What You Need to Know About ADHD: Insights from Dr. Esther Park
In this blog post, board certified child, adolescent, and adult psychiatrist Dr. Esther Park answers common questions that she has received during her time diagnosing and treating ADHD. We hope these answers help illuminate this neurological disorder and provide some clarity into any misconceptions.
“How do you normally diagnose a child with ADHD?“
Dr. Park: During the interview process we would look for all the different criteria for the ‘inattentive type’ of ADHD and the ‘hyperactive / impulsive type’ of ADHD. If they meet at least 6 out of 9 of the criteria, then we have a high suspicion that they do have ADHD. We also try to collect information from multiple sources – especially from the parents/caregivers themselves, relatives, and the child’s teachers at school. We also recommend psychological testing measures when necessary, such as the TOVA (test of variable attention). It is a neuropsychological assessment that is objective and screens for ADHD.
“How do you normally diagnose an adult with ADHD?“
Dr. Park: “This is a very important question because I do receive evaluation requests from college students or older adults who automatically think they have ADHD because they have trouble focusing at school or work.
The reasons for having difficulty in focusing are numerous and ADHD is just one of them. What we try to do is conduct a thorough interview during the evaluation process. When it still is not clear whether an adult has ADHD, we also recommend objective psychological testing measures such as the aforementioned TOVA. We take care not to rush the evaluation process. If we misdiagnose this disorder, we would provide treatment in an incorrect way. People may have trouble focusing due to other causes such as anxiety or depression, for example.
“Where does my ADHD come from? Why do I have it? Is it because I’m lazy or missing some character trait?“
Dr. Park: Some people mistakenly think that ADHD is due to laziness or some other personality deficit. Research studies have shown that ADHD is a true neurological issue. There is a neurotransmitter dysfunction in the dopaminergic system in those with ADHD. This means that those who are struggling with ADHD have great difficulty in sustaining focus, complete tasks in a timely manner, and managing time – even if they are trying their best to do so.
“What are the different types of ADHD diagnoses out there?”
Dr. Park: There are three types of ADHD:
– predominantly inattentive type
– predominantly hyperactive impulsive type
– combined presentation type
In adults, we find that the predominantly inattentive type is most common.
“Can you explain a little more about the inattentive-type of ADHD in adults?”
Dr. Park: The criteria to diagnose the “predominantly inattentive type” of ADHD is a list of nine symptoms. At least six out of nine have to be met for this diagnosis. The symptoms for this type include but are not limited to poor sustained focus (unable to focus on something for a long period of time), distractibility, forgetfulness, task avoidance on things that take sustained focus, losing important items, and more. You can see more information about the symptoms here.
“Can you explain a little more about the hyperactive impulsive type of ADHD?”
Dr. Park: The predominantly hyperactive impulsive type also comes with potentially nine symptoms where six out of nine have to be met for a diagnosis. The symptoms for this type include but are not limited to constant movement, fidgeting and squirming, nonstop chattering, interrupting others when speaking, not recognizing when situations are dangerous, and constantly getting into trouble. You can see more information about the symptoms here.
“What are some recommendations after one has been diagnosed with ADHD as an adult?”
Dr. Park: Sometimes we don’t go straight to recommending medications. We evaluate case by case. If the person exhibits more executive functioning issues such as poor organization, poor time management, we then provide tips and different strategies to improve these skills. However, if it starts to affect their performance at school, work duties, or responsibilities at home causing problems in their lives, then we start recommending medication treatment.
“What ADHD medications would you recommend?”
Dr. Park: For children and adults we always first recommend what we call the “stimulant class” of medications. This is just a generic name to categorize the type of neurotransmitter involved for the treatment of ADHD. Stimulant medications help by improving the function of important neurotransmitters dopamine and norepinephrine in your brain to help increase attention span, control impulsive behavior, and reduce hyperactivity. This is confirmed to be the number one treatment of choice for treating ADHD. The stimulant class medications include Adderall, Ritalin, Focalin and more.
“Does ADHD treatment only focus on medication?
Dr. Park: I must say that treatment for ADHD does not only involve medication. We advise taking a comprehensive approach in ADHD treatment. Executive functioning training, for example, helps children and adults on training memory and improving their overall focus, attention, and organization. We also coach parents and adults in structuring and routine settings in the home and in the school.
Medication is only part of the treatment but is necessary as well – it is the number one treatment of choice to correct and alleviate the chemical dysfunction in the brain.
“Can my child grow out of ADHD?”
Dr. Park: This is a question I receive often from parents and statistics show that about half of the children who are diagnosed with ADHD “grow out of it”. However the other half continue to struggle with their ADHD symptoms into adulthood. I never promise any parent that patients will be able to stop their medications when they turn 18. We would just observe year after year and make sure they treat it properly and achieve their greatest potential.
“I have hesitations about ADHD medication. What do you advise?”
Dr. Park: I do meet occasionally parents and adults who are hesitant about ADHD medication treatment. It is understandable – they may have gotten by all their lives and all of a sudden they are receiving an ADHD diagnosis by me as well as a prescription for medication. What I explain is the indication, the risks and benefits, as well as alternatives. Alternatives can include psychotherapy, and executive functioning training and see how well that works first.
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