Current studies identify the negative impacts of failing to diagnose and treat attention deficit hyperactivity disorder (ADHD), which contributes to well-described impairment, morbidity, and mortality. Timely diagnosis, acceptance, and treatment do, in fact, improve outcomes. Benefits include a decrease in negative impacts on self-esteem, depression and other mood disorders, substance use disorders, suicidality, motor vehicle crashes, and criminality. These consequences result from easy distractibility and impulsiveness, which can be damaging if left untreated. ADHD is now more frequently identified later in life, which is consistent with findings that children do not routinely “age out” of the diagnosis. Additionally, many adults have missed childhood diagnoses, especially girls more than boys, due in part to the externalized symptoms in boys versus the quieter presentation of attention deficit disorder (ADD) without hyperactivity in girls.
Multiple studies show ADHD to be predominantly genetic (75–90 percent), with multiple genes contributing to its complexity. This complexity leads to confusion about the validity of the diagnosis and reluctance to treat it. In other words, patterns pathognomonic of the diagnosis are not always obvious. ADHD, as manifested in behaviors, results from multiple pathways and neural connectivity patterns in the brain. It is easy to make assumptions and draw intuitive conclusions that do not align with robust data describing ADHD and its etiologies. While questions remain about the impact of different perinatal exposures, studies support prematurity, hypertension, and cigarette smoking during pregnancy as known contributors to ADHD. Injuries such as stroke and traumatic brain injury can also cause symptoms consistent with ADHD. The apparent increase in prevalence likely stems from improved survival of premature babies due to medical advances.
Diagnosis cannot rely solely on assessment scales, as these can produce false positives. Accurate diagnosis also requires a careful history and medical examination. The sequelae of household adversity, specific learning disorders, and mood disorders can mimic features of ADHD on assessments. Therefore, a trained professional familiar with these factors must evaluate the diagnosis. Although neuropsychological testing is not required, it can help identify learning disabilities and social skill deficits and may be necessary to qualify for certain benefits.
Timely childhood diagnosis enables multi-modal treatment, including psychoeducation, behavioral therapy for children, parent training, teacher awareness, and stimulant medication. These interventions help reduce a child’s exposure to chronic failure and criticism from adults who do not understand the disorder. Because ADHD is characterized by poor time management, easy distractibility, and a tendency to procrastinate due to underlying brain function, it is important to mitigate everyone’s frustration early. Understanding a child’s lower frustration threshold and increased emotional dysregulation also presents opportunities for more effective management. An exhausted child is unlikely to sit and concentrate—regardless of ADHD—but a child with ADHD is more likely to fall apart quickly, making the experience more painful for everyone. Standard approaches to child-rearing can be disastrous for children with ADHD. Learning what the diagnosis truly means contributes to everyone’s well-being.
Underlying deficits in executive function characterize and unify the diagnosis of ADHD—a complex, behaviorally manifested disorder. These deficits also explain the need for environmental modification as part of treatment. Environment does not cause ADHD, but it can either support success or contribute to worsening symptoms and outcomes. Executive function underlies the ability to plan for the future. This includes identifying and completing steps toward a goal, suppressing distractions in the environment, managing multiple variables, keeping track of time, and regulating frustration.
Some children and adults develop systems that allow them to function well without diagnostically guided input. Coping skills developed by those navigating life with ADHD can lead to extraordinary success—for example, gaining admission to professional schools, starting and running businesses, and maintaining healthy relationships. Despite these exceptions, robust data support the benefits of early diagnosis and treatment and the negative consequences of neglecting them. These include impacts on self-esteem, social integration, and academic and professional achievement. Not everyone is fortunate enough to cope well. Some individuals are born with more severe manifestations of the disorder, while others grow up with limited resources or in chaotic environments. Like all mental health conditions, ADHD is not a one-size-fits-all diagnosis. Human behavior is complex, influenced by emotion, implicit memory, and mistaken assumptions. However, it is possible to distinguish the effects of environment—including early childhood trauma—from ADHD, a neurodevelopmental disorder that is certainly affected by but not caused by environmental factors.
As Russell Barkley succinctly describes, impairments in working memory, motivation, distractibility, impulsivity, and time management require strategic intervention. External reminders compensate for what those without ADHD can track internally. A poor sense of time, if unmanaged, leads to chronic tardiness and missed appointments. Susceptibility to external stimuli also means that adults with ADHD are more likely to be sidetracked while trying to complete tasks—for example, leaving the laundry, groceries, bills, or home projects unfinished. They may also become completely absorbed in an activity and miss an appointment, despite having reminded themselves earlier that day. This phenomenon, sometimes referred to as hyper-focus, may seem counterintuitive in a diagnosis associated with inattention. However, the difficulty in ADHD lies not only in focusing but also in switching gears, particularly when future goals are involved. Tasks requiring delayed gratification and stepwise planning are especially challenging. In contrast, short tasks with few steps and immediate rewards are often easier to complete.
Some treatment strategies for children with ADHD involve breaking projects into simpler, more manageable steps—a practice that can benefit adults as well. A full book report may feel overwhelming. Instead, start by reading the book in small increments. Then write a single paragraph summarizing the story, followed by a second paragraph analyzing key points, and finally a third paragraph to conclude. This approach is far more attainable for a brain that struggles to hold an entire project in working memory and highlights the importance of environmental support in treatment. Imagine the difference between an adult who learned this strategy during formative years and one who continues to wonder why they struggle to reach their potential. Or consider the adult who achieves goals but only through immense, unseen effort that leads to chronic demoralization.
As previously discussed, the inability to filter out extraneous stimuli plays a role in ADHD. White noise can help by drowning out distracting sounds. For many adults, starting medication brings the poignant realization that they can, for the first time, effectively block distractions. In classrooms, this issue may be managed by assigning specific seating, enforcing quiet time, or providing white noise or noise-canceling headphones—although this last strategy may heighten feelings of alienation in children who already feel embarrassed.
ADHD is treatable with evidence-based guidelines. Stimulant medication often plays a crucial role in helping individuals focus effectively. Managing the environment, particularly in childhood, is also essential. Recognizing when a child has reached their limit and extending grace for both their frustration and your own yields long-term benefits. These interventions help children grow into adults who feel capable rather than defeated and who can confidently build on their strengths—just like everyone else.
Maire Daugharty is an anesthesiologist who expanded her expertise by earning a master’s degree in clinical mental health counseling, merging her long-standing interest in mental health with her medical background. As a licensed professional counselor, licensed addiction counselor, and licensed marriage and family therapist, she brings a well-rounded perspective to her private practice, where she works with adult individuals and couples on a wide range of concerns. In addition to her counseling practice, she continues to work part-time as an anesthesiologist and has a deep understanding of the unique challenges faced by clinicians in today’s medical landscape. To learn more about her practice, visit Physician Vitality Services.