Let’s face it, there is an abundance of ADHD diagnoses lately. Why is this? Is it a result of a greater acceptance of mental health and more people pursuing help? Is it that more parents are recognizing it in themselves as their children are diagnosed? Is it a result of our fast-paced, instant-gratification culture? Or is it a combination of all these factors?
Like most mental health diagnoses, ADHD exists on a spectrum. Given the right set of circumstances, most of us can dip into distractibility, inattention, procrastination, depression, anxiety, or poor impulse control. Often with the right tools, like a good night’s sleep, a good chat with a friend, exercise or some time management skills, we recover and get back on track. At what point does it become a diagnosis? At what point do the symptoms exceed our coping mechanisms?
The answer to this of course varies depending on the person.
ADHD is HIGHLY genetic. First, we may have inherited some genes for ADHD, but we have also likely lived with one or two parents whose behaviours were classified as ADHD thereby teaching us many of the traits and behaviours of ADHD.
Dr Daniel Amen, a renowned child and adult psychiatrist, suggests that there are 5 hallmark symptoms of ADHD:
- Short attention span: but not for everything, just for routine things, while new, novel or highly stimulating things capture your attention
- Distractibility: you see and feel too much
- Organization: is hard both for time and space
- Procrastination: you tend to put things off to the last minute
- Impulse control: you say things or do things that you likely shouldn’t or later regret
He goes on to suggest that if you have 3/5 symptoms you likely have ADHD. Now again, I circle back to the fact that pretty much everyone has some of these symptoms sometimes, so I suggest this list is viewed through the lens of whether or not these traits are consistent for you and whether or not they interfere with daily functioning and exceed your ability to cope with them.
Dr Amen has revolutionized our understanding of ADHD through extensive brain scans done on thousands of patients. Consistently on the scans of his ADHD patients, he sees brains that are healthy at rest that drop when trying to concentrate especially in the prefrontal cortex, basal ganglia (where dopamine is made) and in the cerebellum. Dr Amen goes on to describe 7 types of ADHD that he sees on these scans, which help to differentiate the subtypes that exist within the ADHD diagnosis.
Where to begin? This is the process I typically work through with a patient who we suspect may have ADHD:
- Do you have a family history?
- Do you have 3 of the 5 symptoms listed above?
- Do they interfere with your daily functioning and exceed the mechanisms you have to cope with them?
- Together we figure out which of the 7 types of ADHD you have, including whether the ADHD came from a head injury or not
- We engage in the 6 steps of treatment
Contrary to many, I do not believe that medication is the first step. While I have nothing against medication, I believe it is overprescribed, does not account for individual types of ADHD, and when used alone does not equip the person with adequate life skills to manage their ADHD.
Step 1: Address head injuries, if relevant. If there has been a head injury, dealing with this is the first step. Taking on a proper brain rehabilitation plan for past concussions is key to success in these cases.
Step 2: Get honest with instant gratifications behaviours and emotional coping mechanisms you rely on. These can include such things as smoking, drinking, scrolling (social media, news, Reddit, online shopping, etc), watching TV/shows/movies, eating (especially carbs), pornography, video games, and so on. Think of things that give you a hit of dopamine but that don’t require much effort. When we engage in these types of activities we decrease the tonic amount of dopamine that we have, thereby leaving us with less dopamine and forcing us back to dopamine-hit activities in order to get our brains to engage. These are activities to strictly limit in your life, especially if you have ADHD.
Step 3: Discover your effort-based reward system. These are activities that take some effort to achieve the reward and thereby increase tonic dopamine. Examples include exercise, artistic projects, working on personal growth, spending time with people you love, work (if you find fulfillment in your work), working towards goals, and so on. We need to maximize the amount of these activities we engage in and employ more of these as our coping mechanisms when we are emotionally dysregulated.
Step 4: Work on life skills – organization, time management, optimizing focus, etc.
Step 5: Work with stimulating supplements and foods. These can have profound impacts on ADHD symptoms and functioning. There are a variety of substances that can be used depending on the type of ADHD.
Step 6: Consider medications. Likewise, medications can have profoundly beneficial effects when used properly. The reality is that almost everyone feels good on ADHD medications, as most have similar effects on the brain as cocaine. Remember, just because you feel good on them does not mean you have ADHD. First, we need to ensure the diagnosis is correct, then we need to ensure that the lifestyle factors are supportive, then work on endogenous supports and finally arrive at medications as needed.
I believe a holistic and integrative approach to ADHD offers the greatest chance of success no matter what age you are.
We are here to help!
