The psychological perspective of ADHD is crucial to understand due to its reflection of medical advancements, social practices and the experiences that different groups with ADHD have. For the purposes of this website, groups are defined as people with definable characteristics in terms of age, gender, country, ADHD severity and sex, which can be compared and contrasted with one another. The Treatments surrounding ADHD vary by country and depend on the time of diagnosis, diagnostic method, the appearance of symptoms, and medical protocols regarding potential treatment.
Our research focus
Sub Question 1
How do ADHD symptoms and comorbidities manifest themselves in different groups?
Sub Question 2
What are the drawbacks and benefits of different forms of ADHD treatment? How does treatment choice vary by country?
Diagnostic Focus
The DSM-5 is the main diagnostic criteria used in North America, Australia and parts of Europe, and emphasises great detail to the appearance of symptoms in early childhood, specifying that 5 of the 7 main symptoms in the inattentive and hyperactive-impulsive categories need to appear by the time a patient is 12 years old to qualify for an ADHD diagnosis (CDC, 2024). The inattentive category of diagnosis specifies symptoms relating to a lack of attention, avoidance, and procrastination; while the hyperactive-impulsive category includes symptoms relating to restlessness and risk-taking. Group differentiation is present in the categories of symptoms, with a higher tendency amongst female patients to show signs of inattentive ADHD. In contrast, the hyperactive-impulsive symptoms are more characteristic of male ADHD patients (Clay et al., 2024).
Limitations
One limitation of ADHD diagnosis is the shift of symptoms throughout the development of a person's lifetime. Undiagnosed adults with ADHD often have to recount childhood experiences or behaviours to obtain a diagnosis from a psychiatrist (Brownlie et al., 2011). A common misconception amongst the wider society, but also prevalent amongst some practising psychologists in more conservative areas, is the disappearance of childhood ADHD symptoms. However, studies conducted over a wider period (longitudinal studies) show that ADHD symptoms persist into adulthood for a significant number of individuals (Brownlie et al., 2011). The persistence of ADHD symptoms depends on the method used to determine an ADHD diagnosis; for example, when using DSM-5 as diagnostic criteria, parent-reporting of symptoms yielded a 10% higher rate of ADHD diagnosis when compared to reporting your symptoms yourself (Sibley et al., 2016). However, data collected on the persistence of ADHD is oftentimes unreliable due to the wide estimated margin of ADHD symptoms persisting into adulthood, as well as a general lack of in depth understanding on the manifestation of ADHD symptoms in adults.
Treatment
Treatments of ADHD concern 2 classes of medications: stimulant and non-stimulant medications. Both medications work by increasing the levels of dopamine and norepinephrine in the brain, which are responsible for prolonged attention and motivation; notable examples of stimulant drugs used for ADHD treatment include Adderall and Ritalin (Stimulant medications for ADHD, n.d). On the other hand, non-stimulants can be prescribed in case of potential adverse side-effects from stimulant drugs, or to combat the risk of abuse and addiction. Additional drugs which have been prescribed and have shown some levels of improved attention include antidepressants, antipsychotics and blood pressure medications (Nonstimulants and Other ADHD Drugs, n.d.). A Meta-analysis conducted by Hauck et al. (2017) sought to analyse demographic factors which could influence the medications prescribed to patients, using medical records of 250,000 patients from a sample based in Ontario, Canada, where 7.9% of all males and 2.7% of females had been diagnosed with ADHD. On average, a greater percentage of females diagnosed with ADHD received antidepressants as part of treatment for their condition. Meanwhile, antipsychotics were roughly equally prescribed between males and females diagnosed with ADHD, with 13% for Males and 12% for Females. This can suggest that symptoms in females with ADHD are more likely to resemble anxiety or depression, which would explain the significant difference in antidepressant prescription. Females with ADHD are also more likely to get misdiagnosed with anxiety or depression than male patients and are additionally less likely to receive a diagnosis in infancy, which can explain the higher percentage of antidepressant medication along with additional comorbidies.
Country Dimensions for medication treatment
Depending on medical practices in a respective country, children may or may not be prescribed alternative medication for severe ADHD if first-line treatment with stimulant drugs on norepinephrine receptors doesn’t work. First-line treatment is generally understood as the prescription of stimulant medications. In the U.S, it is generally tolerated to use non-stimulant drugs that lack FDA approval for treatment when a client does not respond well to stimulant drugs from side effects such as insomnia, restlessness, weight gain and lack of appetite (Nazrova et al., 2022). However, further drug treatment is not recommended in the UK if a patient under 6 years old does not respond to first-line treatment. The differences between countries in treatment practices can sometimes lead to controversy over treatment practices from psychiatrists, whereby there is a general social attitude that people with ADHD are overmedicated in certain social spaces. Such is the question of overmedication or undermedication, as meta-analyses conducted by Masutti et al. (2021) estimated that 70% of their sample of 104,305 participants would benefit from ADHD medication; however, only 19.1% of all youths were receiving medical treatment, mainly focusing on stimulants and atomoxetine. Furthermore, the lowest rates of ADHD patients who are medicated were in Europe and Oceania, this can be attributed to differences in preferred treatment options in those respective areas, favouring treatment options such as Cognitive Behavioural Therapy or resorting to medication in more severe cases.
Non-medication treatment
In younger children diagnosed with ADHD, behavioural parent and teacher training (BPT) is often used to establish methods of encouraging and discouraging certain behaviours present in young children (Leon-Barriera et al., 2022). This can be combined with Cognitive Behavioural Therapy, especially as the client progresses into teenagehood, where CBT is used to approach someone’s daily routine differently or help deal with task fatigue and emotional dysregulation. Due to its focus on analysing fears, unhelpful ways of thinking, and distortions of reality CBT has been proven to be an effective form of treatment for many disorders, including common comorbidities associated with ADHD such as anxiety and depression, due to its ability to provoke permanent changes to a client’s lifestyle and the presence of far fewer side effects, both of the following attributes makes it appealing to certain clients (American Psychological Association, 2017). However, the research did emphasize the limited scope which CBT has in the treatment of ADHD as treating supplementary commorbidies, participant A recounted how medications were of great help to him, but stressed their impacts on comorbidities.
The question of gender identity
Information on gender identity regarding ADHD treatment or misdiagnosis has been sparse. At the same time, there have been numerous studies correlating neurodivergence to feelings of gender dysphoria and non-conformity. However, this is more specific to individuals diagnosed with Autism Spectrum Disorder rather than ADHD, in the context that people with ASD have difficulties in gender performance and are more likely to express gender incongruent feelings (Kallitsounaki et al., 2021). While there is the possibility that ADHD symptoms can manifest differently based on gender identity, in Clay et al. (2024) study analysing the success of ADHD treatment methods using quality measures, patients without gender dysphoria were 1.6 times more likely to meet 3 quality measures examined in the paper successfully, however the sample of patients with gender dysphoria was too small to make any significant measurement on how gender identity affects the success of ADHD treatment.
Comorbidities
ADHD doesn’t act alone, oftentimes a diagnosis of ADHD is a signifier of other comorbidities, which refers to additional mental disorders that may be present along a primary disorder. Several references have been made to comorbidities by both literature and interviewees; in a Norwegian study with a sample of 40,000 participants ADHD was associated with a 4-9 times greater rate of Substance Use Disorder, Anxiety, Depression, Bipolar, and Borderline Personality Disorder. Women with ADHD had higher rates of anxiety and depression, meanwhile men showed greater prevalence in substance use disorder, which is more characteristic of the hyperactive-impulsive traits, more closely correlated to the experience of men with ADHD (Solberg et al., 2017). An interview conducted with a participant also suggested additional diagnosis of anxiety and depression as comorbidies to an evaluation of ADHD which impaired the ability of the participant to focus on everyday tasks and environments.
