ADHD Treatment, Symptoms, and Dual Diagnosis

Like many mental disorders, there is not one cause for ADHD. Instead, it is likely that a combination of factors contributes to a person developing ADHD.

Brain Structure

When it comes to the brain structure of those with ADHD, researchers are faced with a “chicken-or-egg” question. Brain scans show that those with ADHD have less gray and white matter than those without the disorder. The frontal lobe, limbic regions, and basal ganglia are also affected in the brain of a person with ADHD. Those with ADHD also have fewer neurotransmitters in their brain, such as norepinephrine and dopamine. But it’s not clear if these things cause ADHD or are caused by ADHD.

Genetic

Genes also play a significant role in who develops ADHD and who does not. While there is no “ADHD gene,” those whose parents have ADHD are more likely to have ADHD.

Environmental

Environmental factors are also part of why a person might develop ADHD. These can include:

• Having a low birth weight
• Being born prematurely
• Exposure to lead or other toxic chemicals
• Having a brain injury
• Parental mental health
• Exposure to nicotine or alcohol during pregnancy
• Growing up in an unsupportive environment or experiencing poverty, or even getting too little sleep can contribute to the development of ADHD.

The impulsivity and emotional challenges that come with attention-deficit/hyperactivity disorder create a heightened risk for substance abuse among adolescents and young adults.[2] Many people with ADHD turn to alcohol or drugs as a way to manage symptoms like inattention, restlessness, or low self-esteem, creating a cycle where substance use temporarily masks ADHD symptoms but ultimately makes them worse. This dual diagnosis presents complex challenges that require specialized behavioral health interventions, as traditional addiction treatment alone often fails to address the underlying ADHD symptoms that contributed to substance use in the first place.

When ADHD and substance abuse co-occur, both mental health conditions must be treated simultaneously through comprehensive dual diagnosis programs. An effective treatment plan addresses the interconnected nature of these co-occurring disorders through evidence-based approaches that help people develop healthy coping skills.

Anyone can develop ADHD, but it is more often diagnosed in boys than girls. This may say more about our diagnostic processes and tools than the prevalence among one gender; girls often present with more inattentive symptoms (see below), which may be harder to recognize.

The symptoms of ADHD are many and differ between the three main kinds of ADHD.

Inattentive Type

Those who have the inattentive type of ADHD have trouble with focus. Some common symptoms include:

• Having trouble staying on task.
• Not paying attention to details.
• Having a hard time listening to instructions.
• Finding it hard to follow through on a task, even if they start well.
• Having a hard time organizing their space or managing their time.
• Forgetting or losing things easily.

Hyperactive/Impulsive Type

Those who present with the hyperactive/impulsive type of ADHD move excessively. Some symptoms include:

• Constant fidgeting.
• The inability to sit still.
• Talking too much for the situation.
• Interrupting.
• Having trouble taking turns.
• Inability to play or read quietly.

Combined Type

Those who have the combined type of ADHD have symptoms from both lists. This is the most common form of ADHD.

ADHD affects all aspects of one’s life. For a child, ADHD makes it difficult to pay attention in school or complete schoolwork. This may rupture relationships with teachers and even cause tension between parents and children.

For adults, ADHD can cause many issues. Adults with ADHD may procrastinate on tasks that seem simple to others, often because they want to do something perfectly and they fear not being able to. They may have trouble with being on time or finishing complex tasks. This also may affect personal relationships, work performance, and even self-esteem.

ADHD is diagnosed when a physician meets with a patient to discuss their symptoms. The symptoms must be persistent for a period of six months or more and cause problems in more than one place (i.e., not just at home or at school). The symptoms also need to be present before the person is 12 years old.

A doctor, psychologist, or psychiatrist will also want to make sure the symptoms are not due to other disorders or underlying illnesses, such as depression, anxiety, sleep issues, or learning disabilities.

ADHD is usually managed with a mix of medication and therapy. Lifestyle changes and support systems are also crucial to making sure a person with ADHD can thrive.

Therapy

For young children, therapy is usually the first form of treatment. Parent-Child Interaction Therapy (PCIT) is especially helpful for children with ADHD and their parents.

For adults, Cognitive Behavior Therapy, which aims to change a person’s behavior by changing the thought patterns that lead to the behavior, is most used.

Medication

Medication is also a common part of treatment for ADHD. For younger children, amphetamines are most often prescribed, while non-amphetamines can be prescribed for those who are older. Both types of medications increase the creation of neurotransmitters, like dopamine and norepinephrine, in the brain.

Lifestyle and Support

ADHD is a chronic disorder, so those who develop it will deal with it their entire lives. However, ADHD is not debilitating with the right lifestyle choices and support system in conjunction with medication and therapy.

For some adults, adding more physical activity to their daily routine, making sure they get enough sleep, and eating regular meals is helpful. Talking with a life coach or therapist who can help them increase their organizational skills can also be beneficial.

For children, having a support system is crucial. Children who are diagnosed with ADHD qualify for Individual Education Plans (IEP) at school, and parents or caregivers can help children learn skills to help them manage daily life. For example, it may help to break large tasks into chunks and even write down a step-by-step list of the smaller tasks.