Editor's note: This article has been reviewed and verified for accuracy by Theresa Cerulli, MD., a nationally certified neuropsychiatrist with over 20 years of expertise in diagnosing and treating ADHD in children and adults.
It can be overwhelming when you learn that you or a loved one has ADHD, whether they're an adult or a child. There’s so much information available - but how do you begin to sort through it all? In this article, I will provide you with a framework to understand ADHD and some of the science that sheds light on symptoms of ADHD, your options for treatment, and resources you can use to equip yourself with the knowledge that will empower you to make decisions that work for you. Our table of contents below will make it easier to scan for what you'd like to learn about.
- How Common is ADHD?
- The Dopamine Connection to ADHD: Why Motivation is a Problem
- Executive Dysfunction: The Core of ADHD
- What are the Consequences of Untreated ADHD?
- What are Some ADHD Treatments Beyond Medication?
- Therapy’s role in ADHD treatment
- How Executive Function Coaching Helps Manage ADHD Challenges
- Summary: Medication, Therapy, and Coaching
- Resources to Learn More About ADHD and Executive Functioning
1) How common is ADHD?
Thanks to the efforts of high-profile and successful people with ADHD, like.png?width=404&name=21%20aspect%20ratio%20images%20(2).png)
Olympians Simone Biles and Michael Phelps, there’s less stigma associated with the diagnosis than ever before. In fact, you’ll meet many people who consider their ADHD a superpower of sorts - providing great energy and creativity when managed and channeled effectively.
As a person living with ADHD, it can be comforting to know you’re in good company. The latest research from The National Institute of Mental Health (NIMH) reveals that 11% of children and 4.4% of adults meet the criteria for ADHD - with males diagnosed at a higher rate than females. That adds up to 16.1 million kids and adults with ADHD in the US alone. Some research within families shows that there’s a significant genetic component to ADHD: a study of 60,000 twins that concluded in 2013 suggested that it’s about 80% likely that ADHD is passed on from parents to children.
With that degree of prevalence, you can see why it’s essential to educate caregivers, children, and adults with ADHD and help them identify supports to manage symptoms. And because ADHD tends to run in families, support that helps the entire family unit function well can greatly improve the quality of life for all who are impacted by the challenges of ADHD.
Another aspect of ADHD is that it often co-occurs with other conditions, which can complicate the treatment plan. The Centers for Disease Control (CDC) cites a 2016 study, in which 60% of children with ADHD had at least one other mental, emotional, or behavioral disorder, the most common being behavior/conduct problems, anxiety, and depression. Given that there can be some overlap of symptoms, it can be hard to tease apart the full picture that takes into account the cause and effect of the challenges you’re seeing. For people with ADHD and co-occurring (sometimes called “comorbid”) conditions, it’s important to assemble a trusted team of medical, psychological, and behavioral professionals for a holistic approach to promoting overall wellbeing.
2) The Dopamine Connection to ADHD: Why Motivation is a Problem
ADHD is a neurodevelopmental condition that primarily affects the brain’s focus/concentration circuits, as well as Executive Functions. Scans of the ADHD brain show low activity levels of neurotransmitters such as dopamine, which is one of the brain chemicals that helps us focus and stay on task. Dopamine can also make us feel good when we take a particular action. That action could be anything from finishing your laundry to heading out to the gym for your workout. Because people with ADHD have underactive frontal lobe circuits, their brains require a higher level of stimulation to function properly. They appear unmotivated to do boring or difficult tasks because their brains don’t get the same reward for doing them. It’s like telling a person without ADHD to sort through a mountain of toothpicks and count them all. It would be very hard to make yourself do such a dull, ceaseless task, right?
Here’s where the role of medication comes in. Stimulant medication, though it seems counterintuitive, actually works to activate those underactive areas in the brain of a person with ADHD. With a prescriber’s oversight, the right medication and dosage can provide that motivational brain-bump to initiate and complete those essential but unexciting tasks in life. Of course, not every person reacts well to medication, but given the science behind the motivation challenges inherent with ADHD, many medical professionals with ADHD expertise, such as Dr. Theresa Cerulli, recommend that families at least have a conversation about medication in order to make an informed choice.
3) Executive Dysfunction: The Core of ADHD
Let’s do a deeper dive into those self-management skills, or executive functioning, which are at the core of ADHD. We find it helpful to use an iceberg analogy.
Here’s the top of the ADHD iceberg - the part that everyone else sees.
Now, remember that icebergs are mostly hidden under the water. It’s the same with Executive Function challenges. When we look deeper and see the whole picture, we see the specific skill deficits that people with ADHD can often have that are causing the behaviors we see.
A person may have a poor sense of time or difficulty planning ahead - and that may make them seem scattered. They may have trouble regulating emotions and seem irritable or moody. When they have no strategies to self-monitor, a person can look impulsive. Students or adults who are too overwhelmed to get started can look lazy. When they have no systems to track belongings or maintain their focus, they can be forgetful. And when a person has trouble thinking flexibly, it affects their problem solving and perspective-taking - and that can come off as rude or demanding behavior.
Above all, ADHD is a condition that can impact one or more of these skill areas - and that’s why ADHD can have repercussions for managing everyday demands. So, what happens when ADHD is left untreated? Imagine the accumulated outcome of all the challenges shown above in our iceberg.
4) What are the Consequences of Untreated ADHD?
When a person with untreated (or under-treated) ADHD goes through their daily life constantly being told that they’re lazy, messy, or annoying, they pay a heavy price in terms of their self-esteem and belief in their ability to be successful. Imagine being in those shoes. You view yourself as fundamentally different and flawed. You don’t understand why you can’t follow through on things that you know are important, even though there is a perfectly reasonable brain-based explanation. Pretty soon, you come to believe all the negative messages you’ve received. In fact, it’s been estimated that children with ADHD receive 20,000 more negative messages than positive ones by age 10. It’s not surprising then that adolescents with ADHD are 10 times more likely to develop depression/anxiety than those without ADHD.
Now try to feel the weight of all those failures if ADHD is left undiagnosed and/or untreated until adulthood.
- Due to impulsive decision-making, challenges with maintaining a household, and trouble managing emotions, adults with ADHD can have difficulty in their relationships, making it harder to maintain a solid network of friends or find a life partner.
- In terms of career advancement, untreated ADHD symptoms make it difficult to meet deadlines, stay focused on work, and manage competing responsibilities - any of which can derail professional goals and severely curtail lifetime earning potential and financial stability.
- Finally, adults without well-controlled ADHD symptoms often choose to self-medicate with substances such as alcohol and drugs that can lead to addiction. A 2020 study indicated that 34-46% of individuals who seek treatment for a cannabis use disorder have ADHD.
It’s clear that early diagnosis and treatment across the lifespan are key to helping people live fulfilling and healthy lives with well-managed ADHD symptoms.
5) What are Some ADHD Treatments Beyond Medication?
Medication provides a solid foundation for many with ADHD, but pills don’t teach skills. I didn’t make up that phrase, but it’s worth noting for the reminder it provides. Medication, if you choose to use it, can set the stage to make learning and applying new skills easier by turning on the brain’s ability to focus. The other half of the equation is how you go about learning new habits and behaviors.
Let’s find out more about two options: therapy and coaching. Therapy and Executive Function coaching work together to address the negative behaviors and habits that have been learned over time - but in different ways. Let’s dig into some of those main distinctions next.
6) Therapy’s role in ADHD treatment
Therapists help transform negative patterns of thinking influenced by living with ADHD and constructively rebuild the way people feel about themselves. Therapy can be a helpful piece of overall treatment - particularly if there are self-esteem issues or co-existing mental health conditions like depression or anxiety that are part of your overall ADHD picture.
How can those negative self-images form? The longer that ADHD is untreated, the more likely that there are deep-seated beliefs about self-worth and potential that could be holding a person back. Remember those statistics above on negative messages? That’s fertile ground for feelings of shame to take root. A psychotherapist familiar with ADHD can be a lifeline for people struggling to find their self-worth.
According to the CDC, the American Academy of Pediatrics (AAP) recommends behavior therapy and medication for children 6 years of age and older with ADHD, preferably both together. Still, most therapeutic approaches won’t focus on building Executive Function skills. It’s important to understand this distinction as you formulate your own plan to treat ADHD for yourself or your child. Traditional psychotherapists typically don’t help you organize your room, plan out your week on a calendar, chunk out a big project for school or work, or get you to stop procrastinating. If these concerns are the root problem, then Executive Function coaching can help in those very pragmatic areas. Next, let’s get a clearer picture of Executive Function coaching.
7) How Executive Function Coaching Helps Manage ADHD Challenges
Executive Function coaching teaches adults and students how to organize, plan, prioritize, manage time, maintain focus, self-assess, and learn more efficiently. In other words, coaching concretely helps people with ADHD manage and improve their daily lives. At Beyond BookSmart, we work 1:1 online to help people of all ages learn tools and strategies that foster better habits with ongoing support, reflection, and refinement. What does this process look like?
Many people with ADHD who begin coaching initially work on undoing a cycle of failure they’ve experienced in their lives.
Ingrained habits lead to negative outcomes (poor grades, losing a job, relationship problems, etc.); the negative outcome hurts confidence, and that loss of confidence makes it harder to change those ingrained habits, leading to more negative outcomes. Maybe you’ve seen some examples of this in yourself or a loved one with ADHD. Executive Function coaching works to break that cycle by interrupting it with small successes that build confidence and motivation, transforming the cycle from one of failure to growth.
Coaches introduce tools to help build better habits and individuals apply that tool to their week’s responsibilities. With guidance, they achieve a small positive outcome which boosts confidence, making it easier to build on those gains. This leads to more positive outcomes that over time snowball into big transformations. All this work is done with a coach who guides the process as a trusted ally and who celebrates those wins along the way.
Summary: Medication, Therapy, and Coaching
To recap, here’s a summary of the three ADHD treatments we discussed in this article:
- Medication - Provides the “on switch” in an ADHD brain, easing the severity of symptoms
- Therapy - Helps replace negative self-perceptions from ADHD experiences with healthy self-acceptance
- Executive Function Coaching - Strengthens core Executive Function skills by countering bad habits, breaking a cycle of failure, and building confidence through a series of small successes
8) Resources to Learn More About ADHD and Executive Functioning
One of the best ways to feel empowered in living with ADHD is by educating yourself. Now that you’ve learned some ADHD basics, here’s a linked list of resources that can help you get more information and perspectives on ADHD and Executive Functioning.
Learn more about ADHD
Learn more about Executive Functioning
- Focus Forward podcast
- Beyond BookSmart (for caregivers of students up to college age)
- WorkSmart Coaching: (for adults)
- Smart But Scattered series
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