Many patients with ADHD have long suffered under the impression that they just have a “character problem,”  ”just need to work harder” or are purposely “self-sabotaging,” when in fact they are working quite hard to try to manage a treatable biologic problem. There are patterns and life stories of inattention, distractibility, impulsivity and disorganization that only be coherently explained and addressed by the diagnosis of ADHD.

On the other hand, not all patients with difficulties in attention and distractibility have ADHD. The following are some of these other factors:

-Depression, anxiety, learning disabilities, substance abuse and sleep disorders can all cause similar difficulties and are not best treated with ADHD medications.

-In some cases there can be a mismatch between a person’s talents and their chosen career that can manifest as problems with focus and task completion.

-Some people attribute problems with excessive attention to detail (“hyperfocusing”) to ADHD, but there is very little research that supports this conceptualization. In these cases there is certainly a dysfunction of attention, but it is not usually best explained by a diagnosis of ADHD; the underlying biologic challenge of ADHD is usually a deficit, rather than surplus of attention. Hyperfocusing is more likely due variously to obsessive personality styles, anxiety, or to one of the many neurocognitive states that can cause difficulties for a person but that have not yet been scientifically categorized.

-There are many patients who likely have some, but not all, of the genetic makeup that it takes to have the full syndrome of ADHD. They experience attentional or organizational difficulty, but not enough whereby the can be diagnosed with the disorder. In this sense, ADHD is a “spectrum disorder,” whereby there are some people who definitively do have it,  others that definitively do not, and many people who are somewhere on the diagnostic spectrum. In this last group, patients can struggle with certain attention-related areas of their life and even though they don’t formally have ADHD, neither is another problem or disorder a better explanation for the difficulties. It is essentially a partial case of ADHD.  In these situations treatment with medications is generally not recommend as a first step in treatment; cognitive-behavioral therapy, organizational help, or finding ways to alter the working environment may be better treatment plans.

The following is a link to a recent podcast discussion regarding diagnosing ADHD:

http://dl.dropbox.com/u/27785958/IAPADHDNYTimesDiscussion.mp3

ADHD is characterized by difficulty initiating or completing tasks, sustaining attention, and controlling impulsive actions. Patients may have difficulties with organization and time management. As a result of these difficulties, ADHD can have serious negative impacts on the educational, social, and occupational lives of those who experience these symptoms.

Three types of ADHD are diagnosed:

• Combined inattentive and hyperactive-impulsive (this is the most common type, found in about 80% percent of patients).
• Predominantly inattentive (about 15%).
• Predominantly hyperactive-impulsive (about 5%)

The terminology can be confusing. Attention Deficit Disorder (ADD) is an older term for what is now called Attention-Deficit/Hyperactivity Disorder (ADHD). There is no longer any actual disorder “officially” called ADD, but some people still use ADD (or Adult ADD) to refer to the type of ADHD that is predominantly inattentive, and use ADHD (or Adult ADHD) for the type of ADHD that is predominantly hyperactive or impulsive. However, these all refer to the same disorder, and in regard to medications, the treatments are generally the same. Hyperactive symptoms often improve by adulthood, and it is for this reason that it was previously thought that patients outgrow ADHD. It is now clear, however, that inattentive symptoms usually do not resolve, though they are not always outwardly apparent if someone has structured their life in a way that avoids situations requiring extended periods of sustained focus.

Although the exact mechanism is unknown, a number of associated neurochemical abnormalities have been observed, and considerable evidence suggests that the disorder has a strong genetic component and a biological underpinning; the pathophysiology includes dysfunction in both norepinephrine and dopamine activity, particularly in the frontal cortex.