podcast #411] with Leslie F. Graham, MSW, Douglas Russell, M.D., Sheryl Morelli, M.D., which was broadcast live on July 12, 2022.

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Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

How Learning Disorders Breed Shame

We, as parents, know all too well the stress, anxiety, and physical and emotional symptoms associated with learning challenges. We understand the frustration of trying to turn around woeful school engagement in our kids and their educators, too. When my children are denied the accommodations they need, this quickly leads to anger, battles about going to school, and self-talk that includes “stupid” and “I know I have to try harder.”

I have seen how difficult it is to enlighten school district personnel and explain that a student’s poor behavior and negative self-talk are the direct result of not receiving the accommodations that are appropriate and necessary for academic success. When I asked for support and a 504 Plan, school administrators said to me: “Suzy knows what she needs to do.” As if my daughter chooses not to do it. As if any child chooses ADHD, dyslexia, or any other learning challenges.

[Download: What Learning Disabilities Look Like in the Classroom]

In another 504 Plan meeting, I asked the teacher if my child, who had just received a good grade for an assignment, had used any accommodations. The teacher’s response: “No, she did not cheat.” How can my child feel good about using the services she needs if this is the prevailing opinion of her teacher?

It’s a devastating blow when teachers and administrators fail to provide adequate assessments and resources — whether due to budget issues, staffing shortages, ignorance about ADHD, or the pandemic — to support a child’s academic success. As parents, we watch as these interactions project shame and blame onto our children, who suffer through years of negative experiences in school. More awareness and an investment in teacher training would go a long way toward improving academic success in students with learning differences.

The Social-Emotional Impact of Learning Disorders

After living through three academic years impacted by the pandemic, all parents understand the heartbreak of witnessing their students’ social-emotional struggles, learning loss, and mental health conflicts. Let this experience be a window through which parents and educators gain insight into the too-often unmet needs of kids with learning differences.

Most students with learning challenges have long struggled with the emotional and social toll resulting not from the disability directly, but from a school system that limits or creates barriers to accessing the full suite of accommodations kids need to engage fully in learning. We must all speak up to help our local educators and policy makers see this important connection.

Learning Disorders and ADHD: Next Steps

• Download: IEP vs 504 – What’s the Difference?
• Watch: Securing Accommodations – Working With Your Child’s School
• Read: When Learning Differences Are Embraced, Not Shunned

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

ADHD is a complex diagnosis that most clinicians are ill-equipped to make thanks, in part, to poor understanding of condition comorbidities and inadequate diagnostic tools, especially for adults. This is the finding of the ADHD Expert Consortium, a panel of experts convened to study barriers to effective diagnosis and treatment for attention deficit hyperactivity disorder (ADHD), and to propose solutions in a consensus statement that included five main recommendations:

1. Leverage, expand, and update existing ADHD screening in children to be more universal, across disciplines and improve awareness.
2. Develop adult ADHD diagnostic and treatment guidelines in the U.S.
3. Make evidence-based, objective testing the standard of care for ADHD in children and adults.
4. Better education, rooted in equity, of medical residents and practitioners in pediatrics, neurology, psychiatry, and primary care for the diagnosis and treatment of ADHD.
5. Improve insurance coverage for evidence-based ADHD evaluation and treatment.

“ADHD must be viewed as a public health problem producing a substantial impact on the health, quality of life, and economic viability of the U.S. population,” the panel wrote.

Most primary care providers, psychiatrists, and neurologists today lack the confidence and skills needed to accurately screen, treat, and make referrals for ADHD ¹, leading to “negative effects on personal development, academic outcomes, and family interactions.”^{2, 3} Quality ADHD care is scarce, according to the consortium, because most healthcare professionals lack an “understanding about the intersection between culture and ADHD presentation and management.”

The development of universal best practices and consistent use of objective testing would help improve diagnosis and treatment outcomes for patients, especially adults who don’t present stereotypical hyperactive or impulsive symptoms and those who come from diverse cultures or socio-economic backgrounds. However, few objective, evidence-based tools exist today. Reimbursements by insurance payers are limited and often low, which makes it difficult to maintain an efficient and financially sustainable practice. This is worsened by the addition of high administrative burdens like prior authorization requirements.

“Taken together, low reimbursements coupled with high administrative burden highlights the persistent lack of parity between mental health and physical health in our country today,” the panel wrote. “We believe that payers play a critical role in fixing our current mental health crisis through evolution of their payment and utilization management models for mental health.”

The one-day meeting included psychiatrists, neurologists, developmental pediatricians, pediatricians, nurse practitioners, psychologists, neuropsychologists, and patient advocates.

Sources

¹ADHD Expert Consortium Community Call To Action. (2022). Qbtech. https://www.qbtech.com/consensus-statement
²Hollis, C., Hall, C., Guo, B., Groom, M., Brown, N., Kaylor-Hughes, C., & … Moldavsky, M. (2018). The impact of a computerised test of attention and activity (QbTest) on diagnostic decision-making in children and young people with suspected attention deficit hyperactivity disorder: Single-blind randomised controlled trial. Journal Of Child Psychology And Psychiatry And Allied Disciplines. doi:10.1111/jcpp.12921
³Shaw, M., Hodgkins, P., Caci, H., Young, S., Kahle, J., Woods, A. G., & Arnold, L. E. (2012). A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: Effects of treatment and non-treatment. BMC Medicine, 10(1). https://doi.org/10.1186/1741-7015-10-99