Understanding ADHD: What It Really Is (and Isn’t)

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition characterized by patterns of inattention, hyperactivity, and impulsivity that are more frequent or severe than typically seen in people of similar developmental level.

Key points to remember:

• ADHD is not simply “bad behavior,” laziness, or lack of willpower.

• It is not caused by poor parenting, sugar, or video games—though environment and support matter in managing it.

• Many people with ADHD also have strengths (creativity, energy, divergent thinking, perseverance) that can flourish with understanding and support.

Types of ADHD

According to the DSM-5, there are three main presentations of ADHD:

1. Predominantly Inattentive (ADHD-I): distractibility, disorganization, forgetfulness.

2. Predominantly Hyperactive-Impulsive (ADHD-HI): restlessness, fidgeting, interrupting, acting without thinking.

3. Combined Presentation (ADHD-C): meets criteria for both inattentive and hyperactive/impulsive symptoms.

   
   

Presentations may shift across development. Hyperactivity tends to be more visible in children, while older teens and adults may experience it more as “internal restlessness.”

How ADHD Presents Across Ages

In Children:

• Difficulty sitting still

• Trouble waiting their turn, blurting out answers

• Appearing not to listen, losing things

• Disorganized schoolwork

• Forgetfulness and distractibility

  
  

In Adolescents / Teens:

• More internal restlessness, less overt hyperactivity

• Difficulty with time management and planning

• Social and emotional challenges (peer issues, rejection sensitivity)

• Risk-taking behaviors

• Missed or delayed diagnoses, especially for inattentive type

  
  

In Adults:

• Challenges with organization, prioritization, and time management

• Trouble sustaining focus on routine tasks

• Impulsivity in decision-making

• Emotional dysregulation (frustration, irritability)

• Difficulties in relationships or at work

  
  

Genetic and Neurological Factors

• Genetics: ADHD is highly heritable. Many genes of small effect are involved, especially those linked to dopamine and norepinephrine regulation.

  
  

• Brain structure: Research shows subtle differences in subcortical regions (caudate, putamen, hippocampus) and in cortical connectivity.

  
  

• Brain function: Altered activity in networks related to attention, executive control, and reward processing.

  

• Neurochemistry: Differences in dopamine and noradrenaline systems play a role.

These are probabilistic findings—there is overlap with “typical” individuals, and brain scans cannot diagnose ADHD alone.

Myths vs. Facts

Myth: Only children have ADHD.

Fact: About two-thirds of children with ADHD continue to have symptoms into adulthood.

Myth: ADHD is caused by poor parenting.

Fact: Parenting style may influence outcomes, but ADHD is rooted in brain and genetic factors.

Myth: Kids with ADHD just need to try harder.

Fact: Many children struggle even in structured, supportive settings.

Myth: ADHD is overdiagnosed.

Fact: In some groups (especially girls and inattentive type), ADHD is actually underdiagnosed.

Myth: Medication is a cure.

Fact: Medication can be effective in managing symptoms, but it is not a cure and works best as part of a broader treatment plan.

Myth: Sugar or screens cause ADHD.

Fact: These do not cause ADHD, though lifestyle factors can influence symptom management.

What This Means for Families in the Netherlands

1. Early awareness helps. If you suspect ADHD, request an assessment from a qualified professional.

2. Get a comprehensive evaluation. Diagnosis should involve history, questionnaires, and input from multiple settings.

3. Multimodal treatment works best. Behavioral strategies, school accommodations, and when appropriate, medication.

4. Know your resources. Dutch organizations like Impuls & Woortblind provide information and support.

5. Adapt over time. ADHD looks different across childhood, adolescence, and adulthood—strategies should evolve too.

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

National Institute of Mental Health (NIMH). (2023). Attention-Deficit/Hyperactivity Disorder: What You Need to Know. Retrieved from: https://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-what-you-need-to-know

Faraone, S. V., & Larsson, H. (2019). Genetics of attention deficit hyperactivity disorder. Molecular Psychiatry, 24(4), 562–575.

Hoogman, M., et al. (2017). Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis. The Lancet Psychiatry, 4(4), 310–319.

Cortese, S., et al. (2023). Attention-deficit/hyperactivity disorder. Nature Reviews Disease Primers, 9(1), 1–24.