The Advantages of an Attention Deficit

Turning the Improbable 

Into the Exceptional! 

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The Advocacy Foundation, Inc. 

Helping Individuals, Organizations & Communities 

Achieve Their Full Potential 

Since its founding in 2003, The Advocacy Foundation has become recognized as an effective 

provider of support to those who receive our services, having real impact within the communities 

we serve. We are currently engaged in community and faith-based collaborative initiatives, 

having the overall objective of eradicating all forms of youth violence and correcting injustices 

everywhere. In carrying-out these initiatives, we have adopted the evidence-based strategic 

framework developed and implemented by the Office of Juvenile Justice & Delinquency 

Prevention (OJJDP). 

The stated objectives are: 

1. Community Mobilization; 

2. Social Intervention; 

3. Provision of Opportunities; 

4. Organizational Change and Development; 

5. Suppression [of illegal activities]. 

Moreover, it is our most fundamental belief that in order to be effective, prevention and 

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Collaborative. The Violence Prevention and Intervention programming we employ in 

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Dedication 

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Every publication in our many series’ is dedicated to everyone, absolutely everyone, who by 

virtue of their calling and by Divine inspiration, direction and guidance, is on the battlefield dayafter-day 

striving to follow God’s will and purpose for their lives. And this is with particular affinity 

for those Spiritual warriors who are being transformed into excellence through daily academic, 

professional, familial, and other challenges. 

We pray that you will bear in mind: 

Matthew 19:26 (NIV) 

Jesus looked at them and said, "With man this is impossible, 

but with God all things are possible." (Emphasis added) 

To all of us who daily look past our circumstances, and naysayers, to what the Lord says we will 

accomplish: 

Blessings!! 

- The Advocacy Foundation, Inc. 



The Transformative Justice Project 

Eradicating Juvenile Delinquency Requires a Multi-Disciplinary Approach 

The way we accomplish all this is a follows: 

The Juvenile Justice system is incredibly overloaded, and 

Solutions-Based programs are woefully underfunded. Our 

precious children, therefore, particularly young people of 

color, often get the “swift” version of justice whenever they 

come into contact with the law. 

Decisions to build prison facilities are often based on 

elementary school test results, and our country incarcerates 

more of its young than any other nation on earth. So we at 

The Foundation labor to pull our young people out of the 

“school to prison” pipeline, and we then coordinate the efforts 

of the legal, psychological, governmental and educational 

professionals needed to bring an end to delinquency. 

We also educate families, police, local businesses, elected 

officials, clergy, and schools and other stakeholders about 

transforming whole communities, and we labor to change 

their thinking about the causes of delinquency with the goal 

of helping them embrace the idea of restoration for the young 

people in our care who demonstrate repentance for their 

mistakes. 

1. We vigorously advocate for charges reductions, wherever possible, in the adjudicatory (court) 

process, with the ultimate goal of expungement or pardon, in order to maximize the chances for 

our clients to graduate high school and progress into college, military service or the workforce 

without the stigma of a criminal record; 

2. We then enroll each young person into an Evidence-Based, Data-Driven Restorative Justice 

program designed to facilitate their rehabilitation and subsequent reintegration back into the 

community; 

3. While those projects are operating, we conduct a wide variety of ComeUnity-ReEngineering 

seminars and workshops on topics ranging from Juvenile Justice to Parental Rights, to Domestic 

issues to Police friendly contacts, to CBO and FBO accountability and compliance; 

4. Throughout the process, we encourage and maintain frequent personal contact between all 

parties; 

5 Throughout the process we conduct a continuum of events and fundraisers designed to facilitate 

collaboration among professionals and community stakeholders; and finally 


6. 1 We disseminate Quarterly publications, like our e-Advocate series Newsletter and our e-Advocate 

Quarterly electronic Magazine to all regular donors in order to facilitate a lifelong learning process 

on the ever-evolving developments in the Justice system. 

And in addition to the help we provide for our young clients and their families, we also facilitate 

Community Engagement through the Restorative Justice process, thereby balancing the interesrs 

of local businesses, schools, clergy, elected officials, police, and all interested stakeholders. Through 

these efforts, relationships are rebuilt & strengthened, local businesses and communities are enhanced & 

protected from victimization, young careers are developed, and our precious young people are kept out 

of the prison pipeline. 

This is a massive undertaking, and we need all the help and financial support you can give! We plan to 

help 75 young persons per quarter-year (aggregating to a total of 250 per year) in each jurisdiction we 

serve) at an average cost of under $2,500 per client, per year.* 

Thank you in advance for your support! 

* FYI: 

1. The national average cost to taxpayers for minimum-security youth incarceration, is around 

$43,000.00 per child, per year. 

2. The average annual cost to taxpayers for maximun-security youth incarceration is well over 

$148,000.00 per child, per year. 

- (US News and World Report, December 9, 2014); 

3. In every jurisdiction in the nation, the Plea Bargain rate is above 99%. 

The Judicial system engages in a tri-partite balancing task in every single one of these matters, seeking 

to balance Rehabilitative Justice with Community Protection and Judicial Economy, and, although 

the practitioners work very hard to achieve positive outcomes, the scales are nowhere near balanced 

where people of color are involved. 

We must reverse this trend, which is right now working very much against the best interests of our young. 

Our young people do not belong behind bars. 

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1 

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The Advocacy Foundation, Inc. 

Helping Individuals, Organizations & Communities 

Achieve Their Full Potential 

…a collection of works on 

The Advantages of 

Attention Deficit 

________________ 

“Turning the Improbable Into the Exceptional” 

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Biblical Authority 

______ 

Romans 8:18-28 (NASB) 

18 

For I consider that the sufferings of this present time are not worthy to be compared 

with the glory that is to be revealed to us. 19 For the anxious longing of the creation waits 

eagerly for the revealing of the sons of God. 20 For the creation was subjected to futility, 

not willingly, but because of Him who subjected it, in hope 21 that the creation itself also 

will be set free from its slavery to corruption into the freedom of the glory of the children 

of God. 22 For we know that the whole creation groans and suffers the pains of childbirth 

together until now. 23 And not only this, but also we ourselves, having the first fruits of 

the Spirit, even we ourselves groan within ourselves, waiting eagerly for our adoption as 

sons, the redemption of our body. 24 For in hope we have been saved, but hope that is 

seen is not hope; for who hopes for what he already sees? 25 But if we hope for what 

we do not see, with perseverance we wait eagerly for it. 

Our Victory in Christ 

26 

In the same way the Spirit also helps our weakness; for we do not know how to pray 

as we should, but the Spirit Himself intercedes for us with groanings too deep for 

words; 27 and He who searches the hearts knows what the mind of the Spirit is, because 

He intercedes for the saints according to the will of God. 

28 

And we know that God causes all things to work together for good to those who love 

God, to those who are called according to His purpose. 

Romans 6:14 

14 

For sin shall not be master over you, for you are not under law but under grace. 

Yodh. 

Psalm 119:73-81 

73 

Your hands made me and fashioned me; 

Give me understanding, that I may learn Your commandments. 

74 

May those who fear You see me and be glad, 

Because I wait for Your word. 

75 

I know, O Lord, that Your judgments are righteous, 

And that in faithfulness You have afflicted me. 

76 

O may Your lovingkindness comfort me, 


According to Your word to Your servant. 

77 

May Your compassion come to me that I may live, 

For Your law is my delight. 

78 

May the arrogant be ashamed, for they subvert me with a lie; 

But I shall meditate on Your precepts. 

79 

May those who fear You turn to me, 

Even those who know Your testimonies. 

80 

May my heart be blameless in Your statutes, 

So that I will not be ashamed. 

Kaph. 

81 

My soul languishes for Your salvation; 

I wait for Your word. 

2 Corinthians 10:4-5 

4 

for the weapons of our warfare are not of the flesh, but divinely powerful for the 

destruction of fortresses. 5 We are destroying speculations and every lofty thing raised 

up against the knowledge of God, and we are taking every thought captive to 

the obedience of Christ, 

Jeremiah 29:11-13 

11 

For I know the plans that I have for you,’ declares the Lord, ‘plans for welfare and not 

for calamity to give you a future and a hope. 12 Then you will call upon Me and come 

and pray to Me, and I will listen to you. 13 You will seek Me and find Me when you search 

for Me with all your heart. 


Table of Contents 

…a compilation of works on 

The Advantages of 


Biblical Authority 

I. Introduction: Attention Deficit…………………………………… 15 

II. Attention Deficit Hyperactivity Disorder………………………… 21 

III. The Advantages of ADD/ ADHD……………………………….. 41 

IV. Autism Spectrum…………………………………………………. 51 

V. Asperger Syndrome……………………………………………... 67 

VI. Adult ADHD…………….………………………………………… 83 

VII. Cognitive Solutions for ADHD…………………....................... 93 

VIII. Famous People with ADHD…………………………………… 107 

IX. References…………………………………………………….... 111 

______ 

Attachments 

A. About ADHD 

B. Adult ADHD Self-Report Scale Symptoms Checklist 

C. Dream Jobs for Adults with ADHD 

Copyright © 2018 The Advocacy Foundation, Inc. All Rights Reserved. 



I. Introduction 


What Is Attention Deficit Disorder? 

by Jane Framingham, Ph.D. 

Since the early part of this century, doctors have ascribed an array of names to this 

constellation of behaviors — among them hyperkinesis, hyperactivity, minimal brain 

damage and minimal brain dysfunction. In the late 1970s, attention deficit hyperactivity 

disorder (ADHD) became the accepted term. 

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of 

Mental Disorders (DSM-5), ADHD is characterized by a “persistent pattern of inattention 

and/or hyperactivity or impulsivity that is more frequent and severe than is typically 

observed in individuals at a comparable level of development.” You can review the 

full symptoms of ADHD here. 


In recent years, major advances have been made in our understanding of ADHD. Consider 

these striking facts: 

 

 

 

 

 

ADHD is the most commonly diagnosed psychiatric condition in children and is a 

major reason for referral to a pediatrician, family physician, pediatric neurologist, or 

child psychologist. Over 11 percent — more than 1 in 10 children — of school-age 

youngsters are affected — more than 6 million between the ages of 5 and 18 (CDC). 

A significant number of them also are diagnosed with associated learning disabilities. 

Boys are more than 3 times more likely to develop and be diagnosed with the 

disorder than girls. 

Researchers no longer believe that the symptoms of ADHD fade with the passage of 

time for most people with the diagnosis. 

It is estimated that more than 4 percent of adults have ADHD as well (CDC). Many 

adults with ADHD were never diagnosed when they were young and may not even 

be aware they have the disorder. Some may have been wrongly diagnosed 

with depression or a personality disorder in childhood or as adults. 

ADHD crosses ethnic boundaries; researchers have found it exists in every nation 

and culture they have studied. 

ADHD presents many challenges, both for the individuals who grapple with it as well as for 

society. At its worst, some experts say, ADHD saddles individuals with an increased risk of 

accidents, drug abuse, failure at school, antisocial behavior and criminal activity. And 

people with ADHD frequently battle associated problems. These include: 

 

 

 

 

 

 

anxiety 

various learning disabilities 

speech or hearing deficits 

obsessive-compulsive disorders 

tic disorders 

or behavioral problems such as oppositional defiant disorder (ODD) or conduct 

disorder (CD) 

Yet others insist ADHD sparks creative genius and is the mark of an inventive mind. 

The causes of ADHD have not been pinpointed, though many psychologists and 

researchers believe that psychological, neurobiological, and genetic elements likely play a 

role. In addition, numerous social factors such as family conflict or poor child-rearing 

practices may complicate the course of ADHD and its treatment. 

The public health significance of ADHD was emphasized by the National Institutes of Health 

in November 1998, when it convened the NIH Consensus Development Conference on 

Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder. This meeting was 

attended by leading national experts who reviewed the current scientific facts. Additional 


scientific meetings have been held since that time, to review the evidence about this 

disorder and whether it’s become overdiagnosed in more recent times. 

Symptoms of ADHD 

________ 

Attention Deficit Disorders: 

Causes, Symptoms and Treatments 

by The Douglas Institute 

The primary symptoms of ADHD are focusing difficulties, hyperactivity (excessive 

activity), and impulsivity (acting before considering the consequences). The behavior 

must be excessive, appear before age 7, and seriously handicap at least two areas in a 

person's life (home and school, for example). 

The three main categories are: 

• Inattentive: difficulty focusing or staying focused on a task or activity 

• Hyperactive-Impulsive: excessive activity and impulsivity 

• Combined: focusing problems plus excessive activity and impulsivity 


Who is affected by ADHD? 

• 3 to 5% of children have an ADHD 

• Boys are three times as likely as girls to be affected 

• ADHD touches people of all ages (including adults) 

Usually, it's only over time that it becomes clear that certain children are not just 

daydreamers or extraordinarily active – that they are, in fact, handicapped with a 

medical disorder. This is because children with attention disorders exhibit the same 

behaviors seen in any normal child, except that their behaviors are exaggerated, and 

debilitating. Children with ADD have a neurobiologically-based disability that causes 

them to be inappropriately inattentive, and, in some cases, inappropriately impulsive for 

their age. Many have poor short-term memories, difficulties in completing tasks, and 

problems with intrusiveness. 

Sleep problems are also common. Falling within in this category are children who 

daydream incessantly. They find it almost impossible to stay with the task at hand, 

which can have devastating consequences for their school performance. Because these 

children are not disruptive, they can also be harder to spot and treat. They are often 

found sitting in the back rows of classrooms, gazing out the windows. Teachers may 

think they're “slow”. Chances are they're not. 

Those who have ADHD, as opposed to ADD, have the additional challenge of being 

hyperactive (inappropriately active for their age). In a constant physical whirl of 

unfocussed activity, they dart from here to there. Critically hampering their ability to 

achieve goals, this variant of attention disorder can wreak havoc on family, school and 

social life. ADHD (representing ADD and ADHD) affects two to three times more boys 

than girls, but the girls who are affected can be impaired as severely as boys. It can 

place great stress on parents, siblings, friends, teachers, and others closely connected 

with the child. 

Causes of ADHD 

Like all mental disorders, Attention-Deficit/Hyperactivity Disorder results from a 

combination of genetic and environmental risk factors. Several studies have shown that 

a small molecule responsible for communication between neurons—dopamine—plays 

an important role in attention, task orientation, and action. In fact, the drugs used to 

treat attention deficit/hyperactivity disorder increase its level between certain neurons. It 

is therefore possible that an imbalance in dopamine-related nervous system activities 

may play a role in the development of attention deficit/hyperactivity disorder. 

Since 30 to 40 percent of people diagnosed with ADHD have relatives with the same 

disorder, genes are thought to be at least partially involved. Although parents, teachers, 

spouses etc. do not cause ADHD, they can greatly affect the person's ability to cope 

with their disorder. 


Consequences of ADHD 

A cruel consequence of these attention disorders is the tendency towards low selfesteem. 

Not being able to sit still, to wait your turn, to control your ability to focus – all 

these things make children stand out in a crowd when they don't want to! In addition, 

most of these children have great difficulty in reading the same social cues that most 

children learn automatically, so they may inadvertently appear gauche or “weird”. These 

children also are at greater risk for having additional psychological problems such as 

anxiety, depression, and conduct disorder (a tendency to be chronically disruptive, 

disobedient, often aggressive). 

As adults, they are at a greater risk for divorce, job conflict and suicide than the general 

population. Approximately 3-5% of children have ADHD and approximately 50% of 

those children will carry significant challenges into adulthood. 

Fortunately, these children can be very creative, and evolve into highly accomplished 

adults. Perhaps because their thoughts tend to jump around more than most, they tend 

to approach problems in unique ways. In fact, Mozart, Einstein and Edison are 

suspected by many of having an attention disorder. It is important, as well, to realize 

that the intellectual potential of these children is no different from that of the rest of the 

general population. 

There are lawyers, doctors, school principals – people from all walks of life – who have 

successfully dealt with their ADHD challenges. Fortunately, many of the problems with 

social awkwardness, chronic inattentiveness, and intrusiveness often respond well to 


counseling and group therapy. In addition, if these children are raised in a loving home 

and have an understanding school environment structured to meet their needs, their 

chances of having a positive outcome as adults rise significantly. 

Treatments of ADHD 

Available treatments are adapted to meet the needs of the individual child following a 

biopsychosocial assessment. Treatments include specific medications, 

psychoeducation, social skills training, special supervision at school, and individual 

psychotherapy. 

Parents may also receive help to better understand attention deficit disorder and 

improve their parenting skills. This therapy is offered in group sessions on Saturdays or 

at specialized summer camps. 

All children are also assessed to determine their response to drug treatments in terms 

of both behaviour and possible side effects. 

What to do? 

If you suspect that someone has ADHD, he should be evaluated by a trained 

professional. If the person does not have a family doctor, contact the CLSC in your area 

for directions to an appropriate resource. 


II. Attention Deficit 

Hyperactivity Disorder 

Attention deficit hyperactivity disorder (ADHD) is a mental disorder of the 

neurodevelopmental type. It is characterized by problems paying attention, excessive 

activity, or difficulty controlling behavior which is not appropriate for a person's age. [1][2] 

The symptoms appear before a person is twelve years old, are present for more than 

six months, and cause problems in at least two settings (such as school, home, or 

recreational activities). In children, problems paying attention may result in poor school 

performance. Although it causes impairment, particularly in modern society, many 

children with ADHD have a good attention span for tasks they find interesting. 

Despite being the most 

commonly studied and 

diagnosed mental disorder in 

children and adolescents, the 

exact cause is unknown in 

the majority of cases. It 

affects about 5–7% of 

children when diagnosed via 

the DSM-IV criteria and 1– 

2% when diagnosed via the 

ICD-10 criteria. As of 2015 it 

is estimated to affect about 

51.1 million people globally. 

Rates are similar between 

countries and depend mostly 

on how it is diagnosed. 

ADHD is diagnosed 

approximately three times 

more often in boys than in 

girls, although the disorder is 

often overlooked in girls due 

to their symptoms differing 

from those of boys. About 30–50% of people diagnosed in childhood continue to have 

symptoms into adulthood and between 2–5% of adults have the condition. The condition 

can be difficult to tell apart from other conditions, as well as to distinguish from high 

levels of activity that are still within the range of normative behaviors. 

ADHD management recommendations vary by country and usually involve some 

combination of counseling, lifestyle changes, and medications. The British guideline 

only recommends medications as a first-line treatment in children who have severe 

symptoms and for medication to be considered in those with moderate symptoms who 

either refuse or fail to improve with counseling, though for adults medications are a first- 


line treatment. Canadian and American guidelines recommend that medications and 

behavioral therapy be used together as a first-line therapy, except in preschool-aged 

children. Stimulant medication therapy is not recommended as a first-line therapy in 

preschool-aged children in either guideline. Treatment with stimulants is effective for up 

to 14 months; however, its long term effectiveness is unclear. Adolescents and adults 

tend to develop coping skills which make up for some or all of their impairments. 

The medical literature has described symptoms similar to ADHD since the 19th century. 

ADHD, its diagnosis, and its treatment have been considered controversial since the 

1970s. The controversies have involved clinicians, teachers, policymakers, parents, and 

the media. Topics include ADHD's causes and the use of stimulant medications in its 

treatment. Most healthcare providers accept ADHD as a genuine disorder in children 

and adults, and the debate in the scientific community mainly centers on how it is 

diagnosed and treated. The condition was officially known as attention deficit disorder 

(ADD) from 1980 to 1987, while before this it was known as hyperkinetic reaction of 

childhood. 

Signs and symptoms 

Inattention, hyperactivity (restlessness in adults), disruptive behavior, and impulsivity 

are common in ADHD. Academic difficulties are frequent as are problems with 

relationships. The symptoms can be difficult to define, as it is hard to draw a line at 

where normal levels of inattention, hyperactivity, and impulsivity end and significant 

levels requiring interventions begin. 

According to the fifth version of the Diagnostic and Statistical Manual of Mental 

Disorders (DSM-5), symptoms must be present for six months or more to a degree that 

is much greater than others of the same age and they must cause significant problems 

functioning in at least two settings (e.g., social, school/work, or home). The full criteria 

must have been met prior to age twelve in order to receive a diagnosis of ADHD. 

ADHD is divided into three subtypes: predominantly inattentive (ADHD-PI or ADHD-I), 

predominantly hyperactive-impulsive (ADHD-PH or ADHD-HI), and combined type 

(ADHD-C). 

A child with ADHD inattentive type has most or all of following symptoms, excluding 

situations where these symptoms are better explained by another psychiatric or medical 

condition: 

 

 

 

 

Be easily distracted, miss details, forget things, and frequently switch from one 

activity to another 

Have difficulty maintaining focus on one task 

Become bored with a task after only a few minutes, unless doing something they 

find enjoyable 

Have difficulty focusing attention on organizing or completing a task 


Have trouble completing or turning in homework assignments, often losing things 

(e.g., pencils, toys, assignments) needed to complete tasks or activities 

Appear not to be listening when spoken to 

Daydream, become easily confused, and move slowly 

Have difficulty processing information as quickly and accurately as others 

Struggle to follow instructions 

Have trouble understanding details; overlooks details 

A child with ADHD hyperactive-impulsive type has most or all of the following 

symptoms, excluding situations where these symptoms are better explained by another 

psychiatric or medical condition: 

 

 

 

 

 

Fidget or squirm a great deal 

Talk nonstop 

Dash around, touching or playing with anything and everything in sight 

Have trouble sitting still during dinner, school, doing homework, and story time 

Be constantly in motion 


Have difficulty performing quiet tasks or activities 

Be impatient 

Blurt out inappropriate comments, show their emotions without restraint, and act 

without regard for consequences 

Have difficulty waiting for things they want or waiting their turn in games 

Often interrupt conversations or others' activities 

Girls tend to have less hyperactivity, inattention, and impulsivity but greater symptoms 

pertaining to inattention and distractability. Symptoms of hyperactivity tend to go away 

with age and turn into "inner restlessness" in teens and adults with ADHD. 

People with ADHD of all ages are more likely to have problems with social skills, such 

as social interaction and forming and maintaining friendships. This is true for all 

subtypes. About half of children and adolescents with ADHD experience social rejection 

by their peers compared to 10–15% of non-ADHD children and adolescents. People 

with attention deficits are prone to having difficulty processing verbal and nonverbal 

language, which can negatively affect social interaction. They also may drift off during 

conversations, miss social cues, and have trouble learning social skills. 

Difficulties managing anger are more common in children with ADHD as are poor 

handwriting and delays in speech, language and motor development. Although it causes 

significant difficulty, many children with ADHD have an attention span equal to or better 

than that of other children for tasks and subjects they find interesting. 

Associated Disorders 

In children, ADHD occurs with other disorders about two-thirds of the time. Some 

commonly associated conditions include: 

 

 

 

Learning disabilities have been found to occur in about 20–30% of children with 

ADHD. Learning disabilities can include developmental speech and language 

disorders and academic skills disorders. ADHD, however, is not considered a 

learning disability, but it very frequently causes academic difficulties. 

Oppositional defiant disorder (ODD) and conduct disorder (CD), which occur with 

ADHD in about 50% and 20% of cases respectively. They are characterized by 

antisocial behaviors such as stubbornness, aggression, frequent temper 

tantrums, deceitfulness, lying, and stealing. About half of those with hyperactivity 

and ODD or CD develop antisocial personality disorder in adulthood. Brain 

imaging supports that conduct disorder and ADHD are separate conditions. 

Primary disorder of vigilance, which is characterized by poor attention and 

concentration, as well as difficulties staying awake. These children tend to fidget, 

yawn and stretch and appear to be hyperactive in order to remain alert and 

active. 


Sluggish cognitive tempo (SCT) is a cluster of symptoms that potentially 

comprises another attention disorder. It may occur in 30–50% of ADHD cases, 

regardless of the subtype. 

Mood disorders (especially bipolar disorder and major depressive disorder). Boys 

diagnosed with the combined ADHD subtype are more likely to have a mood 

disorder. Adults with ADHD sometimes also have bipolar disorder, which requires 

careful assessment to accurately diagnose and treat both conditions. 

Anxiety disorders have been found to occur more commonly in the ADHD 

population. 

 

 

 

Obsessive-compulsive disorder (OCD) can co-occur with ADHD and shares 

many of its characteristics. 

Substance use disorders. Adolescents and adults with ADHD are at increased 

risk of substance abuse. This is most commonly seen with alcohol or 

cannabis. [19] The reason for this may be an altered reward pathway in the brains 

of ADHD individuals. This makes the evaluation and treatment of ADHD more 

difficult, with serious substance misuse problems usually treated first due to their 

greater risks. [57][58] 

Restless legs syndrome has been found to be more common in those with ADHD 

and is often due to iron deficiency anaemia. However, restless legs can simply 


e a part of ADHD and requires careful assessment to differentiate between the 

two disorders. 

 

 

 

Sleep disorders and ADHD commonly co-exist. They can also occur as a side 

effect of medications used to treat ADHD. In children with ADHD, insomnia is the 

most common sleep disorder with behavioral therapy the preferred treatment. 

Problems with sleep initiation are common among individuals with ADHD but 

often they will be deep sleepers and have significant difficulty getting up in the 

morning. Melatonin is sometimes used in children who have sleep onset 

insomnia. 

People with ADHD have an increased risk of persistent bed wetting. 

A 2016 systematic review found a well established association between ADHD 

and obesity, asthma and sleep disorders, and tentative evidence for association 

with celiac disease and migraine, while another 2016 systematic review did not 

support a clear link between celiac disease and ADHD, and stated that routine 

screening for celiac disease in people with ADHD is discouraged. 

Intelligence 

Overall, studies have shown that people with ADHD tend to have lower scores on 

intelligence quotient (IQ) tests. The significance of this is controversial due to the 

differences between people with ADHD and the difficulty determining the influence of 

symptoms, such as distractibility, on lower scores rather than intellectual capacity. In 

studies of ADHD, higher IQs may be over represented because many studies exclude 

individuals who have lower IQs despite those with ADHD scoring on average nine 

points lower on standardized intelligence measures. 

Cause 

Most ADHD cases are of unknown causes. It is believed to involve interactions between 

genetics, the environment, and social factors. Certain cases are related to previous 

infection of or trauma to the brain. 

Genetics 

Twin studies indicate that the disorder is often inherited from one's parents with genetics 

determining about 75% of cases. Siblings of children with ADHD are three to four times 

more likely to develop the disorder than siblings of children without the disorder. Genetic 

factors are also believed to be involved in determining whether ADHD persists into 

adulthood. 

Typically, a number of genes are involved, many of which directly affect dopamine 

neurotransmission. Those involved with dopamine include DAT, DRD4, DRD5, TAAR1, 

MAOA, COMT, and DBH. Other genes associated with ADHD include SERT, HTR1B, 


SNAP25, GRIN2A, ADRA2A, TPH2, and BDNF. A common variant of a gene called 

LPHN3 is estimated to be responsible for about 9% of cases and when this variant is 

present, people are particularly responsive to stimulant medication. The 7 repeat variant 

of dopamine receptor D4 (DRD4–7R) causes increased inhibitory effects induced by 

dopamine and is associated with ADHD. The DRD4 receptor is a G protein-coupled 

receptor that inhibits adenylyl cyclase. The DRD4–7R mutation results in a wide range 

of behavioral phenotypes, including ADHD symptoms reflecting split attention. 

Evolution may have played a role in the high rates of ADHD, particularly hyperactive 

and impulsive traits in males. Some have hypothesized that some women may be more 

attracted to males who are risk takers, increasing the frequency of genes that 

predispose to hyperactivity and impulsivity in the gene pool. Others have claimed that 

these traits may be an adaptation that help males face stressful or dangerous 

environments with, for example, increased impulsivity and exploratory behavior. In 

certain situations, ADHD traits may have been beneficial to society as a whole even 

while being harmful to the individual. The high rates and heterogeneity of ADHD may 

have increased reproductive fitness and benefited society by adding diversity to the 

gene pool despite being detrimental to the individual. In certain environments, some 

ADHD traits may have offered personal advantages to individuals, such as quicker 

response to predators or superior hunting skills. 

People with Down syndrome are more likely to have ADHD. 


Environment 

In addition to genetics, some environmental factors might play a role in causing ADHD. 

Alcohol intake during pregnancy can cause fetal alcohol spectrum disorders which can 

include ADHD or symptoms like it. Children exposed to certain toxic substances, such 

as lead or polychlorinated biphenyls, may develop problems which resemble ADHD. 

Exposure to the organophosphate insecticides chlorpyrifos and dialkyl phosphate is 

associated with an increased risk; however, the evidence is not conclusive. Exposure to 

tobacco smoke during pregnancy can cause problems with central nervous system 

development and can increase the risk of ADHD. 

Extreme premature birth, very low birth weight, and extreme neglect, abuse, or social 

deprivation also increase the risk as do certain infections during pregnancy, at birth, and 

in early childhood. These infections include, among others, various viruses (measles, 

varicella zoster encephalitis, rubella, enterovirus 71). There is an association between 

long term but not short term use of acetaminophen during pregnancy and ADHD. At 

least 30% of children with a traumatic brain injury later develop ADHD and about 5% of 

cases are due to brain damage. 

Some studies suggest that in a small number of children, artificial food dyes or 

preservatives may be associated with an increased prevalence of ADHD or ADHD-like 

symptoms, but the evidence is weak and may only apply to children with food 

sensitivities. The United Kingdom and the European Union have put in place regulatory 

measures based on these concerns. In a minority of children, intolerances or allergies to 

certain foods may worsen ADHD symptoms. 

Research does not support popular beliefs that ADHD is caused by eating too much 

refined sugar, watching too much television, parenting, poverty or family chaos; 

however, they might worsen ADHD symptoms in certain people. 

Society 

In some cases, the diagnosis of ADHD may reflect a dysfunctional family or a poor 

educational system, rather than problems with the individuals themselves. In other 

cases, it may be explained by increasing academic expectations, with a diagnosis being 

a method for parents in some countries to get extra financial and educational support for 

their child. The youngest children in a class have been found to be more likely to be 

diagnosed as having ADHD possibly due to their being developmentally behind their 

older classmates. Behaviors typical of ADHD occur more commonly in children who 

have experienced violence and emotional abuse. 

The social construct theory of ADHD suggests that because the boundaries between 

"normal" and "abnormal" behavior are socially constructed, (i.e. jointly created and 

validated by all members of society, and in particular by physicians, parents, teachers, 

and others) it then follows that subjective valuations and judgements determine which 

diagnostic criteria are used and, thus, the number of people affected. This could lead to 


the situation where the DSM-IV arrives at levels of ADHD three to four times higher than 

those obtained with the ICD-10. Thomas Szasz, a supporter of this theory, has argued 

that ADHD was "... invented and then given a name". 

Pathophysiology 

Current models of ADHD suggest that it is associated with functional impairments in 

some of the brain's neurotransmitter systems, particularly those involving dopamine and 

norepinephrine. The dopamine and norepinephrine pathways that originate in the 

ventral tegmental area and locus coeruleus project to diverse regions of the brain and 

govern a variety of cognitive processes. 

The dopamine pathways and norepinephrine pathways which project to the prefrontal 

cortex and striatum are directly responsible for modulating executive function (cognitive 

control of behavior), motivation, reward perception, and motor function; these pathways 

are known to play a central role in the pathophysiology of ADHD. Larger models of 

ADHD with additional pathways have been proposed. 

Brain Structure 

In children with ADHD, there is a general reduction of volume in certain brain structures, 

with a proportionally greater decrease in the volume in the left-sided prefrontal cortex. 

The posterior parietal cortex also shows thinning in ADHD individuals compared to 

controls. 

Other brain structures in the prefrontal-striatal-cerebellar and prefrontal-striatal-thalamic 

circuits have also been found to differ between people with and without ADHD. 


Neurotransmitter Pathways 

Previously it was thought that the elevated number of dopamine transporters in people 

with ADHD was part of the pathophysiology but it appears that the elevated numbers 

are due to adaptation to exposure to stimulants. Current models involve the 

mesocorticolimbic dopamine pathway and the locus coeruleus-noradrenergic system. 

ADHD psychostimulants possess treatment efficacy because they increase 

neurotransmitter activity in these systems. There may additionally be abnormalities in 

serotoninergic, glutamatergic, or cholinergic pathways. 

Executive Function and Motivation 

The symptoms of ADHD arise from a deficiency in certain executive functions (e.g., 

attentional control, inhibitory control, and working memory). Executive functions are a 

set of cognitive processes that are required to successfully select and monitor behaviors 

that facilitate the attainment of one's chosen goals. The executive function impairments 

that occur in ADHD individuals result in problems with staying organized, time keeping, 

excessive procrastination, maintaining concentration, paying attention, ignoring 

distractions, regulating emotions, and remembering details. People with ADHD appear 

to have unimpaired long-term memory, and deficits in long-term recall appear to be 

attributed to impairments in working memory. The criteria for an executive function 

deficit are met in 30–50% of children and adolescents with ADHD. One study found 

that 80% of individuals with ADHD were impaired in at least one executive function task, 

compared to 50% for individuals without ADHD. Due to the rates of brain maturation 

and the increasing demands for executive control as a person gets older, ADHD 

impairments may not fully manifest themselves until adolescence or even early 

adulthood. 

ADHD has also been associated with motivational deficits in children. Children with 

ADHD often find it difficult to focus on long-term over short-term rewards, and exhibit 

impulsive behavior for short-term rewards. 

Diagnosis 

ADHD is diagnosed by an assessment of a child's behavioral and mental development, 

including ruling out the effects of drugs, medications and other medical or psychiatric 

problems as explanations for the symptoms. It often takes into account feedback from 

parents and teachers with most diagnoses begun after a teacher raises concerns. It 

may be viewed as the extreme end of one or more continuous human traits found in all 

people. Whether someone responds to medications does not confirm or rule out the 

diagnosis. As imaging studies of the brain do not give consistent results between 

individuals, they are only used for research purposes and not diagnosis. 

In North America, DSM-5 criteria are used for diagnosis, while European countries 

usually use the ICD-10. With the DSM-IV criteria a diagnosis of ADHD is 3–4 times 

more likely than with the ICD-10 criteria. It is classified as neurodevelopmental 


psychiatric disorder. Additionally, it is classified as a disruptive behavior disorder along 

with oppositional defiant disorder, conduct disorder, and antisocial personality disorder. 

A diagnosis does not imply a neurological disorder. 

Associated conditions that should be screened for include anxiety, depression, 

oppositional defiant disorder, conduct disorder, and learning and language disorders. 

Other conditions that should be considered are other neurodevelopmental disorders, 

tics, and sleep apnea. 

Diagnosis of ADHD using quantitative electroencephalography (QEEG) is an ongoing 

area of investigation, although the value of QEEG in ADHD is currently unclear. In the 

United States, the Food and Drug Administration has approved the use of QEEG to 

evaluate the morbidity of ADHD. 

Self-rating scales, such as the ADHD rating scale and the Vanderbilt ADHD diagnostic 

rating scale are used in the screening and evaluation of ADHD. 


Diagnostic and Statistical Manual 

As with many other psychiatric disorders, formal diagnosis should be made by a 

qualified professional based on a set number of criteria. In the United States, these 

criteria are defined by the American Psychiatric Association in the DSM. Based on the 

DSM criteria, there are three sub-types of ADHD: 

1. ADHD predominantly inattentive type (ADHD-PI) presents with symptoms 

including being easily distracted, forgetful, daydreaming, disorganization, poor 

concentration, and difficulty completing tasks. 

2. ADHD, predominantly hyperactive-impulsive type presents with excessive 

fidgetiness and restlessness, hyperactivity, difficulty waiting and remaining 

seated, immature behavior; destructive behaviors may also be present. 

3. ADHD, combined type is a combination of the first two subtypes. 

This subdivision is based on presence of at least six out of nine long-term (lasting at 

least six months) symptoms of inattention, hyperactivity–impulsivity, or both. To be 

considered, the symptoms must have appeared by the age of six to twelve and occur in 

more than one environment (e.g. at home and at school or work). The symptoms must 

be not appropriate for a child of that age and there must be evidence that it is causing 

social, school or work related problems. 

International Classification of Diseases 

In the tenth revision of the International Statistical Classification of Diseases and 

Related Health Problems (ICD-10) by the World Health Organization, the symptoms of 

"hyperkinetic disorder" are analogous to ADHD in the DSM-5. When a conduct disorder 

(as defined by ICD-10) is present, the condition is referred to as hyperkinetic conduct 

disorder. Otherwise, the disorder is classified as disturbance of activity and attention, 

other hyperkinetic disorders or hyperkinetic disorders, unspecified. The latter is 

sometimes referred to as hyperkinetic syndrome. 

In the preliminary draft for ICD-11 (planned for 2018), ADHD is classified under 6A42 

(Attention deficit hyperactivity disorder) and everything seems to be fully identical now 

to DSM-5. 

Adults 

Adults with ADHD are diagnosed under the same criteria, including that their signs must 

have been present by the age of six to twelve. Questioning parents or guardians as to 

how the person behaved and developed as a child may form part of the assessment; a 

family history of ADHD also adds weight to a diagnosis. While the core symptoms of 

ADHD are similar in children and adults they often present differently in adults than in 

children, for example excessive physical activity seen in children may present as 


feelings of restlessness and constant mental activity in adults. It is estimated that 

between 2–5% of adults have ADHD. Around 25–50% of children with ADHD continue 

to experience ADHD symptoms into adulthood, while the rest experiences fewer or no 

symptoms. Currently, most adults remain untreated. Many adults with ADHD without 

diagnosis and treatment have a disorganized life and some use non-prescribed drugs or 

alcohol as a coping mechanism. Other problems may include relationship and job 

difficulties, and an increased risk of criminal activities. Associated mental health 

problems include: depression, anxiety disorder, and learning disabilities. 

Some ADHD symptoms in adults differ from those seen in children. While children with 

ADHD may climb and run about excessively, adults may experience an inability to relax, 

or they talk excessively in social situations. Adults with ADHD may start relationships 

impulsively, display sensation-seeking behavior, and be short-tempered. Addictive 

behavior such as substance abuse and gambling are common. The DSM-V criteria do 

specifically deal with adults, unlike those in DSM-IV, which were criticized for not being 

appropriate for adults; those who presented differently may lead to the claim that they 

outgrew the diagnosis. 

Differential Diagnosis 

ADHD Symptoms Which Are Related to Other Disorders 

Depression Anxiety disorder Bipolar disorder 

 

 

 

 

 

 

 

 

 

 

Feelings of 

hopelessness, low 

self-esteem or 

unhappiness 

Loss of interest in 

hobbies or regular 

activities 

Fatigue 

Sleep problems 

Difficulty maintaining 

attention 

Change in appetite 

Irritability or hostility 

Low tolerance for 

stress 

Thoughts of death 

Unexplained pain 

 

 

 

 

 

 

 

 

Persistent feeling 

of anxiety 

Irritability 

Occasional 

feelings of panic 

or fear 

Being hyperalert 

Inability to pay 

attention 

Tire easily 

Low tolerance for 

stress 

Difficulty 

maintaining 

attention 

In manic state 

Excessive 

happiness 

Hyperactivity 

Racing thoughts 

Aggression 

Excessive talking 

Grandiose delusions 

Decreased need for 

sleep 

Inappropriate social 

behavior 

Difficulty maintaining 

attention 

In depressive state 

Same symptoms as 

in depression 

section 


Symptoms of ADHD, such as low mood and poor self-image, mood swings, and 

irritability, can be confused with dysthymia, cyclothymia or bipolar disorder as well as 

with borderline personality disorder. [19] Some symptoms that are due to anxiety 

disorders, antisocial personality disorder, developmental disabilities or mental 

retardation or the effects of substance abuse such as intoxication and withdrawal can 

overlap with some ADHD. These disorders can also sometimes occur along with ADHD. 

Medical conditions which can cause ADHD type symptoms include: hyperthyroidism, 

seizure disorder, lead toxicity, hearing deficits, hepatic disease, sleep apnea, drug 

interactions, untreated celiac disease, and head injury. 

Primary sleep disorders may affect attention and behavior and the symptoms of ADHD 

may affect sleep. It is thus recommended that children with ADHD be regularly 

assessed for sleep problems. Sleepiness in children may result in symptoms ranging 

from the classic ones of yawning and rubbing the eyes, to hyperactivity and 

inattentiveness. Obstructive sleep apnea can also cause ADHD type symptoms. 

Biomarker Research 

Reviews of ADHD biomarkers have noted that platelet monoamine oxidase expression, 

urinary norepinephrine, urinary MHPG, and urinary phenethylamine levels consistently 

differ between ADHD individuals and healthy control. These measurements could 

potentially serve as diagnostic biomarkers for ADHD, but more research is needed to 

establish their diagnostic utility. Urinary and blood plasma phenethylamine 

concentrations are lower in ADHD individuals relative to controls and the two most 

commonly prescribed drugs for ADHD, amphetamine and methylphenidate, increase 

phenethylamine biosynthesis in treatment-responsive individuals with ADHD. Lower 

urinary phenethylamine concentrations are also associated with symptoms of 

inattentiveness in ADHD individuals. Electroencephalography (EEG) is not accurate 

enough to make the diagnosis. 

Management 

The management of ADHD typically involves counseling or medications either alone or 

in combination. While treatment may improve long-term outcomes, it does not get rid of 

negative outcomes entirely. Medications used include stimulants, atomoxetine, alpha-2 

adrenergic receptor agonists, and sometimes antidepressants. In those who have 

trouble focusing on long-term rewards, a large amount of positive reinforcement 

improves task performance. ADHD stimulants also improve persistence and task 

performance in children with ADHD. 

Behavioral Therapies 

There is good evidence for the use of behavioral therapies in ADHD and they are the 

recommended first line treatment in those who have mild symptoms or are preschoolaged. 

Psychological therapies used include: psychoeducational input, behavior therapy, 

cognitive behavioral therapy (CBT), interpersonal psychotherapy, family therapy, 

school-based interventions, social skills training, behavioral peer intervention, 


organization training, parent management training, and neurofeedback. Parent training 

may improve a number of behavioral problems including oppositional and noncompliant 

behaviours. It is unclear if neurofeedback is useful. 

There is little high quality research on the effectiveness of family therapy for ADHD, but 

the evidence that exists shows that it is similar to community care and better than a 

placebo. ADHD-specific support groups can provide information and may help families 

cope with ADHD. 

Training in social skills, behavioral modification and medication may have some limited 

beneficial effects. The most important factor in reducing later psychological problems, 

such as major depression, criminality, school failure, and substance use disorders is 

formation of friendships with people who are not involved in delinquent activities. 

Regular physical exercise, particularly aerobic exercise, is an effective add-on treatment 

for ADHD in children and adults, particularly when combined with stimulant medication, 

although the best intensity and type of aerobic exercise for improving symptoms are not 

currently known. In particular, the long-term effects of regular aerobic exercise in ADHD 

individuals include better behavior and motor abilities, improved executive functions 

(including attention, inhibitory control, and planning, among other cognitive domains), 

faster information processing speed, and better memory. 

Parent-teacher ratings of behavioral and socio-emotional outcomes in response to 

regular aerobic exercise include: better overall function, reduced ADHD symptoms, 

better self-esteem, reduced levels of anxiety and depression, fewer somatic complaints, 

better academic and classroom behavior, and improved social behavior. 


Exercising while on stimulant medication augments the effect of stimulant medication on 

executive function. It is believed that these short-term effects of exercise are mediated 

by an increased abundance of synaptic dopamine and norepinephrine in the brain. 

Medication 

Stimulant medications are the pharmaceutical treatment of choice. They have at least 

some effect on symptoms, in the short term, in about 80% of people. Methylphenidate 

appears to improve symptoms as reported by teachers and parents. Stimulants may 

also reduce the risk of unintentional injuries in children with ADHD. 

There are a number of non-stimulant medications, such as atomoxetine, bupropion, 

guanfacine, and clonidine that may be used as alternatives, or added to stimulant 

therapy. There are no good studies comparing the various medications; however, they 

appear more or less equal with respect to side effects. Stimulants appear to improve 

academic performance while atomoxetine does not. Atomoxetine, due to its lack of 

addiction liability, may be preferred in those who are at risk of recreational or 

compulsive stimulant use. There is little evidence on the effects of medication on social 

behaviors. As of June 2015, the long-term effects of ADHD medication have yet to be 

fully determined. Magnetic resonance imaging studies suggest that long-term treatment 

with amphetamine or methylphenidate decreases abnormalities in brain structure and 

function found in subjects with ADHD. 

Guidelines on when to use medications vary by country, with the United Kingdom's 

National Institute for Health and Care Excellence (NICE) recommending use for children 

only in severe cases, though for adults medication is a first-line treatment. While most 

United States guidelines recommend medications in most age groups. Medications are 

not recommended for preschool children. Underdosing of stimulants can occur and 

result in a lack of response or later loss of effectiveness. This is particularly common in 

adolescents and adults as approved dosing is based on school-aged children, causing 

some practitioners to use weight based or benefit based off-label dosing instead. 

School-age boys are twice as likely as their female counterparts to take medication, 

while among adults, women are far more likely to take medication than men. 

While stimulants and atomoxetine are usually safe, there are side-effects and 

contraindications to their use. A large overdose on ADHD stimulants is commonly 

associated with symptoms such as stimulant psychosis and mania. Although very rare, 

at therapeutic doses these events appear to occur in approximately 0.1% of individuals 

within the first several weeks after starting amphetamine therapy. Administration of an 

antipsychotic medication has been found to effectively resolve the symptoms of acute 

amphetamine psychosis. 

Regular monitoring has been recommended in those on long-term treatment. Stimulant 

therapy should be stopped periodically to assess continuing need for medication, 

decrease possible growth delay, and reduce tolerance. Long-term misuse of stimulant 

medications at doses above the therapeutic range for ADHD treatment is associated 

with addiction and dependence. Untreated ADHD, however, is also associated with 


elevated risk of substance use disorders and conduct disorders. The use of stimulants 

appears to either reduce this risk or have no effect on it. The safety of these 

medications in pregnancy is unclear. 

Diet 

Dietary modifications may be of benefit to a small proportion of children with ADHD. A 

2013 meta-analysis found less than a third of children with ADHD see some 

improvement in symptoms with free fatty acid supplementation or decreased eating of 

artificial food coloring. These benefits may be limited to children with food sensitivities or 

those who are simultaneously being treated with ADHD medications. This review also 

found that evidence does not support removing other foods from the diet to treat ADHD. 

A 2014 review found that an elimination diet results in a small overall benefit. A 2016 

review stated that the use of a gluten-free diet as standard ADHD treatment is 

discouraged. Iron, magnesium and iodine may also have an effect on ADHD symptoms. 

There is a small amount of evidence that lower tissue zinc levels may be associated 

with ADHD. In the absence of a demonstrated zinc deficiency (which is rare outside of 

developing countries), zinc supplementation is not recommended as treatment for 

ADHD. 

However, zinc supplementation may reduce the minimum effective dose of 

amphetamine when it is used with amphetamine for the treatment of ADHD. There is 


evidence of a modest benefit of omega 3 fatty acid supplementation, but it is not 

recommended in place of traditional medication. 

Prognosis 

ADHD persists into adulthood in about 30–50% of cases. Those affected are likely to 

develop coping mechanisms as they mature, thus compensating to some extent for their 

previous symptoms. Children with ADHD have a higher risk of unintentional injuries. 

Effects of medication on functional impairment and quality of life (e.g. reduced risk of 

accidents) have been found across multiple domains. But learning disorders and 

executive function deficits do not seem to respond to ADHD medications. 

Epidemiology 

ADHD is estimated to affect about 6–7% of people aged 18 and under when diagnosed 

via the DSM-IV criteria. When diagnosed via the ICD-10 criteria rates in this age group 

are estimated at 1–2%. Children in North America appear to have a higher rate of 

ADHD than children in Africa and the Middle East; this is believed to be due to differing 

methods of diagnosis rather than a difference in underlying frequency. If the same 

diagnostic methods are used, the rates are more or less the same between countries. It 

is diagnosed approximately three times more often in boys than in girls. This difference 

between sexes may reflect either a difference in susceptibility or that females with 

ADHD are less likely to be diagnosed than males. 

Rates of diagnosis and treatment have increased in both the United Kingdom and the 

United States since the 1970s. This is believed to be primarily due to changes in how 

the condition is diagnosed and how readily people are willing to treat it with medications 

rather than a true change in how common the condition is. It is believed that changes to 

the diagnostic criteria in 2013 with the release of the DSM-5 will increase the 

percentage of people diagnosed with ADHD, especially among adults. 

History 

Hyperactivity has long been part of the human condition. Sir Alexander Crichton 

describes "mental restlessness" in his book An inquiry into the nature and origin of 

mental derangement written in 1798. ADHD was first clearly described by George Still in 

1902. 

The terminology used to describe the condition has changed over time and has 

included: in the DSM-I (1952) "minimal brain dysfunction," in the DSM-II (1968) 

"hyperkinetic reaction of childhood," and in the DSM-III (1980) "attention-deficit disorder 

(ADD) with or without hyperactivity." In 1987 this was changed to ADHD in the DSM-III- 

R and the DSM-IV in 1994 split the diagnosis into three subtypes, ADHD inattentive 

type, ADHD hyperactive-impulsive type and ADHD combined type. These terms were 

kept in the DSM-5 in 2013. Other terms have included "minimal brain damage" used in 

the 1930s. 


The use of stimulants to treat ADHD was first described in 1937. In 1934, Benzedrine 

became the first amphetamine medication approved for use in the United States. 

Methylphenidate was introduced in the 1950s, and enantiopure dextroamphetamine in 

the 1970s. 

Society and Culture 

ADHD, its diagnosis, and its treatment have been controversial since the 1970s. The 

controversies involve clinicians, teachers, policymakers, parents, and the media. 

Positions range from the view that ADHD is within the normal range of behavior to the 

hypothesis that ADHD is a genetic condition. Other areas of controversy include the use 

of stimulant medications in children, the method of diagnosis, and the possibility of 

overdiagnosis. In 2009, the National Institute for Health and Care Excellence, while 

acknowledging the controversy, states that the current treatments and methods of 

diagnosis are based on the dominant view of the academic literature. In 2014, Keith 

Conners, one of the early advocates for recognition of the disorder, spoke out against 

overdiagnosis in a New York Times article. In contrast, a 2014 peer-reviewed medical 

literature review indicated that ADHD is underdiagnosed in adults. 

With widely differing rates of diagnosis across countries, states within countries, races, 

and ethnicities, some suspect factors other than the presence of the symptoms of 

ADHD are playing a role in diagnosis. Some sociologists consider ADHD to be an 

example of the medicalization of deviant behavior, that is, the turning of the previously 

non-medical issue of school performance into a medical one. Most healthcare providers 

accept ADHD as a genuine disorder, at least in the small number of people with severe 


symptoms. Among healthcare providers the debate mainly centers on diagnosis and 

treatment in the much greater number of people with mild symptoms. 


III. The Advantages of ADD/ ADHD 

The Benefits of ADHD 

Medically reviewed by Timothy J. Legg PhD, PMHNP-BC on January 25, 2016 

Written by Rachel Nall, RN, BSN, CCRN 

Attention hyperactivity disorder (ADHD) is a medical condition that affects a person’s 

ability to focus, pay attention, or control their behavior. Healthcare providers usually 

diagnose this condition in childhood. However, some people are not diagnosed until 

adulthood. 

The three main characteristics of a person with ADHD are Inattention, 

Hyperactivity, and Impulsivity. ADHD also can cause a person to experience very 

high energy levels. Some symptoms associated with ADHD include: 

 

 

 

 

 

 

 

being highly impatient 

difficulty performing tasks quietly 

difficulty following instructions 

trouble waiting for things or showing patience 

losing things frequently 

often seeming as if they aren’t paying attention 

talking seemingly nonstop 


There is no definitive test to diagnose ADHD. However, healthcare providers can 

evaluate children or adults for the condition based on symptoms. A number of 

treatments are available to improve a person’s concentration and behavior. These 

include medications and therapy. ADHD is a highly manageable disease. When taught 

adaptive techniques to help with time management and organization skills, people with 

ADHD are able to achieve better levels of concentration. 

ADHD can be difficult for a person to live with. Some people think those with ADHD are 

“out of control” or difficult because they have trouble following directions. While ADHD 

can mean behavioral challenges, having the condition has proven to be an advantage to 

some. 

Celebrities With ADHD 

Many people with ADHD have turned their unique behavioral challenges into wellknown 

success. Examples of celebrities whose healthcare providers have diagnosed 

them with ADHD include: 

 

 

 

 

 

 

 

 

 

 

 

 

Adam Levine 

Albert Einstein 

Channing Tatum 

Glenn Beck 

James Carville 

Justin Timberlake 

Karina Smirnoff 

Richard Branson 

Salvador Dali 

Solange Knowles 

Ty Pennington 

Whoopi Goldberg 

Attention hyperactivity disorder (ADHD) is a medical condition that affects a person’s 

ability to focus, pay attention, or control their behavior. Healthcare providers usually 

diagnose this condition in childhood. However, some people are not diagnosed until 

adulthood. 

The three main characteristics of a person with ADHD are inattention, hyperactivity, and 

impulsivity. ADHD also can cause a person to experience very high energy levels. 

Some symptoms associated with ADHD include: 

 

 

 

 

 

 

being highly impatient 

difficulty performing tasks quietly 

difficulty following instructions 

trouble waiting for things or showing patience 

losing things frequently 

often seeming as if they aren’t paying attention 


talking seemingly nonstop 

There is no definitive test to diagnose ADHD. However, healthcare providers can 

evaluate children or adults for the condition based on symptoms. A number of 

treatments are available to improve a person’s concentration and behavior. These 

include medications and therapy. ADHD is a highly manageable disease. When taught 

adaptive techniques to help with time management and organization skills, people with 

ADHD are able to achieve better levels of concentration. 

ADHD can be difficult for a person 

to live with. Some people think 

those with ADHD are “out of 

control” or difficult because they 

have trouble following directions. 

While ADHD can mean 

behavioral challenges, having the 

condition has proven to be an 

advantage to some. 

Celebrities With ADHD 

Many people with ADHD have 

turned their unique behavioral 

challenges into well-known 

success. Examples of celebrities whose healthcare providers have diagnosed them with 

ADHD include: 

 

 

 

 

 

 

 

 

 

 

 

 

Adam Levine 

Albert Einstein 

Channing Tatum 

Glenn Beck 





Salvador Dali 


Ty Pennington 

Whoopi Goldberg 

Athletes with ADHD also use the extra energy toward their respective fields. Examples 

of athletes with ADHD include: 

 

 

 

swimmer Michael Phelps 

soccer goalie Tim Howard 

baseball player Shane Victorino 


NFL Hall of Famer Terry Bradshaw 

Personality Strengths and ADHD 

Not every person with ADHD has the same personality traits, but there are some 

personal strengths that can make having the condition an advantage, not a drawback. 

Examples of these traits include: 

 

 

 

 

Energetic: Some with ADHD often have seemingly endless amounts of energy, 

which they are able to channel toward success on the playing field, school, or 

work. 

Spontaneous: Some people with ADHD can turn impulsivity into spontaneity. 

They may be the life of the party or may be more open and willing to try new 

things and break free from the status quo. 

Creative And Inventive: Living with ADHD may give the person a different 

perspective on life and encourage them to approach tasks and situations with a 

thoughtful eye. As a result, some with ADHD may be inventive thinkers. Others 

words to describe them may be original, artistic, and creative. 

Hyperfocused: According to Pepperdine University, some people with ADHD 

may become hyperfocused. This makes them so intently focused on a task that 

they may not even notice the world around them. The benefit to this is when 

given an assignment, a person with ADHD may work at it until its completion 

without breaking concentration. 

Sometimes a person with ADHD needs assistance in harnessing these traits to their 

benefit. Teacher, counselors, therapists, and parents can all play a role. These experts 

can help a person with ADHD explore a creative side or devote energy to finishing a 

task. 

Research About ADHD Benefits 

Research about ADHD benefits is often based more on stories from people with ADHD 

than actual statistics. Some people with the condition report that the condition has 

affected them for the better. 

A study published in the journal Child Neuropsychology found that ADHD sample 

groups displayed greater levels of creativity in performing certain tasks than their peers 

without a diagnosis of ADHD. Researchers asked participants to draw animals that lived 

on a plant that was different from Earth and create an idea for a new toy. These findings 

support the idea that those with ADHD are often creative and innovative. 

A diagnosis of ADHD does not have to put a person at a disadvantage in life. Instead, 

ADHD can and has contributed to the success of many movie stars, athletes, and 


usinesspeople. From Albert Einstein to Michael Jordan to President George W. Bush, 

there are many people who have reached the pinnacles of their fields with ADHD. 

________ 

151 Positives of ADHD 

By Pete Quilly, Adult ADHD Coach 

The Advantages of Attention Deficit Disorder 

151 Positive Characteristics of People with Attention Deficit HyperActivity Disorder: 

Ability to find alternate paths to overcome obstacles 

Able to take on large situations 

Adaptive/collaborative 

Adventurous, courageous, lives outside of boundaries 

Always finding alternate routes to any given location. 

Always willing to help others 

Ambitious – you want to be everything when “you grow up” 

Artistic 

Attractive personality – magnetic due 

to high energy 

Being able to see the big picture 

Being able to see the patterns in 

the chaos. 

Being intuitive towards others’ difficulties 

Broad focus – can 

see more, notice things more 

Can create order from 

Can do many projects 

Can make people feel 

Can see the big picture 

Can talk about several things 

Can think on my feet 

Career variety 

Centre of attention 

Comfortable talking in front of 

Comfortable with change and 

Compassion for others and for 

Conceptualizes well 

Confidence 

Constantly evolving 

Courageous 

Creates connections easily 

Creative 

Creative writing 

groups 

chaos 

at once 

they are heard 

at one time 

chaos 

themselves 


Creative – musical, artistic, “dramatic” 

Dedicated 

Detail-oriented 

Determined to gain more control 

Energetic 

Eager to make friends 

Eager to try new things 

Empathetic, sensitive 

Entrepreneurial 

Excellent organizers using journals and reminders (notes etc.) 

Flexible – changes as the situation requires 

Fun guy to be around 

Good in a crisis 

Goal-oriented 

Good at conceptualizing 

Good at customer relations 

Good at motivating self and others 

Good at multitasking 

Good at problem solving 

Good at public speaking 

Good at understanding others/mind reading – empathetic 

Good conversationalist 

Good delegator and good at organizing others 

Good in emergency situations 

Good listener 

Good looking and aware of it 

Good people skills 

Good self esteem, energetic 

Great brain-stormer 

Great multitasker 

Great self-company 

Great sense of humour 

Great storyteller 

Great with kids (central figure around kids) 

Hands-on workers 

Hard worker1 

Has friendly relations with their family 

Has the gift of gab 

Helpful 

Helps others who are also in trouble 

High energy – go, go, go 


Holistic thinking 

Humour, very healthy, quick picking up ideas 

Hyper focus !! 

Hypersensitive – very empathetic and good at non-verbal communications 

Idea generator 

Imaginative 

Impulsive (in a good way) not afraid to act 

Initiators 

Intelligent 

Intuitive 

It’s ok to not finish everything 

Learning as much as I can to help children and others with ADHD 

Less sleep is good (midnight to 6 am) 

Like to talk a lot 

Likes learning new things 

Look at multidimensional sides to a situation 

Lots of interests 

Loves to cook and be creative 

Magnetic 

Master idea generator 

Mentoring others/helpful 

Mentoring people with low self esteem 

Modesty 

Move on fast – never hold a grudge 

Multitasks well 

Never bored and rarely boring 

Never intimidated to try new things 

Non-linear, multi-dimensional/edge of chaos 

Not afraid to speak mind 

Not contained by boundaries. 

On stage and ready 

Optimistic 

Outgoing 

Passionate 

Persistent 

Philosophical 

Playful 

Pragmatic 

Problem solver 

Profound 


Quick thinking 

Quick witted 

Resourceful 

Resistant 

Relates to people easily 

Saves money in the short term by forgetting to file tax returns 

See and remember details – recount them later 

Sees the big picture 

Socially adaptive and flexible. 

Spontaneous 

Stabilizer during difficult situations 

Stable 

Successful 

Takes initiative 

Tenacious 

Theoretical 

Think outside the box 

Thinks 2 meters ahead of the world 

Thinks big, dreams big 

Thorough 

Tolerant 

Unlimited energy 

Unconventional 

Unorthodox 

Very creative, able to generate a lot of ideas 

Very hard working to compensate – workaholic 

Very intuitive 

Very resourceful 

Very successful 

Versatile 

Visionary 

Visual learner 

Willing to take risks 

Willingness to help others 

Witty 

Won’t tolerate boredom 

Works well under pressure 

Worldly 

______ 


[The] Potential Benefits 

of Having an ADHD Employee 

While not nearly enough research has been done on ADHD’s benefits, we have 

compiled a list of attributes that seems to apply to many employees. This list has been 

gathered over our years of dealing with the ADHD community, but there is some 

research that might explain why people with ADHD may exhibit these qualities. It’s 

important to note that just as every employee may not be impacted by the same ADHD 

symptoms, each ADHDer has unique skills and advantages. Within the ADHD 

community these advantages are oftentimes referred to as: 

“ADHD Superpowers” 

People with ADHD can be some of the most creative resources on a team, bringing 

energy and new approaches to their projects. Several studies have shown that adults 

with ADHD tend to be out-of-the-box thinkers. A study done at the University of 

Memphis confirmed what many experts have told us, and many ADHD books claim… 

People with ADHD tend to be more creative than their Non-ADHD peers. In the study, 

30 ADHD students scored higher than their peers on 11 different tests for creativity. 

When focused on work that aligns with their interests and strengths, they often deliver 

results that easily offset any (often minimal) costs associated with accommodations. 

Organizations can create a competitive advantage by capitalizing on the diversity ADHD 

minds bring to their teams. 

A recent study also found that the ADHD brain tends to produce more Theta waves than 

average brains. Theta waves indicate a state of deep relaxation, and ADHD employees’ 

over-abundance of theta waves can make them great in a crisis. We often see higher 

rates of ADHD among E.R. doctors and nurses, police officers, fire and rescue 

personnel, journalists, stock traders, professional athletes, and entertainers. When 

others are in crisis, those with ADHD can be cool, calm and under control. 

ADHDers seem to notice things others miss, sometimes to the point of seeming 

extraordinarily intuitive or (dare we say!) psychic! The average brain manages to sort 

and filter all incoming sights, sounds, tastes, smells, and touch sensations to a 

manageable 40 bits of information per second. The ADHD brain is overloaded with 

sensory input and faces issues with Executive Functions – sorting, filtering, discarding, 


prioritizing, following through, tracking progress, following procedures. Since the ADHD 

brain lets in a lot of what some employees might consider irrelevant noise, sometimes, 

ADHDers are able to notice things that others naturally filter out. 

While impulsivity is an ADHD symptom, that often means that people with ADHD are 

quick starters. They jump right in without worrying or doing endless research. If your 

team is resistant to risk, resistant to change, hung up on process and procedure, you 

know it can take forever to get anything done. People resist change and will stick with 

systems even if they don’t work, or get stuck in analysis paralysis. Although sometimes, 

employees with ADHD struggle to get started, but often, once they do get going on 

something that they’re passionate about, they are able to hyper-focus! 

Our list is by no means extensive and you’ll likely find yourself adding to the list as you 

get to know your ADHD employee. 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ability to find unique solutions to difficult problems 

Adventurous, courageous, thinks “outside the box” 

Being able to derive patterns where others see chaos 

Able to talk about many different topics at one time 

Constant evolution, continual learning 

Good in a crisis – Some of the most stressful jobs are staffed by those with 

ADHD 

Seemingly endless desire to try new ideas, tasks and projects 

Empathetic and intuitive 

Entrepreneurial 

Hyper-focus – Can be a wonderful asset when the ADHD employee us focused 

on the “right” thing 

Continual source of new ideas, methods and strategies 

Ability to see many if not all sides of a situation 

Resourceful 


IV. Autism Spectrum 

Autism Spectrum, also known as autism spectrum disorder (ASD), is a range 

of conditions classified as neurodevelopmental disorders. Individuals diagnosed with 

autism spectrum disorder present with two types of symptoms: problems in social 

communication and social interaction, and restricted, repetitive patterns of behavior, 

interests or activities. Symptoms are typically recognized between one and two years of 

age. Long term issues may include difficulties in creating and keeping relationships, 

maintaining a job, and performing daily tasks. 

The cause of autism spectrum is uncertain. Risk factors include having an older parent, 

a family history of the condition, and certain genetic conditions. Diagnosis is based on 

symptoms. The DSM-5 redefined the autism spectrum disorders to encompass the 

previous diagnoses of autism, Asperger syndrome, pervasive developmental disorder 

not otherwise specified (PDD-NOS), and childhood disintegrative disorder. 

Treatment efforts are generally individualized to the person's condition. Medications 

may be used to try to help improve certain associated problems. Evidence to support 

the use of medications, however, is not very strong. 

Autism spectrum is estimated to affect about 1% of people (62.2 million globally as of 

2015). Males are diagnosed more often than females. [ 


Classification 

In the United States, a revision to autism spectrum disorder (ASD) was presented in the 

Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM-5), released May 

2013. The new diagnosis encompasses previous diagnoses of autistic disorder, 

Asperger syndrome, childhood disintegrative disorder, and PDD-NOS. Compared with 

the DSM-IV diagnosis of autistic disorder, the DSM-5 diagnosis of ASD no longer 

includes communication as a separate criterion, and has merged social interaction and 

communication into one category. 

Slightly different diagnostic definitions are used in other countries. For example, the 

ICD-10 is the most commonly-used diagnostic manual in the UK and European Union. 

Rather than categorizing these diagnoses, the DSM-5 has adopted a dimensional 

approach to diagnosing disorders that fall underneath the autism spectrum umbrella. 

Some have proposed that individuals on the autism spectrum may be better 

represented as a single diagnostic category. Within this category, the DSM-5 has 

proposed a framework of differentiating each individual by dimensions of severity, as 

well as associated features (i.e., known genetic disorders, and intellectual disability). 

Another change to the DSM includes collapsing social and communication deficits into 

one domain. Thus, an individual with an ASD diagnosis will be described in terms of 

severity of social communication symptoms, severity of fixated or restricted behaviors or 

interests, and associated features. The restricting of onset age has also been loosened 

from 3 years of age to "early developmental period", with a note that symptoms may 

manifest later when social demands exceed capabilities. 

Autism forms the core of the autism spectrum disorders. Asperger syndrome is closest 

to autism in signs and likely causes; unlike autism, people with Asperger syndrome 

usually have no significant delay in language development, according to the older DSM- 

4 criteria. PDD-NOS is diagnosed when the criteria are not met for a more specific 

disorder. Some sources also include Rett syndrome and childhood disintegrative 

disorder, which share several signs with autism but may have unrelated causes; other 

sources differentiate them from ASD, but group all of the above conditions into the 

pervasive developmental disorders. 

Autism, Asperger syndrome, and PDD-NOS are sometimes called the autistic disorders 

instead of ASD, whereas autism itself is often called autistic disorder, childhood autism, 

or infantile autism. Although the older term pervasive developmental disorder and the 

newer term autism spectrum disorder largely or entirely overlap, the earlier was 

intended to describe a specific set of diagnostic labels, whereas the latter refers to a 

postulated spectrum disorder linking various conditions. ASD is a subset of the broader 

autism phenotype (BAP), which describes individuals who may not have ASD but do 

have autistic-like traits, such as avoiding eye contact. 


Characteristics 

Under the DSM-5, autism is characterized by persistent deficits in social communication 

and interaction across multiple contexts, as well as restricted, repetitive patterns of 

behavior, interests, or activities. These deficits are present in early childhood, and lead 

to clinically significant functional impairment. There is also a unique form of autism 

called autistic savantism, where a child can display outstanding skills in music, art, and 

numbers with no practice. Because of its relevance to different populations, selfinjurious 

behaviors (SIB) are not considered a core characteristic of the ASD population 

however approximately 50% of those with ASD take part in some type of SIB (headbanging, 

self-biting) and are more at risk than other groups with developmental 

disabilities. 

Other characteristics of ASD 

include restricted and 

repetitive behaviors (RRBs) 

which include a large range 

of specific gestures and 

acts, it can even include 

certain behavioral traits as 

defined in the Diagnostic 

and Statistic Manual for 

Mental Disorders. 

Asperger syndrome was 

distinguished from autism in 

the DSM-IV by the lack of 

delay or deviance in early 

language development. 

Additionally, individuals 

diagnosed with Asperger 

syndrome did not have 

significant cognitive delays. 

PDD-NOS was considered 

"subthreshold autism" and 

"atypical autism" because it 

was often characterized by 

milder symptoms of autism 

or symptoms in only one 

domain (such as social 

difficulties). The DSM-5 

eliminated the four separate 

diagnoses: Asperger 

Syndrome, Pervasive 


Developmental Disorder Not Otherwise Specified (PDD-NOS), Childhood Degenerative 

Disorder, and Autistic Disorder and combined them under the diagnosis of Autism 

Spectrum Disorder. 

Developmental Course 

Autism spectrum disorders are thought to follow two possible developmental courses, 

although most parents report that symptom onset occurred within the first year of life. 

One course of development is more gradual in nature, in which parents report concerns 

in development over the first two years of life and diagnosis is made around 3–4 years 

of age. Some of the early signs of ASDs in this course include decreased looking at 

faces, failure to turn when name is called, failure to show interests by showing or 

pointing, and delayed pretend play. 

A second course of development is characterized by normal or near-normal 

development followed by loss of skills or regression in the first 2–3 years. Regression 

may occur in a variety of domains, including communication, social, cognitive, and selfhelp 

skills; however, the most common regression is loss of language. 

There continues to be a debate over the differential outcomes based on these two 

developmental courses. Some studies suggest that regression is associated with poorer 

outcomes and others report no differences between those with early gradual onset and 

those who experience a regression period. While there is conflicting evidence 

surrounding language outcomes in ASD, some studies have shown that cognitive and 

language abilities at age 2 1⁄2 may help predict language proficiency and production 

after age 5. Overall, the literature stresses the importance of early intervention in 

achieving positive longitudinal outcomes. 

Social Skills 

Social skills present the most challenges for individuals with ASD. This leads to 

problems with friendships, romantic relationships, daily living, and vocational success. 

Marriages are less common for those with ASD. Many of these challenges are linked to 

their atypical patterns of behavior and communication. All of these issues stem from 

cognitive impairments. Difficulties in this thought process is called "theory of the mind" 

or mind blindness which translates that the mind has difficulty with thought process as 

well as being aware of what is going on around them. 

Communication Skills 

Communication deficits are generally characterized by impairments regarding joint 

attention and social reciprocity, challenges with verbal language cues, and poor 

nonverbal communication skills such as lack of eye contact and meaningful gestures 

and facial expressions. Language behaviors typically seen in children with autism may 

include repetitive or rigid language, specific interests in conversation, and atypical 

language development. Many children with ASD develop language skills at an uneven 


pace where they easily acquire some aspects of communication, while never fully 

developing other aspects. In some cases, children remain completely nonverbal 

throughout their lives, although the accompanying levels of literacy and nonverbal 

communication skills vary. 

They may not pick up on body language or may ignore cues such as eye contact and 

facial expressions if they provide more information than the person can process at that 

time. Similarly, they have trouble recognizing subtle expressions of emotion and 

identifying what various emotions mean for the conversation. They struggle with 

understanding the context and subtext of conversational or printed situations, and have 

trouble forming resulting conclusions about the content. This also results in a lack of 

social awareness and atypical language expression. 

It is also common for individuals with ASD to communicate strong interest in a specific 

topic, speaking in lesson-like monologues about their passion instead of enabling 

reciprocal communication with whomever they are speaking to. What seems as selfinvolvement 

or indifference toward others stems from a struggle to realize or remember 

that other people have their own personalities, perspectives, and interests. 

Language expression for those on the autism spectrum can also contain repetitive and 

rigid language. Often children with ASD repeat certain words, numbers, or phrases 

during an interaction that are unrelated to the topic of conversation. They can also 

exhibit a condition called echolalia where they respond to a question by repeating the 

inquiry instead of answering. However, this repetition is usually a form of meaningful 

communication, a way that individuals with ASD try to express a lack of understanding 

or knowledge regarding the answer to the question. 


Causes 

While specific causes of autism spectrum disorders have yet to be found, many risk 

factors have been identified in the research literature that may contribute to their 

development. These risk factors include genetics, prenatal and perinatal factors, 

neuroanatomical abnormalities, and environmental factors. It is possible to identify 

general risk factors, but much more difficult to pinpoint specific factors. In the current 

state of knowledge, prediction can only be of a global nature and therefore requires the 

use of general markers. 

Genetic Risk Factors 

Of all of the theories of causes, genetics have shown to provide the highest risk of being 

diagnosed with autism. If a family member is on the autism spectrum, the rest of the 

family has a 50 percent chance of being diagnosed with the disorder as well and being 

a twin gives a 69 to 90 percent chance of being diagnosed with ASD. In addition, 

research suggests that there is a much higher concordance rate among monozygotic 

twins compared to dizygotic twins. It appears that there is no single gene that can 

account for autism. Instead, there seem to be multiple genes involved, each of which is 

a risk factor for components of the autism spectrum disorders. Gene for autism have 

been found on chromosome arms 2q, 7q, 15q. The SHANK gene family has been 

associated with symptoms of ASD. In particular, the Shank3 gene has been linked to 

more severe deficits than other genes within the family. Genetics appears to interact 

with environmental factors. 

Prenatal and Perinatal Risk Factors 

Several prenatal and perinatal complications have been reported as possible risk 

factors for autism. These risk factors include maternal gestational diabetes, maternal 

and paternal age over 30, bleeding after first trimester, use of prescription medication 

(e.g. valproate) during pregnancy, and meconium in the amniotic fluid. While research is 

not conclusive on the relation of these factors to autism, each of these factors has been 

identified more frequently in autistic children compared to their non-autistic siblings and 

other normally developing youth. While it is unclear if any single factors during the 

prenatal phase affect the risk of autism, complications during pregnancy may be a risk. 

Low vitamin D levels in early development has been hypothesized as a risk factor for 

autism. 

Vaccine Controversy 

Perhaps the most controversial claim regarding autism etiology was the "vaccine 

controversy". This conjecture, arising from a case of scientific misconduct, suggested 

that autism results from brain damage caused either by (1) the measles, mumps, rubella 

(MMR) vaccine itself, or by (2) thiomersal, a vaccine preservative. No convincing 

scientific evidence supports these claims, and further evidence continues to refute 


them, including the observation that the rate of autism continues to climb despite 

elimination of thimerosal from routine childhood vaccines. A 2014 meta-analysis 

examined ten major studies on autism and vaccines involving 1.25 million children 

worldwide; it concluded that neither the MMR vaccine, which has never contained 

thimerosal, nor the vaccine components thimerosal or mercury, lead to the development 

of ASDs. 


In general, neuroanatomical studies support the concept that autism may involve a 

combination of brain enlargement in some areas and reduction in others. These studies 

suggest that autism may be caused by abnormal neuronal growth and pruning during 

the early stages of prenatal and postnatal brain development, leaving some areas of the 

brain with too many neurons and other areas with too few neurons. Some research has 

reported an overall brain enlargement in autism, while others suggest abnormalities in 

several areas of the brain, including the frontal lobe, the mirror neuron system, the 

limbic system, the temporal lobe, and the corpus callosum. 

In functional neuroimaging studies, when performing theory of mind and facial emotion 

response tasks, the median person on the autism spectrum exhibits less activation in 

the primary and secondary somatosensory cortices of the brain than the median 


member of a properly sampled control population. This finding coincides with reports 

demonstrating abnormal patterns of cortical thickness and grey matter volume in those 

regions of autistic persons' brains. 

Mirror Neuron System 

The mirror neuron system (MNS) consists of a network of brain areas that have been 

associated with empathy processes in humans. In humans, the MNS has been 

identified in the inferior frontal gyrus (IFG) and the inferior parietal lobule (IPL) and is 

thought to be activated during imitation or observation of behaviors. The connection 

between mirror neuron dysfunction and autism is tentative, and it remains to be seen 

how mirror neurons may be related to many of the important characteristics of autism. 

"Social Brain" Interconnectivity 

A number of discrete brain regions and networks among regions that are involved in 

dealing with other people have been discussed together under the rubric of the "social 

brain". As of 2012, there was a consensus that autism spectrum is likely related to 

problems with interconnectivity among these regions and networks, rather than 

problems with any specific region or network. 

Temporal Lobe 

Functions of the temporal lobe are related to many of the deficits observed in individuals 

with ASDs, such as receptive language, social cognition, joint attention, action 

observation, and empathy. The temporal lobe also contains the superior temporal 

sulcus (STS) and the fusiform face area (FFA), which may mediate facial processing. It 

has been argued that dysfunction in the STS underlies the social deficits that 

characterize autism. Compared to typically developing individuals, one fMRI study found 

that individuals with high-functioning autism had reduced activity in the FFA when 

viewing pictures of faces. 

Mitochondrial Dysfunction 

It has been suggested that ASD could be linked to mitochondrial disease (MD), a basic 

cellular abnormality with the potential to cause disturbances in a wide range of body 

systems. A recent meta-analysis study, as well as other population studies have shown 

that approximately 5% of children with ASD meet the criteria for classical MD. It is 

unclear why the MD occurs considering that only 23% of children with both ASD and 

MD present with mitochondrial DNA (mtDNA) abnormalities. 

Serotonin 

It has been hypothesized that increased activity of serotonin in the developing brain 

may facilitate the onset of autism spectrum disorder, with an association found in six out 

of eight studies between the use of selective serotonin reuptake inhibitors (SSRIs) by 


the pregnant mother and the development of ASD by the child exposed to SSRI in the 

antenatal environment. The study could not definitively conclude SSRIs caused the 

increased risk for ASDs due to the biases found in those studies, and the authors called 

for more definitive, better conducted studies. 

Evidence-Based Assessment 

Diagnosis 

ASD can be detected as early as 18 months or even younger in some cases. A reliable 

diagnosis can usually be made by the age of two years. The diverse expressions of 

ASD symptoms pose diagnostic challenges to clinicians. Individuals with an ASD may 

present at various times of development (e.g., toddler, child, or adolescent), and 

symptom expression may vary over the course of development. Furthermore, clinicians 

must differentiate among pervasive developmental disorders, and may also consider 

similar conditions, including intellectual disability not associated with a pervasive 

developmental disorder, specific language disorders, ADHD, anxiety, and psychotic 

disorders. 

Considering the unique challenges in diagnosing ASD, specific practice parameters for 

its assessment have been published by the American Academy of Neurology, the 

American Academy of Child and Adolescent Psychiatry, and a consensus panel with 

representation from various professional societies. The practice parameters outlined by 

these societies include an initial screening of children by general practitioners (i.e., 


"Level 1 screening") and for children who fail the initial screening, a comprehensive 

diagnostic assessment by experienced clinicians (i.e. "Level 2 evaluation"). 

Furthermore, it has been suggested that assessments of children with suspected ASD 

be evaluated within a developmental framework, include multiple informants (e.g., 

parents and teachers) from diverse contexts (e.g., home and school), and employ a 

multidisciplinary team of professionals (e.g., clinical psychologists, neuropsychologists, 

and psychiatrists). 

After a child shows initial evidence of ASD tendencies, psychologists administer various 

psychological assessment tools to assess for ASD. Among these measurements, the 

Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation 

Schedule (ADOS) are considered the "gold standards" for assessing autistic children. 

The ADI-R is a semi-structured parent interview that probes for symptoms of autism by 

evaluating a child's current behavior and developmental history. The ADOS is a 

semistructured interactive evaluation of ASD symptoms that is used to measure social 

and communication abilities by eliciting several opportunities (or "presses") for 

spontaneous behaviors (e.g., eye contact) in standardized context. Various other 

questionnaires (e.g., The Childhood Autism Rating Scale, Autism Treatment Evaluation 

Checklist) and tests of cognitive functioning (e.g., The Peabody Picture Vocabulary 

Test) are typically included in an ASD assessment battery. 

In the UK, there is some diagnostic use of the Diagnostic Interview for Social and 

Communication Disorders (DISCO) was which was developed for use at The Centre for 

Social and Communication Disorders, by Lorna Wing and Judith Gould, as both a 

clinical and a research instrument for use with children and adults of any age. The 

DISCO is designed to elicit a picture of the whole person through the story of their 

development and behaviour. In clinical work, the primary purpose is to facilitate 

understanding of the pattern over time of the specific skills and impairments that 

underlie the overt behaviour. If no information is available, the clinician has to obtain as 

much information as possible concerning the details of current skills and pattern of 

behavior of the person. This type of dimensional approach to clinical description is 

useful for prescribing treatment. 

Comorbidity 

Autism spectrum disorders tend to be highly comorbid with other disorders. Comorbidity 

may increase with age and may worsen the course of youth with ASDs and make 

intervention/treatment more difficult. Distinguishing between ASDs and other diagnoses 

can be challenging, because the traits of ASDs often overlap with symptoms of other 

disorders, and the characteristics of ASDs make traditional diagnostic procedures 

difficult. 

The most common medical condition occurring in individuals with autism spectrum 

disorders is seizure disorder or epilepsy, which occurs in 11-39% of individuals with 

ASD. Tuberous sclerosis, a medical condition in which non-malignant tumors grow in 

the brain and on other vital organs, occurs in 1-4% of individuals with ASDs. 


Intellectual disabilities are some of the most common comorbid disorders with ASDs. 

Recent estimates suggest that 40-69% of individuals with ASD have some degree of an 

intellectual disability, more likely to be severe for females. A number of genetic 

syndromes causing intellectual disability may also be comorbid with ASD, including 

fragile X syndrome, Down syndrome, Prader-Willi and Angelman syndromes, and 

Williams syndrome. 

Learning disabilities are also highly comorbid in individuals with an ASD. Approximately 

25-75% of individuals with an ASD also have some degree of a learning disability. 

Various anxiety disorders tend to co-occur with autism spectrum disorders, with overall 

comorbidity rates of 7-84%. Rates of comorbid depression in individuals with an ASD 

range from 4-58%. The relationship between ASD and schizophrenia remains a 

controversial subject under continued investigation, and recent meta-analyses have 

examined genetic, environmental, infectious, and immune risk factors that may be 

shared between the two conditions. 


Deficits in ASD are often linked to behavior problems, such as difficulties following 

directions, being cooperative, and doing things on other people's terms. Symptoms 

similar to those of attention deficit hyperactivity disorder (ADHD) can be part of an ASD 

diagnosis. 

Sensory processing disorder is also comorbid with ASD, with comorbidity rates of 42- 

88%. 

Treatment 

There is no known cure for autism, although those with Asperger syndrome and those 

who have autism and require little-to-no support are more likely to experience a 

lessening of symptoms over time. The main goals of treatment are to lessen associated 

deficits and family distress, and to increase quality of life and functional independence. 

In general, higher IQs are correlated with greater responsiveness to treatment and 

improved treatment outcomes. Although evidence-based interventions for autistic 

children vary in their methods, many adopt a psychoeducational approach to enhancing 

cognitive, communication, and social skills while minimizing problem behaviors. It has 

been argued that no single treatment is best and treatment is typically tailored to the 

child's needs. 

Intensive, sustained special education programs and behavior therapy early in life can 

help children acquire self-care, social, and job skills. Available approaches include 

applied behavior analysis, developmental models, structured teaching, speech and 

language therapy, social skills therapy, and occupational therapy.[99] Among these 

approaches, interventions either treat autistic features comprehensively, or focus 

treatment on a specific area of deficit. Generally, when educating those with autism, 

specific tactics may be used to effectively relay information to these individuals. Using 

as much social interaction as possible is key in targeting the inhibition autistic 

individuals experience concerning person-to-person contact. Additionally, research has 

shown that employing semantic groupings, which involves assigning words to typical 

conceptual categories, can be beneficial in fostering learning. 

There has been increasing attention to the development of evidence-based 

interventions for young children with ASD. Two theoretical frameworks outlined for early 

childhood intervention include applied behavioral analysis (ABA) and the developmental 

social-pragmatic model (DSP). Although ABA therapy has a strong evidence base, 

particularly in regard to early intensive home-based therapy. ABA's effectiveness may 

be limited by diagnostic severity and IQ of the person affected by ASD. The Journal of 

Clinical Child and Adolescent Psychology has deemed two early childhood interventions 

as "well-established": individual comprehensive ABA, and focused teacher-implemented 

ABA combined with DSP. 

Another evidence-based intervention that has demonstrated efficacy is a parent training 

model, which teaches parents how to implement various ABA and DSP techniques 


themselves. Various DSP programs have been developed to explicitly deliver 

intervention systems through at-home parent implementation. 

A multitude of unresearched alternative therapies have also been implemented. Many 

have resulted in harm to autistic people and should not be employed unless proven to 

be safe. 

In October 2015, the American Academy of Pediatrics (AAP) proposed new evidencebased 

recommendations for early interventions in ASD for children under 3. These 

recommendations emphasize early involvement with both developmental and 

behavioral methods, support by and for parents and caregivers, and a focus on both the 

core and associated symptoms of ASD. 

Epidemiology 

The U.S. Center for Disease Control's most 

recent estimate is that 1 out of every 68 children, 

or 14.7 per 1,000, have some form of ASD as of 

2010[update]. Reviews tend to estimate a 

prevalence of 6 per 1,000 for autism spectrum 

disorders as a whole, although prevalence rates 

vary for each of the developmental disorders in 

the spectrum. Autism prevalence has been 

estimated at 1-2 per 1,000, Asperger syndrome 

at roughly 0.6 per 1,000, childhood disintegrative 

disorder at 0.02 per 1,000, and PDD-NOS at 3.7 

per 1,000. These rates are consistent across 

cultures and ethnic groups, as autism is 

considered a universal disorder. 

While rates of autism spectrum disorders are consistent across cultures, they vary 

greatly by gender, with boys affected far more frequently than girls. The average maleto-female 

ratio for ASDs is 4.2:1, affecting 1 in 70 males, but only 1 in 315 females. 

Females, however, are more likely to have associated cognitive impairment. Among 

those with an ASD and intellectual disability, the sex ratio may be closer to 2:1. 

Prevalence differences may be a result of gender differences in expression of clinical 

symptoms, with autistic females showing less atypical behaviors and, therefore, less 

likely to receive an ASD diagnosis. 

History 

Controversies have surrounded various claims regarding the etiology of autism 

spectrum disorders. In the 1950s, the "refrigerator mother theory" emerged as an 

explanation for autism. The hypothesis was based on the idea that autistic behaviors 

stem from the emotional frigidity, lack of warmth, and cold, distant, rejecting demeanor 

of a child's mother. Naturally, parents of children with an autism spectrum disorder 


suffered from blame, guilt, and self-doubt, especially as the theory was embraced by the 

medical establishment and went largely unchallenged into the mid-1960s. The 

"refrigerator mother" theory has since continued to be refuted in scientific literature, 

including a 2015 systematic review which showed no association between caregiver 

interaction and language outcomes in ASD. 

Another controversial claim suggests that watching extensive amounts of television may 

cause autism. This hypothesis was largely based on research suggesting that the 

increasing rates of autism in the 1970s and 1980s were linked to the growth of cable 

television at this time. 

Caregivers 


Families who care for an autistic child face added stress from a number of different 

causes. Parents may be shocked and dismayed by the diagnosis, and they may 

struggle to understand their child's diagnosis and find appropriate care options. They 

also struggle emotionally. In the words of a physician whose two children were both 

diagnosed with autism, "In the moment of diagnosis, it feels like the death of your hopes 

and dreams." 

More than half of parents over the age of 50 are still living with their child as about 85% 

of people with ASD have difficulties living independently. By the time most parents 

reach 50, 17% still have children living with them. 

Autism Rights Movement 

The autism rights movement (ARM) is a social movement within the neurodiversity 

movement that encourages autistic people, their caregivers, and society to adopt a 

position of neurodiversity, and to accept autism as a variation in functioning rather than 

a disorder to be cured. The ARM advocates for several goals, including a greater 

acceptance of autistic behaviors, therapies that teach autistic individuals coping skills 

rather than therapies focused on imitating behaviors of neurotypical peers, the creation 

of social networks and events that allow autistic people to socialize on their own terms, 

and the recognition of the autistic community as a minority group. 

Autism rights and neurodiversity advocates believe that the autism spectrum is genetic 

and should be accepted as a natural expression of the human genome. This 

perspective is distinct from two other likewise distinct views: 

The perspective that autism is caused by a genetic defect and should be addressed by 

targeting the autism gene(s) 


The perspective that autism is caused by environmental factors, like vaccines and 

pollution, and could be cured by addressing environmental causes. This is a less 

common view, but is likewise contrary to neurodiversity. 

The movement is controversial; a common criticism leveled against autistic activists is 

that many have Asperger syndrome or are otherwise high-functioning, and therefore do 

not represent the views or experiences of all autistic people. 

Academic Performance 

The number of students identified and served as eligible for autism services in the 

United States has increased from 5,413 children in 1991-1992 to 370,011 children in the 

2010-2011 academic school year. The United States Department of Health and Human 

Services reported approximately 1 in 68 children at age 8 are diagnosed with autism 

spectrum disorder (ASD) although onset is typically between ages 2 and 4. 

The increasing number of students with ASD in the schools presents significant 

challenges to teachers, school psychologists, and other school professionals. These 

challenges include developing a consistent practice that best support the social and 

cognitive development of the increasing number of students with ASD. Although there is 

considerable research addressing assessment, identification, and support services for 

children with ASD, there is a need for further research focused on these topics within 

the school context. Further research on appropriate support services for students with 

ASD will provide school psychologists and other education professionals with specific 

directions for advocacy and service delivery that aim to enhance school outcomes for 

students with ASD. 


Attempts to identify and use best intervention practices for students with autism also 

pose a challenge due to overdependence on popular or well-known interventions and 

curricula. Some evidence suggests that although these interventions work for some 

students, there remains a lack of specificity for which type of student, under what 

environmental conditions (one-on-one, specialized instruction or general education) and 

for which targeted deficits they work best. More research is needed to identify what 

assessment methods are most effective for identifying the level of educational needs for 

students with ASD. 


V. Asperger Syndrome 

Asperger Syndrome (AS), also known as Asperger's, is a developmental 

disorder characterized by significant difficulties in social interaction and nonverbal 

communication, along with restricted and repetitive patterns of behavior and 

interests. As a milder autism spectrum disorder (ASD), it differs from other ASDs by 

relatively normal language and intelligence. Although not required for diagnosis, 

physical clumsiness and unusual use of language are common. Signs usually begin 

before two years old and typically last for a person's entire life. 

The exact cause of 

Asperger's 

is 

unknown. While it is 

probably partly inherited, the 

underlying genetics have 

not been determined 

conclusively. Environmental 

factors are also believed to 

play a role. Brain 

imaging has not identified a 

common underlying 

problem. The diagnosis of 

Asperger's was removed in 

the 2013 fifth edition of 

the Diagnostic and 

Statistical Manual of Mental 

Disorders (DSM-5), and 

people with these symptoms 

are now included within the 

autism spectrum disorder along with autism and pervasive developmental disorder not 

otherwise specified (PDD-NOS). It remains within the tenth edition of the International 

Classification of Diseases (ICD-10) as of 2015. 

There is no single treatment, and the effectiveness of particular interventions is 

supported by only limited data. Treatment is aimed at improving poor communication 

skills, obsessive or repetitive routines and physical clumsiness. Interventions may 

include social skills training, cognitive behavioral therapy, physical therapy, speech 

therapy, parent training and medications for associated problems such as mood or 

anxiety. Most children improve as they grow up, but social and communication 

difficulties usually persist. Some researchers and people on the autism spectrum have 

advocated a shift in attitudes toward the view that autism spectrum disorder is a 

difference rather than a disease that must be treated or cured. 

In 2015, Asperger's was estimated to affect 37.2 million people globally. The syndrome 

is named after the Austrian pediatrician Hans Asperger, who in 1944 described children 


in his practice who lacked nonverbal communication, had limited understanding of 

others' feelings, and were physically clumsy. The modern conception of Asperger 

syndrome came into existence in 1981 and went through a period of popularization. It 

became a standardized diagnosis in the early 1990s. Many questions and controversies 

remain about aspects of the disorder. There is doubt about whether it is distinct 

from high-functioning autism (HFA). Partly because of this, the percentage of people 

affected is not firmly established. 


The extent of the overlap between AS and high-functioning autism (HFA—autism 

unaccompanied by intellectual disability) is unclear. The ASD classification is to some 

extent an artifact of how autism was discovered, and may not reflect the true nature of 

the spectrum; methodological problems have beset Asperger syndrome as a valid 

diagnosis from the outset. In the fifth edition of the Diagnostic and Statistical Manual of 

Mental Disorders (DSM-5), published in May 2013, AS, as a separate diagnosis, was 

eliminated and folded into autism spectrum disorder. Like the diagnosis of Asperger 

syndrome, the change was controversial and AS was not removed from the 

WHO's ICD-10. 

The World Health Organization (WHO) defines Asperger syndrome (AS) as one of 

the autism spectrum disorders (ASD) or pervasive developmental disorders (PDD), 

which are a spectrum of psychological conditions that are characterized by 

abnormalities of social interaction and communication that pervade the individual's 

functioning, and by restricted and repetitive interests and behavior. Like other 

psychological development disorders, ASD begins in infancy or childhood, has a steady 

course without remission or relapse, and has impairments that result from maturationrelated 

changes in various systems of the brain. ASD, in turn, is a subset of the broader 

autism phenotype, which describes individuals who may not have ASD but do have 

autistic-like traits, such as social deficits. Of the other four ASD forms, autism is the 

most similar to AS in signs and likely causes, but its diagnosis requires impaired 

communication and allows delay in cognitive development; Rett 

syndrome and childhood disintegrative disorder share several signs with autism but may 

have unrelated causes; and pervasive developmental disorder not otherwise specified 

(PDD-NOS) is diagnosed when the criteria for a more specific disorder are unmet. 

Characteristics 

As a pervasive developmental disorder, Asperger syndrome is distinguished by a 

pattern of symptoms rather than a single symptom. It is characterized by qualitative 

impairment in social interaction, by stereotyped and restricted patterns of behavior, 

activities and interests, and by no clinically significant delay in cognitive development or 

general delay in language. Intense preoccupation with a narrow subject, onesided 

verbosity, restricted prosody, and physical clumsiness are typical of the condition, 

but are not required for diagnosis. Suicidal behavior appears to occur at rates similar to 

those without ASD. 


Social Interaction 

A lack of demonstrated empathy affects aspects of communal living for persons with 

Asperger syndrome. Individuals with AS experience difficulties in basic elements of 

social interaction, which may include a failure to develop friendships or to seek shared 

enjoyments or achievements with others (for example, showing others objects of 

interest); a lack of social or emotional reciprocity (social "games" give-and-take 

mechanic); and impaired nonverbal behaviors in areas such as eye contact, facial 

expression, posture, and gesture. 

People with AS may not be as withdrawn around others, compared with those with 

other, more debilitating forms of autism; they approach others, even if awkwardly. For 

example, a person with AS may engage in a one-sided, long-winded speech about a 

favorite topic, while misunderstanding or not recognizing the listener's feelings or 

reactions, such as a wish to change the topic of talk or end the interaction. This social 

awkwardness has been called "active but odd". Such failures to react appropriately to 

social interaction may appear as disregard for other people's feelings and may come 

across as insensitive. However, not all individuals with AS will approach others. Some 

of them may even display selective mutism, not speaking at all to most people and 

excessively to specific others. Some may choose only to talk to people they like. 

The cognitive ability of children with AS often allows them to articulate social norms in a 

laboratory context, where they may be able to show a theoretical understanding of other 

people's emotions; however, they typically have difficulty acting on this knowledge in 

fluid, real-life situations. People with AS may analyze and distill their observations of 


social interaction into rigid behavioral guidelines and apply these rules in awkward 

ways, such as forced eye contact, resulting in a demeanor that appears rigid or socially 

naïve. Childhood desire for companionship can become numbed through a history of 

failed social encounters. 

Violent or Criminal Behavior 

The hypothesis that individuals with AS are predisposed to violent or criminal behavior 

has been investigated, but is not supported by data. More evidence suggests that 

children diagnosed with Asperger syndrome are victims rather than offenders. 

A 2008 review found that an overwhelming number of reported violent criminals with 

Asperger syndrome had also other coexisting psychotic psychiatric disorders such 

as schizoaffective disorder. 

Restricted and Repetitive Interests and Behavior 

People with Asperger syndrome can display behavior, interests, and activities that are 

restricted and repetitive and are sometimes abnormally intense or focused. They may 

stick to inflexible routines, move in stereotyped and repetitive ways, preoccupy 

themselves with parts of objects, or engage in compulsive behaviors like lining objects 

up to form patterns. 

Pursuit of specific and narrow areas of interest is one of the most striking among 

possible features of AS. Individuals with AS may collect volumes of detailed information 

on a relatively narrow topic such as weather data or star names without necessarily 

having a genuine understanding of the broader topic. For example, a child might 

memorize camera model numbers while caring little about photography. This behavior is 

usually apparent by age 5 or 6. Although these special interests may change from time 

to time, they typically become more unusual and narrowly focused and often dominate 

social interaction so much that the entire family may become immersed. Because 

narrow topics often capture the interest of children, this symptom may go unrecognized. 

Stereotyped and repetitive motor behaviors are a core part of the diagnosis of AS and 

other ASDs. They include hand movements such as flapping or twisting, and complex 

whole-body movements. These are typically repeated in longer bursts and look more 

voluntary or ritualistic than tics, which are usually faster, less rhythmical, and less often 

symmetrical. 

According to the Adult Asperger Assessment (AAA) diagnostic test, a lack of interest in 

fiction and a positive preference towards non-fiction is common among adults with AS. 

Speech and Language 

Although individuals with Asperger syndrome acquire language skills without significant 

general delay and their speech typically lacks significant abnormalities, language 


acquisition and use is often atypical. Abnormalities include verbosity; abrupt transitions; 

literal interpretations and miscomprehension of nuance; use of metaphor meaningful 

only to the speaker; auditory perception deficits; unusually pedantic, formal, 

or idiosyncratic speech; and oddities in loudness, pitch, intonation, prosody, and 

rhythm. Echolalia has also been observed in individuals with AS. 

Three aspects of communication patterns are of clinical interest: poor 

prosody, tangential and circumstantial speech, and marked verbosity. 

Although inflection and intonation may be less rigid or monotonic than in classic autism, 

people with AS often have a limited range of intonation: speech may be unusually fast, 

jerky, or loud. Speech may convey a sense of incoherence; the conversational style 

often includes monologues about topics that bore the listener, fails to provide context for 

comments, or fails to suppress internal thoughts. Individuals with AS may fail to detect 

whether the listener is interested or engaged in the conversation. The speaker's 

conclusion or point may never be made, and attempts by the listener to elaborate on the 

speech's content or logic, or to shift to related topics, are often unsuccessful. 

Children with AS may have a sophisticated vocabulary at a young age and such 

children have often been colloquially called "little professors", but have difficulty 

understanding figurative language and tend to use language literally. Children with AS 

appear to have particular weaknesses in areas of nonliteral language that include 

humor, irony, teasing, and sarcasm. Although individuals with AS usually understand 

the cognitive basis of humor, they seem to lack understanding of the intent of humor to 


share enjoyment with others. Despite strong evidence of impaired humor appreciation, 

anecdotal reports of humor in individuals with AS seem to challenge some 

psychological theories of AS and autism. 

Motor and Sensory Perception 

Individuals with Asperger syndrome may have signs or symptoms that are independent 

of the diagnosis, but can affect the individual or the family. These include differences in 

perception and problems with motor skills, sleep, and emotions. 

Individuals with AS often have excellent auditory and visual perception. Children with 

ASD often demonstrate enhanced perception of small changes in patterns such as 

arrangements of objects or well-known images; typically this is domain-specific and 

involves processing of fine-grained features. Conversely, compared with individuals 

with high-functioning autism, individuals with AS have deficits in some tasks involving 

visual-spatial perception, auditory perception, or visual memory. Many accounts of 

individuals with AS and ASD report other unusual sensory and perceptual skills and 

experiences. They may be unusually sensitive or insensitive to sound, light, and other 

stimuli; these sensory responses are found in other developmental disorders and are 

not specific to AS or to ASD. There is little support for increased fight-or-flight 

response or failure of habituation in autism; there is more evidence of decreased 

responsiveness to sensory stimuli, although several studies show no differences. 

Hans Asperger's initial accounts and other diagnostic schemes include descriptions of 

physical clumsiness. Children with AS may be delayed in acquiring skills 

requiring dexterity, such as riding a bicycle or opening a jar, and may seem to move 

awkwardly or feel "uncomfortable in their own skin". They may be poorly coordinated or 

have an odd or bouncy gait or posture, poor handwriting, or problems with motor 

coordination. They may show problems with proprioception (sensation of body position) 

on measures of developmental coordination disorder (motor planning disorder), 

balance, tandem gait, and finger-thumb apposition. There is no evidence that these 

motor skills problems differentiate AS from other high-functioning ASDs. 

Children with AS are more likely to have sleep problems, including difficulty in falling 

asleep, frequent nocturnal awakenings, and early morning awakenings. AS is also 

associated with high levels of alexithymia, which is difficulty in identifying and describing 

one's emotions. Although AS, lower sleep quality, and alexithymia are associated with 

each other, their causal relationship is unclear. 

Causes 

Hans Asperger described common symptoms among his patients' family members, 

especially fathers, and research supports this observation and suggests a genetic 

contribution to Asperger syndrome. Although no specific gene has yet been identified, 

multiple factors are believed to play a role in the expression of autism, given 

the phenotypic variability seen in children with AS. Evidence for a genetic link is the 


tendency for AS to run in families and an observed higher incidence of family members 

who have behavioral symptoms similar to AS but in a more limited form (for example, 

slight difficulties with social interaction, language, or reading). Most behavioral 

genetic research suggests that all autism spectrum disorders have shared genetic 

mechanisms, but AS may have a stronger genetic component than autism. There is 

probably a common group of genes where particular alleles render an individual 

vulnerable to developing AS; if this is the case, the particular combination of alleles 

would determine the severity and symptoms for each individual with AS. 

A few ASD cases have been linked to exposure to teratogens (agents that cause birth 

defects) during the first eight weeks from conception. Although this does not exclude the 

possibility that ASD can be initiated or affected later, it is strong evidence that ASD 

arises very early in development. Many environmental factors have been hypothesized 

to act after birth, but none has been confirmed by scientific investigation. 

Mechanism 

Asperger syndrome appears to result from developmental factors that affect many or all 

functional brain systems, as opposed to localized effects. Although the specific 

underpinnings of AS or factors that distinguish it from other ASDs are unknown, and no 

clear pathology common to individuals with AS has emerged, it is still possible that AS's 

mechanism is separate from other ASDs. Neuroanatomical studies and the associations 

with teratogens strongly suggest that the mechanism includes alteration of brain 

development soon after conception. Abnormal migration of embryonic cells during fetal 

development may affect the final structure and connectivity of the brain, resulting in 

alterations in the neural circuits that control thought and behavior. Several theories of 

mechanism are available; none are likely to provide a complete explanation. 

The under-connectivity theory hypothesizes under-functioning high-level neural 

connections and synchronization, along with an excess of low-level processes. It maps 

well to general-processing theories such as weak central coherence theory, which 

hypothesizes that a limited ability to see the big picture underlies the central disturbance 

in ASD. A related theory—enhanced perceptual functioning—focuses more on the 

superiority of locally oriented and perceptual operations in autistic individuals. 

The mirror neuron system (MNS) theory hypothesizes that alterations to the 

development of the MNS interfere with imitation and lead to Asperger's core feature of 


social impairment. For example, one study found that activation is delayed in the core 

circuit for imitation in individuals with AS. This theory maps well to social 

cognition theories like the theory of mind, which hypothesizes that autistic behavior 

arises from impairments in ascribing mental states to oneself and others; or hypersystemizing, 

which hypothesizes that autistic individuals can systematize internal 

operation to handle internal events but are less effective at empathizing when handling 

events generated by other agents. 

Diagnosis 

Standard diagnostic criteria require impairment in social interaction and repetitive and 

stereotyped patterns of behavior, activities, and interests, without significant delay in 

language or cognitive development. Unlike the international standard, the DSM-IV- 

TR criteria also required significant impairment in day-to-day functioning; DSM- 

5 eliminated AS as a separate diagnosis in 2013, and folded it into the umbrella of 

autism spectrum disorders. Other sets of diagnostic criteria have been proposed 

by Szatmari et al. and by Gillberg and Gillberg. 

Diagnosis is most commonly made between the ages of four and eleven. A 

comprehensive assessment involves a multidisciplinary team that observes across 

multiple settings, and includes neurological and genetic assessment as well as tests for 

cognition, psychomotor function, verbal and nonverbal strengths and weaknesses, style 

of learning, and skills for independent living. 

The "gold standard" in diagnosing ASDs combines clinical judgment with the Autism 

Diagnostic Interview-Revised (ADI-R), a semistructured parent interview; and 

the Autism Diagnostic Observation Schedule (ADOS), a conversation and play-based 

interview with the child. Delayed or mistaken diagnosis can be traumatic for individuals 

and families; for example, misdiagnosis can lead to medications that worsen behavior. 

Underdiagnosis and overdiagnosis may be problems. The cost and difficulty 

of screening and assessment can delay diagnosis. Conversely, the increasing 

popularity of drug treatment options and the expansion of benefits has motivated 

providers to overdiagnose ASD. There are indications AS has been diagnosed more 

frequently in recent years, partly as a residual diagnosis for children of normal 

intelligence who are not autistic but have social difficulties. 

There are questions about the external validity of the AS diagnosis. That is, it is unclear 

whether there is a practical benefit in distinguishing AS from HFA and from PDD- 

NOS; the same child can receive different diagnoses depending on the screening 

tool. The debate about distinguishing AS from HFA is partly due to a tautological 

dilemma where disorders are defined based on severity of impairment, so that studies 

that appear to confirm differences based on severity are to be expected. 


Differential Diagnosis 

Many children with AS are initially misdiagnosed with attention deficit hyperactivity 

disorder (ADHD). Diagnosing adults is more challenging, as standard diagnostic criteria 

are designed for children and the expression of AS changes with age. Adult diagnosis 

requires painstaking clinical examination and thorough medical history gained from both 

the individual and other people who know the person, focusing on childhood behavior. 

Conditions that must be considered in a differential diagnosis along with ADHD include 

other ASDs, the schizophrenia spectrum, personality disorders, obsessive–compulsive 

disorder, major depressive disorder, semantic pragmatic disorder, nonverbal learning 

disorder, social anxiety disorder, Tourette syndrome, stereotypic movement 

disorder, bipolar disorder, social-cognitive deficits due to brain damage from alcohol 

abuse, and obsessive–compulsive personality disorder (OCPD). 

Screening 

Parents of children with Asperger syndrome can typically trace differences in their 

children's development to as early as 30 months of age. Developmental screening 

during a routine check-up by a general practitioner or pediatrician may identify signs 

that warrant further investigation. The United States Preventive Services Task Force in 

2016 found it was unclear if screening was beneficial or harmful among children in 

whom there are no concerns. 


The diagnosis of AS is complicated by the use of several different screening 

instruments, including the Asperger Syndrome Diagnostic Scale (ASDS); Autism 

Spectrum Screening Questionnaire (ASSQ); Childhood Autism Spectrum Test (CAST), 

previously called the Childhood Asperger Syndrome Test; Gilliam Asperger's disorder 

scale (GADS); Krug Asperger's Disorder Index (KADI); and the autism-spectrum 

quotient (AQ), with versions for children, adolescents, and adults. None have been 

shown to reliably differentiate between AS and other ASDs. 

Management 

Asperger syndrome treatment attempts to manage distressing symptoms and to teach 

age-appropriate social, communication, and vocational skills that are not naturally 

acquired during development, with intervention tailored to the needs of the individual 

based on multidisciplinary assessment. Although progress has been made, data 

supporting the efficacy of particular interventions are limited. 

Therapies 

The ideal treatment for AS coordinates therapies that address core symptoms of the 

disorder, including poor communication skills and obsessive or repetitive routines. While 

most professionals agree that the earlier the intervention, the better, there is no single 

best treatment package. AS treatment resembles that of other high-functioning ASDs, 

except that it takes into account the linguistic capabilities, verbal strengths, and 

nonverbal vulnerabilities of individuals with AS. A typical program generally includes: 

 

 

 

A positive behavior support procedure includes training and support of parents 

and school faculty in behavior management strategies to use in the home and 

school; 

An applied behavior analysis (ABA) technique called social skills training for 

more effective interpersonal interactions; 

Cognitive behavioral therapy to improve stress management relating to anxiety or 

explosive emotions and to cut back on obsessive interests and repetitive 

routines; 

Medication for coexisting conditions such as major depressive 

disorder and anxiety disorders; 

Occupational or physical therapy to assist with poor sensory 

processing and motor coordination; and, 

 

Social communication intervention, which is specialized speech therapy to help 

with the pragmatics and give-and-take of normal conversation. 


Of the many studies on behavior-based early intervention programs, most are case 

reports of up to five participants and typically examine a few problem behaviors such 

as self-injury, aggression, noncompliance, stereotypies, or spontaneous language; 

unintended side effects are largely ignored. Despite the popularity of social skills 

training, its effectiveness is not firmly established. A randomized controlled study of a 

model for training parents in problem behaviors in their children with AS showed that 

parents attending a one-day workshop or six individual lessons reported fewer 

behavioral problems, while parents receiving the individual lessons reported less 

intense behavioral problems in their AS children. Vocational training is important to 

teach job interview etiquette and workplace behavior to older children and adults with 

AS, and organization software and personal data assistants can improve the work and 

life management of people with AS. 

Medications 

No medications directly treat the core 

symptoms of AS. Although research into 

the efficacy of pharmaceutical 

intervention for AS is limited, it is 

essential to diagnose and 

treat comorbid conditions. Deficits in selfidentifying 

emotions or in observing 

effects of one's behavior on others can 

make it difficult for individuals with AS to 

see why medication may be 

appropriate. Medication can be effective 

in combination with behavioral 

interventions and environmental 

accommodations in treating comorbid 

symptoms such as anxiety disorders, major depressive disorder, inattention, and 

aggression. The atypical antipsychotic medications risperidone and olanzapine have 

been shown to reduce the associated symptoms of AS; risperidone can reduce 

repetitive and self-injurious behaviors, aggressive outbursts, and impulsivity, and 

improve stereotypical patterns of behavior and social relatedness. The selective 

serotonin reuptake inhibitors (SSRIs) fluoxetine, fluvoxamine, and sertraline have been 

effective in treating restricted and repetitive interests and behaviors. 

Care must be taken with medications, as side effects may be more common and harder 

to evaluate in individuals with AS, and tests of drugs' effectiveness against comorbid 

conditions routinely exclude individuals from the autism spectrum. Abnormalities 

in metabolism, cardiac conduction times, and an increased risk of type 2 diabetes have 

been raised as concerns with these medications, along with serious long-term 

neurological side effects. SSRIs can lead to manifestations of behavioral activation such 

as increased impulsivity, aggression, and sleep disturbance. Weight gain and fatigue 

are commonly reported side effects of risperidone, which may also lead to increased 

risk for extrapyramidal symptoms such as restlessness and dystonia and increased 


serum prolactin levels. Sedation and weight gain are more common 

with olanzapine, which has also been linked with diabetes. Sedative side-effects in 

school-age children have ramifications for classroom learning. Individuals with AS may 

be unable to identify and communicate their internal moods and emotions or to tolerate 

side effects that for most people would not be problematic. 

Prognosis 

There is some evidence that children with AS may see a lessening of symptoms; up to 

20% of children may no longer meet the diagnostic criteria as adults, although social 

and communication difficulties may persist. As of 2006, no studies addressing the longterm 

outcome of individuals with Asperger syndrome are available and there are no 

systematic long-term follow-up studies of children with AS. Individuals with AS appear to 

have normal life expectancy, but have an 

increased prevalence of comorbid psychiatric conditions, such as major depressive 

disorder and anxiety disorders that may significantly affect prognosis. Although social 

impairment may be lifelong, the outcome is generally more positive than with individuals 

with lower-functioning autism spectrum disorders; for example, ASD symptoms are 

more likely to diminish with time in children with AS or HFA. Most students with AS and 

HFA have average mathematical ability and test slightly worse in mathematics than in 

general intelligence, but some are gifted in mathematics. AS has potentially been linked 

to some accomplishments, such as Vernon L. Smith winning the Nobel Memorial Prize 

in Economic Sciences; however, Smith is self-diagnosed. 

Although many attend regular education classes, some children with AS may 

utilize special education services because of their social and behavioral 

difficulties. Adolescents with AS may exhibit ongoing difficulty with self-care or 

organization, and disturbances in social and romantic relationships. Despite high 

cognitive potential, most young adults with AS remain at home, yet some do marry and 

work independently. The "different-ness" adolescents experience can be 

traumatic. Anxiety may stem from preoccupation over possible violations of routines and 

rituals, from being placed in a situation without a clear schedule or expectations, or 

from concern with failing in social encounters; the resulting stress may manifest as 

inattention, withdrawal, reliance on obsessions, hyperactivity, or aggressive or 

oppositional behavior. Depression is often the result of chronic frustration from repeated 

failure to engage others socially, and mood disorders requiring treatment may 

develop. Clinical experience suggests the rate of suicide may be higher among those 

with AS, but this has not been confirmed by systematic empirical studies. 

Education of families is critical in developing strategies for understanding strengths and 

weaknesses; helping the family to cope improves outcomes in children. Prognosis may 

be improved by diagnosis at a younger age that allows for early interventions, while 

interventions in adulthood are valuable but less beneficial. There are legal implications 

for individuals with AS as they run the risk of exploitation by others and may be unable 

to comprehend the societal implications of their actions. 

Epidemiology 


Frequency estimates vary enormously. In 2015, it was estimated that 37.2 million 

people globally are affected. A 2003 review of epidemiological studies of children found 

autism rates ranging from 0.03 to 4.84 per 1,000, with the ratio of autism to Asperger 

syndrome ranging from 1.5:1 to 16:1; combining the geometric mean ratio of 5:1 with a 

conservative prevalence estimate for autism of 1.3 per 1,000 suggests indirectly that the 

prevalence of AS might be around 0.26 per 1,000. Part of the variance in estimates 

arises from differences in diagnostic criteria. For example, a relatively small 2007 study 

of 5,484 eight-year-old children in Finland found 2.9 children per 1,000 met the ICD-10 

criteria for an AS diagnosis, 2.7 per 1,000 for Gillberg and Gillberg criteria, 2.5 for DSM- 

IV, 1.6 for Szatmari et al., and 4.3 per 1,000 for the union of the four criteria. Boys seem 

to be more likely to have AS than girls; estimates of the sex ratio range from 1.6:1 to 

4:1, using the Gillberg and Gillberg criteria. Females with autism spectrum disorders 

may be underdiagnosed. 

Anxiety disorders and major depressive disorder are the most common conditions seen 

at the same time; comorbidity of these in persons with AS is estimated at 65%. Reports 

have associated AS with medical conditions such as aminoaciduria and ligamentous 

laxity, but these have been case reports or small studies and no factors have been 

associated with AS across studies. One study of males with AS found an increased rate 

of epilepsy and a high rate (51%) of nonverbal learning disorder. AS is associated 

with tics, Tourette syndrome, and bipolar disorder, and the repetitive behaviors of AS 

have many similarities with the symptoms of obsessive–compulsive 

disorder and obsessive–compulsive personality disorder. However many of these 

studies are based on clinical samples or lack standardized measures; nonetheless, 

comorbid conditions are relatively common. 


History 

Named after the Austrian pediatrician Hans Asperger (1906–1980), Asperger syndrome 

is a relatively new diagnosis in the field of autism, though a syndrome like it was 

described as early as 1925 by Grunya Sukhareva (1891–1981). As a child, Asperger 

appears to have exhibited some features of the very condition named after him, such as 

remoteness and talent in language. In 1944, Asperger described four children in his 

practice who had difficulty in integrating themselves socially. The children lacked 

nonverbal communication skills, failed to demonstrate empathy with their peers, and 

were physically clumsy. Asperger called the condition "autistic psychopathy" and 

described it as primarily marked by social isolation. Fifty years later, several 

standardizations of AS as a medical diagnosis were tentatively proposed, many of 

which diverge significantly from Asperger's original work. 

Unlike today's AS, autistic psychopathy could be found in people of all levels of 

intelligence, including those with intellectual disability. Asperger defended the value of 

high-functioning autistic individuals, writing: "We are convinced, then, that autistic 

people have their place in the organism of the social community. They fulfill their role 

well, perhaps better than anyone else could, and we are talking of people who as 

children had the greatest difficulties and caused untold worries to their caregivers." 

Asperger also believed some would be capable of exceptional achievement and 

original thought later in life. His paper was published during World War II and in 

German, so it was not widely read elsewhere. 

Lorna Wing popularized the term Asperger syndrome in the English-speaking medical 

community in her 1981 publication of a series of case studies of children showing 

similar symptoms, and Uta Frith translated Asperger's paper to English in 1991. Sets of 

diagnostic criteria were outlined by Gillberg and Gillberg in 1989 and by Szatmari et 

al. in the same year. AS became a standard diagnosis in 1992, when it was included in 

the tenth edition of the World Health Organization's diagnostic manual, International 

Classification of Diseases (ICD-10); in 1994, it was added to the fourth edition of 

the American Psychiatric Association's diagnostic reference, Diagnostic and Statistical 

Manual of Mental Disorders (DSM-IV). 

Hundreds of books, articles and websites now describe AS and prevalence estimates 

have increased dramatically for ASD, with AS recognized as an important 

subgroup. Whether it should be seen as distinct from high-functioning autism is a 

fundamental issue requiring further study, and there are questions about the empirical 

validation of the DSM-IV and ICD-10 criteria. In 2013, DSM-5 eliminated AS as a 

separate diagnosis, folding it into the autism spectrum on a severity scale. 


People identifying with Asperger syndrome may refer to themselves in casual 

conversation as aspies (a term first used in print by Liane Holliday Willey in 1999). The 


word neurotypical (abbreviated NT) describes a person whose neurological 

development and state are typical and is often used to refer to non-autistic (or allistic) 

people. The Internet has allowed individuals with AS to communicate with each other in 

a way that was not previously possible because of their rarity and geographic dispersal, 

forming a subculture composed of people with Asperger's. Internet sites like Wrong 

Planet have made it easier for individuals to connect. 

Some autistic people have advocated a shift in perception of autism spectrum disorders 

as complex syndromes rather than diseases that must be cured. Proponents of this 

view reject the notion that there is an "ideal" brain configuration and that any deviation 

from the norm is pathological; they promote tolerance for what they 

call neurodiversity. These views are the basis for the autistic rights and autistic 

pride movements. There is a contrast between the attitude of adults with self-identified 

AS, who typically do not want to be cured and are proud of their identity; and parents of 

children with AS, who typically seek assistance and a cure for their children. 

Some researchers have argued that AS can be viewed as a different cognitive style, not 

a disorder, and that it should be removed from the standard Diagnostic and Statistical 

Manual, much as homosexuality was removed. In a 2002 paper, Simon Baron- 

Cohen wrote of those with AS: "In the social world, there is no great benefit to a precise 

eye for detail, but in the worlds of maths, computing, cataloging, music, linguistics, 

engineering, and science, such an eye for detail can lead to success rather than failure." 

Baron-Cohen cited two reasons why it might still be useful to consider AS to be a 


disability: to ensure provision for legally required special support, and to recognize 

emotional difficulties from reduced empathy. Baron-Cohen argues that the genes for 

Asperger's combination of abilities have operated throughout recent human 

evolution and have made remarkable contributions to human history. 

By contrast, Pier Jaarsma and Welin wrote in 2011 that the "broad version of the 

neurodiversity claim, covering low-functioning as well as high-functioning autism, is 

problematic. Only a narrow conception of neurodiversity, referring exclusively to highfunctioning 

autists, is reasonable." They say that "higher functioning" individuals with 

autism may "not [be] benefited with such a psychiatric defect-based diagnosis [...] some 

of them are being harmed by it, because of the disrespect the diagnosis displays for 

their natural way of being", but "think that it is still reasonable to include other categories 

of autism in the psychiatric diagnostics. The narrow conception of the neurodiversity 

claim should be accepted but the broader claim should not." Jonathan Mitchell, 

an autistic author and blogger who advocates a cure for autism, has described autism 

as having "prevented me from making a living or ever having a girlfriend. It's given me 

bad fine motor coordination problems where I can hardly write. I have an impaired ability 

to relate to people. I can't concentrate or get things done." He describes neurodiversity 

as a "tempting escape valve". 


VI. Adult ADHD 

Adult Attention Deficit Hyperactivity Disorder (also referred to as 

adult ADHD, adult with ADHD, or simply ADHD in adults, formerly AADD) is the 

neurobiological condition of attention deficit hyperactivity disorder (ADHD) in adults. 

About one-third to two-thirds of children with symptoms from early childhood continue to 

demonstrate notable ADHD symptoms throughout life. 

Three types of ADHD are identified in the DSM-5 as: 

 

 

 

Predominantly Inattentive Type (ADHD-PI or ADHD-I) 

Predominantly Hyperactive or Hyperactive-Impulsive Type (ADHD-PH or ADHD-HI) 

Combined Type (ADHD-C) 

In later life, the hyperactive/impulsive subtype manifests less frequently. [1](p44) The 

hyperactivity symptoms tend to turn more into "inner restlessness", starting in 

adolescence and carrying on in adulthood. 


Adult ADHD is typically marked by inattentiveness, difficulty getting work done, 

procrastination and organizational problems. Specifically, adults with ADHD present 

with persistent difficulties in following directions, remembering information, 

concentrating, organizing tasks, completing work within specified time frames and 

appearing timely in appointments. These difficulties affect several different areas of an 

ADHD adult's life, causing emotional, social, vocational, marital, legal, financial and/or 

academic problems. As a result, low self-esteem is commonly developed. However, 

given the right guidance and coaching, these traits of ADHD could also lead to career 

success, and in some cases, unique advantages in critical thinking and creativity. 

Diagnosis of the condition follows after one or several assessment interviews by a 

clinician including: 

 

 

 

examination of personal history 

observational evidence from family members or close friends 

academic reports, often going back to school years as well as evaluation to 

diagnose additional possible conditions which often coexist with ADHD, called 

comorbidities or comorbid disorders. 

The condition is highly heritable, and while its exact causes are not fully known, genetic 

or environmental factors are understood to play a part. ADHD is a childhood-onset 

condition, usually requiring symptoms to have been present before age 12 for a 

diagnosis. Children under treatment will migrate to adult health services if necessary as 

they transit into adulthood, however diagnosis of adults involves full examination of their 

history. 

Successful treatment of ADHD is usually based on a combination of medication, 

cognitive behavioral therapy, and coaching or skills training. Medium-to-high intensity 

physical exercise, improved sleep and improved and targeted nutrition are also known 

to have a positive effect. Within school and work, reasonable accommodations may be 

put in place to help the individual work more efficiently and productively. 


The DSM-5, or Diagnostic and Statistical Manual of Mental Disorders, 2013 edition, 

defines three types of ADHD: 

1. a Predominantly Inattentive presentation 

2. a Predominantly Hyperactive-Impulsive presentation 

3. a Combined Type, that displays symptoms from both presentation 

To meet the diagnostic criteria of ADHD, an individual must display: 

 

 

 

at least six inattentive-type symptoms for the inattentive type 

at least six hyperactive-type symptoms for the hyperactive-impulsive type 

all of the above to have the combined type 


The symptoms (see below) were required to have been present since before the 

individual was seven years old, and must have interfered with at least two spheres of 

his or her functioning (at home and at school or work, for example) over the last six 

months. The DSM-IV criteria for ADHD were, however, tailored towards the type of 

symptoms that children would show, and might therefore have underestimated the 

prevalence of ADHD in adults. In 2013, the newer DSM-5 reviewed some of these 

criteria, with more lenient requirements for the diagnosis, especially in adults, and the 

age limit for symptoms first arising raised to twelve years. 

Signs and Symptoms 

ADHD is a chronic condition, beginning in early childhood and persisting throughout a 

person's lifetime. It is estimated that 33–66% of children with ADHD will continue to 

have significant ADHD-related symptoms persisting into adulthood, resulting in a 

significant impact on education, employment, and interpersonal relationships. 

Individuals with ADHD exhibit deficiencies in self-regulation and self-motivation which in 

turn foster problematic characteristics such as distractibility, procrastination and 

disorganization. They are often perceived by others as chaotic, with a tendency to need 

high stimulation to be less distracted and function effectively. The learning potential and 

overall intelligence of an adult with ADHD, however, are no different from the potential 

and intelligence of adults who do not have the disorder. 

Whereas teachers and caregivers responsible for children are often attuned to the 

symptoms of ADHD, employers and others who interact with adults are less likely to 


egard such behaviors as a symptom. In part, this is because symptoms do change with 

maturity; adults who have ADHD are less likely to exhibit obvious hyperactive 

behaviors. Instead, they may report constant mental activity and inner restlessness as 

their hyperactivity internalizes. 

Symptoms of ADHD (see table below) can vary widely between individuals and 

throughout the lifetime of an individual. As the neurobiology of ADHD is becoming 

increasingly understood, it is becoming evident that difficulties exhibited by individuals 

with ADHD are due to problems with the parts of the brain responsible for executive 

functions (see below: Pathophysiology). These result in problems with sustaining 

attention, planning, organization, prioritization, time blindness, impulse control and 

decision making. 

The difficulties generated by these deficiencies can range from moderate to extreme, 

resulting in the inability to effectively structure their lives, plan daily tasks, or think of and 

act accordingly even when aware of potential consequences. These lead to poor 

performance in school and work, followed by underachievement in these areas. In 

young adults, poor driving record with traffic violations as well as histories of alcoholism 

or substance abuse may surface. The difficulty is often due to the ADHD person's 

observed behaviour (e.g. the impulsive types, who may insult their boss for instance, 

resulting in dismissal), despite genuinely trying to avoid these and knowing that it can 

get them in trouble. Often, the ADHD person will miss things that an adult of similar age 

and experience should catch onto or know. These lapses can lead others to label the 

individuals with ADHD as "lazy" or "stupid" or "inconsiderate". 

As problems accumulate, a negativistic self-view becomes established and a vicious 

circle of failure is set up. Up to 80% of adults may have some form of psychiatric 

comorbidity such as depression or anxiety. Many with ADHD also have associated 

learning disabilities, such as dyslexia, which contributes to their difficulties. 

Studies on adults with ADHD have shown that, more than often, they experience self 

stigma and depression in childhood, commonly resulting from feeling neglected and 

different from their peers. These problems may play a role to the high levels of 

depression, substance abuse, and relationship problems that affect adults with ADHD 

later in life. 

In children: 

Inattentive-type 

(ADHD-PI) 

In children: 

Hyperactive/Impulsive-type 

(ADHD-PH) 

 

 

 

 

 

 

Forgetful during daily activities 

Easily distracted by extraneous stimuli 

Losing important items (e.g. pencils, 

homework, toys, etc.) 

Always asking for attention, but 

Not listening and not responding to 

name being called out 

Unable to focus on tasks at hand, cannot 

 

 

 

 

 

 

Squirms and fidgets (with hands and/or 

feet) 

Cannot sit still 

Cannot play quietly or engage in leisurely 

activities 

Talks excessively 

Runs and climbs excessively 

Always on the go, as if "driven by a motor" 


sustain attention in activities 

Avoids or dislikes tasks requiring 

sustained mental effort 

Makes careless mistakes by failing to 

pay attention to details 

Difficulty organizing tasks and activities 

Fails to follow-through on complex 

instructions and tasks (e.g. homework, 

chores, etc.) 

In adults, these evolve into: 

 

 

 

 

 

 

 

 

 

 

Avoiding tasks or jobs that require 

concentration 

Procrastination 

Difficulty initiating tasks 

Difficulty organizing details required for 

a task 

Difficulty recalling details required for a 

task 

Difficulty multitasking 

Poor time management, losing track of 

time 

Indecision and doubt 

Hesitation of execution 

Difficulty persevering or completing and 

following through on tasks 

Delayed stop and transition of 

concentration from one task to another 

Cannot wait for their turn 

Blurts out answers 

Intrudes on others and interrupts 

conversations 

In adults: 

Chooses highly active, stimulating jobs 

Avoids situations with low physical activity 

or sedentary work 

May choose to work long hours or two 

jobs 

Seeks constant activity 

Easily bored 

Impatient 

Intolerant and frustrated, easily irritated 

Impulsive, snap decisions and 

irresponsible behaviors 

Loses temper easily, angers quickly 

The tendency to hyperfocus on 

particularly stimulating or emotionally 

engaging tasks. 


Over the last 30 years, research into ADHD has greatly accelerated. There is no single, 

unified theory that explains the cause of ADHD and research is ongoing. Genetic factors 

are presumed important, and it has been suggested that environmental factors may 

affect how symptoms manifest. 

It is becoming increasingly accepted that individuals with ADHD have difficulty with 

"executive functioning". In higher organisms, such as humans, these functions are 

thought to reside in the frontal lobes. They enable recall of tasks that need 

accomplishing, organization to accomplish these tasks, assessment of consequences of 

actions, prioritization of thoughts and actions, keeping track of time, awareness of 

interactions with surroundings, the ability to focus despite competing stimuli, and 

adaptation to changing situations. 

Several lines of research based on structural and/or functional imaging techniques, 

stimulant drugs, psychological interventions have identified alterations in the 

dopaminergic and adrenergic pathways of individuals with ADHD. In particular, areas of 

the prefrontal cortex appear to be the most affected. Dopamine and norepinephrine are 

neurotransmitters playing an important role in brain function. The uptake transporters for 

dopamine and norepinephrine are overly active and clear these neurotransmitters from 


the synapse a lot faster than in normal individuals. This is thought to increase 

processing latency and salience, and diminished working memory. 

Diagnosis 

The diagnosis of ADHD in adults requires retrospectively establishing whether the 

symptoms were also present in childhood, even if not previously recognized. As with 

other mental disorders such as schizophrenia there is no objective "test" that diagnoses 

ADHD. Rather, it is a combination of a careful history of symptoms up to early 

childhood, including corroborating evidence from family members, previous report 

cards, etc. The screening tests also seek to rule out other conditions or differential 

diagnoses such as depression, anxiety, or substance abuse. Other diseases such as 

hyperthyroidism may exhibit symptoms similar to those of ADHD, and it is imperative to 

rule these out as well. Asperger syndrome, a condition on the autism spectrum, is 

sometimes mistaken for ADHD, due to impairments in executive functioning found in 

some people with Asperger syndrome. However, Asperger syndrome also typically 

involves difficulties in social interaction, restricted and repetitive patterns of behavior 

and interests, and problems with sensory processing, including hypersensitivity. Along 

with this, the quality of diagnosing an adult with ADHD can often be skewed being that 

the majority of adults with ADHD also have other complications, ranging from anxiety 

and depression to substance abuse. 

Assessment of adult patients seeking a possible diagnosis can be better than in children 

due to the adult's greater ability to provide their own history, input, and insight. However, 

it has been noted that many individuals, particularly those with high intelligence, develop 

coping strategies that mask ADHD impairments and therefore they do not seek 

diagnosis and treatment. 

Formal tests and assessment instruments such as IQ tests, standardized achievement 

tests, or neuropsychological tests typically are not helpful for identifying people with 

ADHD. Furthermore, no currently available physiological or medical measure is 

definitive diagnostically. However, psycho-educational and medical tests are helpful in 

ruling in or out other conditions (e.g. learning disabilities, mental retardation, allergies) 

that may be associated with ADHD-like behaviors. 

United States medical and mental health professionals follow the Diagnostic and 

Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association; 

the International Classification of Diseases (ICD) published by the World Health 

Organisation (WHO) is often used by health professionals elsewhere. Periodic updates 

incorporate changes in knowledge and treatments. For example, under DSM-IV 

(published in 1994, with corrections and minor changes in 2000), the diagnostic criteria 

for ADHD in adults broadly follow the same as in children, but the proposed revision for 

the DSM-5 differentiates the presentation of ADHD for children and adults for several 

symptoms. 


It should be noted that every normal individual exhibits ADHD-like symptoms 

occasionally (when tired or stressed, for example) but for a positive diagnosis to be 

received, the symptoms should be present from childhood and persistently interfere with 

functioning in multiple spheres of an individual's life: work, school, and interpersonal 

relationships. The symptoms that individuals exhibit as children are still present in 

adulthood, but manifest differently as most adults develop compensatory mechanisms 

to adapt to their environment. 

Treatment 

Treatment for 

adult ADHD may 

combine 

medication and 

behavioral, 

cognitive, or 

vocational 

interventions. 

Treatment often 

begins with 

medication 

selected to 

address the 

symptoms of 

ADHD, along with 

any comorbid 

conditions that may be present. Medication alone, while effective in correcting the 

physiological symptoms of ADHD, will not address the paucity of skills which many 

adults will have failed to acquire because of their ADHD (e.g., one might regain ability to 

focus with medication, but skills such as organizing, prioritizing and effectively 

communicating have taken others time to cultivate). 

Medications 

Stimulants, the first line medications in adult ADHD, are typically formulated in 

immediate and long-acting formulations. 

Methylphenidate, a stimulant, with short and long-acting formulations, is often the firstline 

therapy and appears effective. In the short term, methylphenidate is well tolerated. 

However, long term studies have not been conducted in adults and concerns about 

increases in blood pressure have not been established. Methylphenidate increases 

concentrations of dopamine and norepinephrine in the synaptic cleft, promoting 

increased neurotransmission. It acts to block the dopamine and norepinephrine 

reuptake transporters, thus slowing the removal at which these neurotransmitters are 

cleared from the synapses. 


Amphetamine and its derivatives, prototype stimulants, are likewise available in 

immediate and long-acting formulations. Amphetamines act by multiple mechanisms 

including reuptake inhibition, displacement of transmitters from vesicles, reversal of 

uptake transporters and reversible MAO inhibition. Thus amphetamines actively 

increases the release of these neurotransmitters into the synaptic cleft. [39] They may 

have a better side-effect profile than methylphenidate cardiovascularly and potentially 

better tolerated. 

The non-stimulant atomoxetine (Strattera), is also an effective treatment for adult 

ADHD. Although atomoxetine has a half life similar to stimulants it exhibits delayed 

onset of therapeutic effects similar to antidepressants. Unlike the stimulants which are 

controlled substances, atomoxetine lacks abuse potential. It is particularly effective for 

those with the predominantly inattentive concentration type of attention deficit due to 

being primarily a norepinephrine reuptake inhibitor. It is often prescribed in adults who 

cannot tolerate the side effects of amphetamines or methylphenidate. It is also 

approved for ADHD by the US Food and Drug Administration. A rare but potentially 

severe side effect includes liver damage and increased suicidal ideation. 

Bupropion and desipramine are two antidepressants that have demonstrated some 

evidence of effectiveness in the management of ADHD particularly when there is 

comorbid major depression, although antidepressants have lower treatment effect sizes. 

Psychosocial Therapy 

Treatment of adult ADHD may also include forms of stress management or relaxation 

training. 

Research has shown that, alongside medication, psychological interventions in adults 

can be effective in reducing symptomatic deficiencies. Emerging evidence suggests a 

possible role for cognitive behavioral therapy (CBT) alongside medication in the 

treatment of adult ADHD. 

For most adults, the psychosocial therapy is not effective. For this reason, medications 

are the first line of therapies. The medications that are prescribed for adults come in 

both stimulant and non-stimulant form. Although the drug therapies are effective for 

adults, the benefits should be discussed with the patient’s physician to ensure the 

benefits of the medications outweigh the risk. If medication is unwanted or not an 

option, increasing exercise and changing one’s diet may help alleviate some of the 

symptoms such as hyperactivity 

Epidemiology 

In North America and Europe, it is estimated that three to five percent of adults have 

ADHD, but only about ten percent of those have received a formal diagnosis. It has 

been estimated that 5% of the global population has ADHD (including cases not yet 

diagnosed). In the context of the World Health Organization World Mental Health 


Survey Initiative, researchers screened more than 11,000 people aged 18 to 44 years in 

ten countries in the Americas, Europe and the Middle East. On this basis they estimated 

the adult ADHD proportion of the population to average 3.5 percent with a range of 1.2 

to 7.3 percent, with a significantly lower prevalence in low-income countries (1.9%) 

compared to high-income countries (4.2%). The researchers concluded that adult 

ADHD often co-occurs with other disorders, and that it is associated with considerable 

role disability. Although they found that few adults are treated for ADHD itself, in many 

instances treatment is given for the co-occurring disorders. 

History 

Early work on disorders of attention was conducted by Alexander Crichton in 1798 

writing about "mental restlessness". The underlying condition came to be recognized 

from the early 1900s by Sir George Still. Efficacy of medications on symptoms was 

discovered during the 1930s and research continued throughout the twentieth century. 

ADHD in adults began to be studied from the early 1970s and research has increased 

as worldwide interest in the condition has grown. 

In the 1970s researchers began to realize that the condition now known as ADHD did 

not always disappear in adolescence, as was once thought. The expansion of the 

definition for ADHD beyond only being a condition experienced by children was mainly 

accomplished by refocusing the diagnosis on inattention instead of hyperactivity. At 

about the same time, some of the symptoms were also noted in many parents of the 

children under treatment. The condition was formally recognized as affecting adults in 


1978, often informally called adult ADD, since symptoms associated with hyperactivity 

are generally less pronounced. 


ADHD in adults, as with children, is recognized as an impairment that may constitute a 

disability under U.S. federal disability nondiscrimination laws, including such laws as the 

Rehabilitation Act of 1973 and the Americans With Disabilities Act (ADA, 2008 revision), 

if the disorder substantially limits one or more of an individual's major life activities. For 

adults whose ADHD does constitute a disability, workplaces have a duty to provide 

reasonable accommodations, and educational institutions have a duty to provide 

appropriate academic adjustments or modifications, to help the individual work more 

efficiently and productively. 

In a 2004 study it was estimated that the yearly income discrepancy for adults with 

ADHD was $10,791 less per year than high school graduate counterparts and $4,334 

lower for college graduate counterparts. The study estimates a total loss in productivity 

in the United States of over $77 billion USD. By contrast, loss estimations are $58 billion 

for drug abuse, $85 billion for alcohol abuse and $43 billion for depression. 

Controversy 

ADHD controversies include concerns about its existence as a disorder, its causes, the 

methods by which ADHD is diagnosed and treated including the use of stimulant 

medications in children, possible overdiagnosis, misdiagnosis as ADHD leading to 

undertreatment of the real underlying disease, alleged hegemonic practices of the 

American Psychiatric Association and negative stereotypes of children diagnosed with 

ADHD. These controversies have surrounded the subject since at least the 1970s. 


VII. Cognitive Solutions 

for ADHD 

Top [Five] Natural Remedies for ADHD 

[plus] Key Lifestyle Changes 

Attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD) are 

neurological and behavior-related conditions that cause difficulty in concentrating, 

impulsiveness and excessive energy. 

Individuals with ADHD symptoms not only have a challenge in concentrating, but have 

a challenge sitting still. Those with ADHD are typically more disruptive than individuals 

with ADD. 

ADHD often has an onset age of 7, but this disorder can continue through teen years 

and well into adulthood. It’s estimated that ADHD affects 9 percent of American 

children between the ages of 13 and 18 and over 4 percent of adults. (1) 

According to the NIH’s National Institute of Mental Health, “the number of children being 

diagnosed with ADHD is increasing, but it is unclear why.” Most physicians and 

research indicate the increase in ADHD is directly linked to the food we eat. 


Root Causes of ADD/ADHD 

According to several international studies, ADHD has a genetic link. In addition, there 

are environmental factors, and dietary concerns that many researchers believe increase 

the risk and in many cases, worsens the symptoms. 

Refined sugar, artificial sweeteners, and chemical food additives, nutritional 

deficiencies, preservatives and food allergies are all causes of ADD/ADHD. 

In children, a partial cause is related to a lack of interest or forcing children to learn in a 

manner to which they are not geared to learn. Some children learn better by seeing or 

doing (kinesthetic), rather than by hearing. 

Symptoms of ADD/ADHD 

The severity of symptoms can vary greatly from individual to individual, depending on 

environment, diet and other factors. 

Children may exhibit one or more of the following symptoms of ADHD/ADD: 

 

 

 

 

 

 

 

 

 

 

Difficulty in concentrating and diminished focus 

Easily distracted 

Easily bored 

Difficulty organizing or completing tasks 

Prone to losing things 

Doesn’t listen 

Difficulty in following instructions 

Fidgety behavior, squirming 

Extreme difficulty being still and/or quiet 

Impatience 

Adults may exhibit one or more of the following symptoms of ADD/ADHD: 

 

 

 

 

 

 

 

 

Difficulty focusing and concentrating on a task, project, or conversation 

Overwhelming emotional and physical restlessness 

Frequent mood swings 

Prone to anger and a hot temper 

Disorganized 

Low tolerance of people, situations, and surroundings 

Unstable relationships 

Increased risk for addiction 

The most common treatment of ADD/ADHD today is using medications such as Ritalin 

and Adderall, both of which have been linked to suicidal thoughts and personality 

changes. Ritalin is a central nervous system stimulant, that can cause nervousness, 


agitation, anxiety, insomnia, vomiting, an increased heart rate, increased blood pressure 

and even psychosis. 

Adderall is an amphetamine that is highly addictive with prolonged use. Side effects 

include tremors, hallucinations, muscle twitches, high blood pressure, fast or irregular 

heartbeats, and extreme mood swings. 

With these side effects, it is easy to see why so many people are seeking effective 

natural remedies for ADHD. The good news is there are natural remedies for 

ADD/ADHD that are both effective and without the scary side effects of prescription 

medications, and this includes following an ADHD diet. 

Top 5 Natural Remedies for ADHD 

While I believe that incorporating new foods into the diet alongside eliminating 

dangerous triggers foods are important, these five supplements represent key natural 

remedies for ADHD. 


1. Fish Oil (1,000 milligrams daily) 

Omega 3 supplements have been shown to benefit ADHD patients, as the 

EPA/DHA in fish oil are critical for brain function and are anti-inflammatory. 

Supplementation has been shown to reduce symptoms and improve learning. 

2. B-Complex (50 milligrams daily) 

Children with ADHD may need more B-vitamins to help with the formation of 

serotonin, especially vitamin B6. 

3. Multi-Mineral Supplement (including zinc, magnesium and calcium) 

I recommend that anyone with ADHD take 500 milligrams calcium, 

250 milligrams of magnesium and 5 milligrams zinc twice daily. All play a role in 

relaxing the nervous system and a deficiency may exacerbate symptoms. 

4. Probiotic (25–50 billion units daily) 

ADHD may be connected to digestive issues, therefore taking a good 

quality probiotic daily will help maintain intestinal health. 

5. GABA (250 milligrams twice daily) 

A calming amino acid, ask your doctor before taking GABA, as it can interact with 

other medications. 

Bonus ADD/ADHD Remedy 

Rhodiola Rosea has been proven effective at improving the focus of both adults and 

children. It works by increasing the sensitivity in the neurological and nervous system 

that produce serotonin and dopamine, which are both essential for effective ADHD 

symptom control. 

Essential Oils for ADHD 

According to a study conducted by Dr. Terry Friedmann, essential oils of vetiver and 

cedarwood are very effective in improving focus and calming down children with ADHD. 

For memory and concentration, rosemary and peppermint oils have been shown to 

improve alertness while enhancing memory. For a calming effect, Ylang Ylang and 

lavender are effective, while frankincense brings emotional wellness, clarity and 

heightened cognitive function. 

Top Foods for ADHD 


Additive-free, Unprocessed Foods — Due to the toxic nature of food additives, it is 

best to eat unprocessed, whole foods. Additives including artificial sweeteners, 

preservatives and colorings that exist within processed foods may be especially 

problematic for those with ADD/ADHD. 

Foods High in B-Vitamins — B vitamins help maintain a healthy nervous system. 

Make sure to include organic wild animal products and lots of green leafy vegetables in 

your diet. According to the University of Maryland Medical Center, Vitamin B-6 is 

needed for the body to make and use essential brain chemicals including serotonin, 

dopamine and norepinephrine. In fact, one preliminary study has found that B-6 is 

slightly more effective than Ritalin in improving behavior! Incorporate wild tuna, 

bananas, wild salmon, grass-fed beef and other foods rich in vitamin B-6 for the 

improvement of ADHD. 

Poultry — Tryptophan is an essential amino acid that helps the body to synthesize 

proteins and aid in the production of serotonin. Serotonin plays significant roles in sleep, 

inflammation, emotional moods and much more. In many individuals suffering from 

ADD/ADHD, imbalances in serotonin levels has been indicated according to the 

University of Michigan Health System. Serotonin is related to impulse control and 

aggression, two of the symptoms of ADD/ADHD. 

Eat Breakfast — For some people, and especially those with ADHD, breakfast helps 

the body properly regulate blood sugar and stabilize hormone fluctuations. Eat a 

breakfast that contains at least 20 grams of protein. Try my Thin Mint Protein 


Smoothie that has 20 grams of protein from whey. It is a tasty and filling way to “break 

the fast.” 

Wild-Caught Salmon — Not only is it rich with vitamin B-6, it’s also packed with omega 

3 fatty acids. According to the University of Maryland Medical Center, a clinical trial 

indicated that lower levels of omega-3 fatty acids had more learning and behavioral 

problems (like those associated with ADHD) than boys with normal levels of omega 3s. 

Individuals, including children, should consume wild salmon at least twice per week. 

ADHD Foods to Avoid 

Sugar — This is the primary trigger for most children, and some adults with ADHD. 

Avoid any forms of concentrated sugar including candy, desserts, soda or fruit juices. 

Gluten — Some researchers and parents report worsening behavior when their child 

eats gluten, which may indicate sensitivity to the protein found in wheat. Avoid all foods 

made with wheat such as bread, pasta and wheat cereal. Look for gluten-free or even 

grain-free alternatives. 

Conventional Dairy — Most cow milk dairy contains A1 casein that can trigger a 

similar reaction as gluten and therefore should be eliminated. If problematic symptoms 

arise after eating dairy, discontinue use. Goat’s milk, however, does not contain the 

protein and is a better option for many individuals with ADD/ADHD. 

Food Coloring and Dyes — Children with ADHD can be sensitive to a variety of food 

dyes and colorings, therefore all processed foods should be avoided. Coloring and dyes 

appear in nearly every commercially processed food. Food dyes can be found in sports 

drinks, candy, cake mixes, chewable vitamins and even toothpaste! 

Caffeine — While some studies have shown that caffeine may help with some ADHD 

symptoms, it is wise to minimize or avoid caffeine, as these studies have not been 

validated. In addition, the side effects of caffeine, including loss of loss, anxiety, and 

nervousness, can contribute to the symptoms of ADD/ADHD. 

MSG and HVP — These two additives are believed to decrease dopamine levels in 

both children and adults. Dopamine is associated with the brain’s pleasure and reward 

systems. For individuals suffering with ADD/ADHD, balanced levels of dopamine are 

essential. 

Nitrites — Commonly found in lunchmeat, canned foods and many processed foods, 

nitrites are linked to an increase of childhood type 1 diabetes, certain types of cancer 

and IBS. In addition, it can cause rapid heart rate, difficulty breathing and restlessness 

that worsen ADHD symptoms. 

Artificial Sweeteners — Artificial sweeteners are just bad for your health, but for those 

living with ADHD, the side effects can be devastating. Artificial sweeteners create 


iochemical changes in the body, some of which can harm cognitive function and 

emotional balance. 

Soy — Soy is a common food allergen and can disrupt hormones that cause ADHD. 

Personal Food Sensitivities/Allergens — Eliminate the top seven allergens, including 

soy, wheat and conventional dairy mentioned above, as well as peanuts, tree nuts, eggs 

and shellfish. In addition, eliminate any foods or beverages that are personal allergens. 

This might include papaya, avocados, bananas and kiwis (for those with latex allergies) 

and/or coriander, caraway or fennel (all from the same family) and/or chocolate. 

Lifestyle Changes for Children with ADHD 

The challenge for the parents of a child with ADD/ADHD is not only to find an effective 

natural remedies for ADHD and ADD, but also to create an environment that supports 

their creativity and spurs learning. Here are some lifestyle changes that may help. 

Show Affection (and Ask for It) — Children living with ADHD need reassurance they 

aren’t a bad child. If you only respond to the negative behaviors, it can trigger more 

negative behaviors. Find ways to compliment your child while holding them accountable 

for their actions. Remember, they are more than just the behaviors of ADHD. Give them 

the chance to “WOW” you. 

Provide Opportunities for Success — A child knows when you are truly excited and 

happy for them. Provide them with opportunities where they can succeed. Engage them 

in creative activities such as painting and sketching. Many top art competitions in the 

world have “quick sketch” competitions that force artists to provide their best work in 30 


to 45 minutes. Celebrate your child’s focus and creative spirit in these types of 

challenges. 

Regular Physical Exercise & Outdoor Playtime — For children with ADHD, burning 

some of the excess energy of the day can help to balance hormone levels and provide 

your child with the building blocks for healthy bones and muscles. 

Create a Child-Friendly Organizational System — Find the methods of organization 

that work best for your child. This may include a notebook with a checklist of daily “to 

dos,” a chart on the wall, or reminders in their smartphone or tablet. Teach them how to 

prioritize tasks including schoolwork, home chores, exercise and fun activities. 

Teach Your Child to Cook — Since ADD/ADHD is linked to the foods consumed and 

has a genetic link, it is essential that your child learn what foods cause ADD/ADHD and 

which ones can cure it. Spend time with your child exploring interesting ways to cook 

wild fish, grass-fed beef, free-range poultry and fresh fruits and vegetables. Engage 

them in the menu planning and cooking process, and the dietary changes 

recommended above will be significantly easier to implement. 

Lifestyle Changes for Adults with ADHD 

Create an Organizational System That Works for You — There is no one 

organization solution that works for everyone. Find the system that works best for you. 

A simple pen and paper checklist may be what some need, while others will need a 

more technical application that could include setting automatic reminders, prioritizing 

tasks and more. 

Use Technology to Your Advantage — There are a variety of apps available for 

smartphones and tablets for productivity. These tools can help you to plan ahead and 

prioritize tasks. In addition, consider noise-cancelling headphones to help stave off the 

distractions in your home or office. 

Exercise — Regular exercise not only helps build muscles and bone, but helps to 

relieve stress. In addition to your regular exercise routine, try something that engages 

your “fun” gene too. Dance, martial arts, playing tennis or volleyball, are all great ways 

to burn calories, balance hormones and reduce stress. 

Get More Sleep — Insomnia is a common side effect for adults with ADD/ADHD. With 

a proper diet, exercise and relaxation techniques, you can get the rest you need. 

Practice good sleep habits, including routine bed times and turning off technology 45 

minutes prior to sleep. 

The dietary changes, supplements and recommended lifestyle changes above will help 

you conquer ADD/ADHD. The solutions above are equally effective for children and 

adults alike. 


For many people, removing the ADD/ADHD trigger foods and replacing them with 

healthy foods that naturally fight ADD/ADHD will dramatically help treat this common 

neurological and behavioral disorder. Remember, detoxing from years of chemicals and 

unhealthy foods takes some time. Stick with the program above and kick ADD/ADHD for 

good! 

________ 

Solutions for Common ADHD Symptoms 

by Margarita Tartakovsky, M.S. 

Getting easily distracted and making hasty decisions makes accomplishing even the 

simplest tasks a challenge. 

For people with attention deficit hyperactivity disorder (ADHD) — whose symptoms 

include distractibility and impulsivity — this is a daily struggle. Fortunately, however, 

there are many ways that you can manage ADHD successfully and minimize its 

symptoms. 

Below is a primer on common ADHD-related problems and solutions along with general 

self-help strategies. 


Distractibility 

“The fundamental weakness for people with ADHD is that they struggle with pausing to 

consider their options,” according to Ari Tuckman, PsyD. He is a psychologist in private 

practice who specializes in ADHD and the author of More Attention, Less Deficit: 

Success Strategies for Adults with ADHD. 

He gave the following examples: If the phone rings while you’re working on a project, 

you probably answer it instead of considering if it’s better to wait till you’re done. When 

you come home, you might head to the kitchen to speak with your spouse and leave 

your keys on the table. The next day you’re late to work because you spend an hour 

hunting for them. 

You’ve probably experienced several variations of these examples. But the result is the 

same: You end up getting distracted and direct your focus to something else, letting the 

task at hand suffer. 

To solve distraction difficulties, establish simple strategies that make it easy “to do the 

right thing at the right moment without having to think about it,” Tuckman said. If you 

lose your keys often, have a bowl by the front door to throw them in immediately. The 

close proximity prevents you from getting distracted with something else in the house. 

If you have an upcoming appointment or another responsibility like making an important 

phone call, use your cell phone alarm to schedule alerts. “That way the phone 

remembers it, even if [you] get caught up in something else and lose track of time,” 

Tuckman said. 

“Squeezing a stress ball or having a fidget toy can help maintain focus in meetings or in 

the classroom,” according to Roberto Olivardia, Ph.D, a psychologist who treats 

attention deficit disorder and clinical instructor in the department of psychiatry at 

Harvard Medical School. 

Impulsivity 

Individuals with ADHD are prone to letting their initial feelings drive their behavior. “They 

are often impulsive, going with how they feel versus how they think about something,” 

Olivardia said. 

Reducing impulsivity is a process that takes time, but you can manage it by “practicing 

mindfulness techniques, practicing being in the moment, becoming aware of one’s self 

talk [and] getting used to writing things down to express one’s thoughts fully,” Olivardia 

said. Research has shown that mindfulness can be very helpful for people with attention 

deficit disorder. 

Stress 


Like any disorder, stress tends to amplify ADHD symptoms. But stress is inevitable. As 

Tuckman said, “The only way to have no stress is to live a tiny little life where nothing 

happens.” So the key is to learn to manage stress effectively. 

Leading a healthy lifestyle is essential. Exercise regularly, get enough sleep, eat well 

and take the time to relax, he said. Tuckman acknowledged that this is easier said than 

done for anyone. Since ADHD symptoms make it more difficult to create effective plans 

and follow through on them, this can seem overwhelming. 

Work on simplifying your activities by taking stock of “your schedule from the last weeks 

or months and write a list of all the activities that you are involved in,” Tuckman said. 

Don’t have a schedule? Then think about how you spend your time. This makes paring 

down your day easier because you’re able to “ evaluate individual activities if you can 

see them in the context of all your activities.” Then, ask yourself if you’re participating “in 

some activities that just don’t add enough to your life — at least relative to what they 

take away.” 

Stress-relievers like yoga and meditation can help some individuals with ADHD, 

Olivardia said. “Vigorous exercise is a guaranteed stress reliever. If your body is tired, it 

leaves less room for stressful energy to prevail,” he said. The same goes for humor and 

laughter. Also important, according to Olivardia, is to surround yourself with people who 

calm and ground you (and make you laugh). 


Low Self-Esteem 

ADHD symptoms can be frustrating, especially when the smallest tasks can require so 

much processing and planning. Consequently, many people with attention deficit 

disorder experience low self-esteem. 

First, acknowledge that ADHD has nothing to do with intelligence — a common 

misconception. “I have patients who are extremely bright individuals and are able to 

accomplish great things, but have trouble getting to a place on time,” Olivardia said. 

Tuckman uses the phrase “change what you can, accept the rest” as his guiding 

treatment philosophy. This means “learning about how [your] brain processes 

information and adopting strategies that take these information processing tendencies 

into account.” Other options, according to Tuckman, might include medication, essential 

for many people with ADHD; coaching, which helps with “mastering daily demands”; 

and therapy, which helps to “understand [yourself] and [your] relationships better with 

less anxiety and depression.” Be sure to see practitioners who have an extensive 

knowledge of ADHD. 

Also, accept that you’ll make mistakes, use them as learning opportunities and then 

move on, Tuckman said. “Setbacks and diversions will happen, but as long as you get 

back to your good habits, you will generally get to where you want to go.” He added, 

“work the process and the product will follow.” 

Ultimately, remember that “Nobody is perfect, so self-esteem shouldn’t be based on an 

expectation of never doing anything wrong,” Tuckman said. “Playing it safe may prevent 

a bruised ego, but it’s boring and unsatisfying.” 

General Self-Help Strategies 

In general, “the most effective strategies are ones that utilize the senses as an 

environmental reminder,” Olivardia said. If time management is a common concern, use 

an alarm or sticky note — or both — as reminders to keep you on track, he suggested. 

If making decisions is difficult, consider the pros and cons of the situation. Write them 

down or say them aloud. 

Remember that you don’t have to “re-invent the wheel,” Tuckman said. Seek expert 

resources that offer insight on managing ADHD symptoms. Experiment with what works 

for you. But don’t let self-consciousness foil your success. If being organized means 

your cell phone sounds like a symphony of alarm alerts, then that’s the better 

alternative. “As I sometimes tell clients, it’s better to be known as the guy who puts 

everything into his phone than to be known as the guy who misses meetings.” 

If a strategy isn’t working, get creative. “Having ADHD is living outside the box, so 

strategies for getting things done have to follow suit,” Olivardia said. “There is no shame 


in using a strategy that seems weird to others, as long as it isn’t unhealthy to yourself or 

others.” 

For instance, inventing a song might help you remember information. So might drawing 

a stick figure. One of Olivardia’s clients used to draw a stick figure to remind him to 

bring the essentials on his travels. He’d go from head to toe, drawing arrows from each 

part of the body to the clothes he needed. Even though his client felt silly, it was a 

successful strategy that worked for him. 

Just because you aren’t organized, meticulous or focused naturally, “it does not mean 

[you] can’t be that person behaviorally,” Olivardia said. 



VIII. Famous People with ADHD 

Who are some of the most famous people with ADHD? 

June Silny, studied Attention Deficit Hyperactivity Disorder 

at ADD Coaching Academy 

Answered Mar 1 2016 

The list of famous people with ADHD is long and can be traced back to Socrates. Even 

Albert Einstein had ADHD! 

The famous artists with ADHD are: Dali, Picasso, Van Gogh, and Rodin. 

The athletes: Terry Bradshaw, Michael Phelps, Pete Rose, Nolan Ryan, Michael 

Jordan, Jason Kidd, Babe Ruth, Carl Lewis, Greg Louganis, Jackie Stewart, and Magic 

Johnson. 

The authors: Charlotte and Emily Bronte, Samuel Clemens, Emily Dickenson, Edgar 

Allan Poe, Ralph Waldo Emerson, Robert Frost, George Bernard Shaw, Henry David 

Thoreau, Leo Tolstoy, Tennessee Williams, Virginia Woolf, Hans Christian Anderson, 

and William Butler Yeats. 


The entrepreneurs and leaders in business: Andrew Carnegie (Carnegie Steel, 

Carnegie hall, Carnegie Mellon Univerrsity and more), Malcolm Forbes (Forbes 

Magazine), Henry Ford (Ford Motor), Bill Gates (Microsoft), David Neeleman (JetBlue), 

Paul Orfalea (Kinko's), Ted Turner (Cable News Network), Sir Richard Branson (Virgin 

Group) and Walt Disney. 

The entertainers with ADHD: Ann Bancroft, Jim Carrey, Steve McQueen, Jack 

Nicholson, Ty Pennington, Elvis Presley, Evil and Robbie Knievel, Sylvester Stallone, 

Robin Williams, Howie Mandel, Justin Timberlake, Channing Tatum, Tom Cruise, Will 

Smith, Keanu Reeves, Cher, Dustin Hoffman, Henry Winkler, James Stewart, Kirk 

Douglas, Whoopi Goldberg, Adam Levine, Will-I-Am, Ozzy Osbourne, and Stevie 

Wonder. 

The inventors are: 

Wright Brothers, 

Alexander Graham 

Bell, Thomas 

Edison, Benjamin 

Franklin, Sir Isaac 

newton, and Louis 

Pasteur. 

Even political 

figures such as: 

Woodrow Wilson, 

James Carville and 

John F. Kennedy 

were known to have 

ADHD. 

Don't forget these 

are the ones that we know about. There are many more that made tremendous 

contributions to society that are unknown. 

If you are wondering how is it known that these historical figures had ADHD when it 

wasn't recognized until 1932; it is is stated in The History of Attention Deficit 

Hyperactivity Disorder (National Center for Biotechnology Information) that the 

behaviors they displayed are consistent with today's symptoms of ADHD. 

ADHD does not have to stop you from making a valuable contribution to society. I hope 

this inspires you to add your name to this impressive list. 

 

 

 

Glenn Beck 

Daniel Bedingfield 

Terry Bradshaw 



Jim Carrey 


Kurt Cobain 

Jennifer Connelly 

Zooey Deschanel 

Cameron Diaz 

Jason Earles 

Cammi Granato 

Forrest Griffin 

Melissa Joan Hart 

Salma Hayek 

Paris Hilton 

Bruce Jenner 

Magic Johnson 

Christopher Knight 


Heather Kuzmich 

Courtney Love 

Howie Mandel 

David Neeleman 

Roxy Olin 

Jamie Oliver 

Mary-Kate Olsen 

Paul Orfalea 

Ty Pennington 

Michael Phelps] 

Michelle Rodriguez 

Peter Rose 



Liv Tyler 

Emma Watson 



IX. References 

1. https://psychcentral.com/lib/what-is-attention-deficit-disorder/ 

2. http://www.douglas.qc.ca/section/the-douglas-27 

3. https://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder 

4. https://www.healthline.com/health/adhd/benefits-of-adhd#1 

5. http://www.addcoach4u.com/positivesofadd.html#participantideas 

6. https://adhdatwork.add.org/potential-benefits-of-having-an-adhd-employee/ 

7. https://en.wikipedia.org/wiki/Autism_spectrum 

8. https://en.wikipedia.org/wiki/Asperger_syndrome 

9. https://en.wikipedia.org/wiki/Adult_attention_deficit_hyperactivity_disorder 

10. https://draxe.com/natural-remedies-adhd/ 

11. https://psychcentral.com/lib/solutions-for-common-adhd-symptoms/ 

12. https://www.quora.com/Who-are-some-of-the-most-famous-people-with-ADHD 

13. http://www.chadd.org/Portals/0/Content/CHADD/NRC/Factsheets/aboutADHD.pdf 

14. https://add.org/wp-content/uploads/2015/03/adhd-questionnaire-ASRS111.pdf 

15. http://olneynorthbethesdapsychology.com/wp-content/uploads/2018/02/10261_Manage- 

Your-Life_8-dream-jobs-for-adults-with-adhd.pdf 


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Attachment A 

About ADHD 


About ADHD 

Everybody can have difficulty sitting still, paying 

attention or controlling impulsive behavior 

once in a while. For some people, however, the 

problems are so pervasive and persistent that 

they interfere with every aspect of their life: 

home, academic, social and work. 

Attention-deficit/hyperactivity disorder 

(ADHD) is a neurodevelopmental disorder 

affecting 11 percent of school-age children 

(Visser, et al., 2014.) Symptoms continue into 

adulthood in more than three-quarters of 

cases (Brown, 2013.) ADHD is characterized by 

developmentally inappropriate levels of 

inattention, impulsivity and hyperactivity. 

Individuals with ADHD can be very successful 

in life. However, without identification and 

proper treatment, ADHD may have serious 

consequences, including school failure, family 

stress and disruption, depression, problems with 

relationships, substance abuse, delinquency, 

accidental injuries and job failure. Early 

identification and treatment are extremely 

important. 

Medical science first documented children 

exhibiting inattentiveness, impulsivity and 

hyperactivity in 1902. Since that time, the 

disorder has been given numerous names, 

including minimal brain dysfunction, 

hyperkinetic reaction of childhood, and 

attention-deficit disorder with or without 

hyperactivity. With the Diagnostic and Statistical 

Manual, Fifth Edition (DSM-5) classification 

system, the disorder has been renamed 

attention-deficit/hyperactivity disorder or 

ADHD. The current name reflects the importance 

of the inattention aspect of the disorder as well 

as the other characteristics of the disorder such 

as hyperactivity and impulsivity. 

Symptoms 

More than 75 percent of children 

with ADHD continue to experience 

significant symptoms in adulthood. 

In early adulthood, ADHD may be 

associated with depression, mood 

or conduct disorders and substance 

abuse. 

Adults with ADHD often cope with 

difficulties at work and in their 

personal and family lives related to 

ADHD symptoms. 

Typically, ADHD symptoms arise in early 

childhood. According to the DSM-5, several 

symptoms are required to be present before 

the age of 12. Many parents report excessive 

motor activity during the toddler years, but 

ADHD symptoms can be hard to distinguish 

from the impulsivity, inattentiveness and active 

behavior that is typical for kids under the age of 

National 

Resource 

Center 

on ADHD 

A Program of CHADD 

help4adhd.org 

1

four. In making the diagnosis, children should 

have six or more symptoms of the disorder 

present; adolescents 17 and older and adults 

should have at least five of the symptoms 

present. The DSM-5 lists three presentations of 

ADHD— Predominantly Inattentive, Hyperactive- 

Impulsive and Combined. The symptoms for each 

are adapted and summarized below. 

ADHD predominantly inattentive presentation 

• Fails to give close attention to details or 

makes careless mistakes 

• Has difficulty sustaining attention 

• Does not appear to listen 

• Struggles to follow through with instructions 

• Has difficulty with organization 

• Avoids or dislikes tasks requiring sustained 

mental effort 

• Loses things 

• Is easily distracted 

• Is forgetful in daily activities 

ADHD predominantly hyperactive-impulsive 

presentation 

• Fidgets with hands or feet or squirms in 

chair 

• Has difficulty remaining seated 

• Runs about or climbs excessively in children; 

extreme restlessness in adults 

• Difficulty engaging in activities quietly 

• Acts as if driven by a motor; adults will often 

feel inside as if they are driven by a motor 

• Talks excessively 

• Blurts out answers before questions have 

been completed 

• Difficulty waiting or taking turns 

• Interrupts or intrudes upon others 

ADHD combined presentation 

• The individual meets the criteria for both 

inattention and hyperactive-impulsive ADHD 

presentations. 

These symptoms can change over time, so children 

may fit different presentations as they get 

older. 

Confusing labels for ADHD 

In 1994, the name of the disorder was changed 

in a way that is confusing for many people. 

Since that time all forms of attention deficit 

disorder are officially called “Attention-Deficit/ 

Hyperactivity Disorder,” regardless of whether 

the individual has symptoms of hyperactivity or 

not. Even though these are the official labels, a 

lot of professionals and lay people still use both 

terms: ADD and ADHD. Some use those terms to 

designate the old subtypes; others use ADD just 

as a shorter way to refer to any presentation. 

Severity of symptoms 

As ADHD symptoms affect each person to 

varying degrees, the DSM-5 now requires 

professionals diagnosing ADHD to include the 

severity of the disorder. How severe the disorder 

is can change with the presentation during 

a person’s lifetime. Clinicians can designate 

the severity of ADHD as “mild,” “moderate” or 

“ severe” under the criteria in the DSM-5. 

Mild: Few symptoms beyond the required 

number for diagnosis are present, and 

symptoms result in minor impairment in social, 

school or work settings. 

Moderate: Symptoms or functional impairment 

between “mild” and “severe” are present. 

Severe: Many symptoms are present beyond 

the number needed to make a diagnosis; 

several symptoms are particularly severe; or 

symptoms result in marked impairment in 

social, school or work settings. As individuals 

age, their symptoms may lessen, change or 

take different forms. Adults who retain some 

of the symptoms of childhood ADHD, but not 

all, can be diagnosed as having ADHD in partial 

remission. 

ADHD throughout the lifespan 

Children with ADHD often experience delays 

in independent functioning and may behave 

younger than their peers. Many children affected 

help4adhd.org 

2

y ADHD can also have mild delays in language, 

motor skills or social development that are not 

part of ADHD but often co-occur. They tend 

to have low frustration tolerance, difficulty 

controlling their emotions and often experience 

mood swings. 

Children with ADHD are at risk for potentially 

serious problems in adolescence and adulthood: 

academic failure or delays, driving problems, 

difficulties with peers and social situations, 

risky sexual behavior, and substance abuse. 

There may be more severe negative behaviors 

with co- existing conditions such as oppositional 

defiant disorder or conduct disorder. Adolescent 

girls with ADHD are also more prone to eating 

disorders than boys. As noted above, ADHD 

persists from childhood to adolescence in the 

vast majority of cases (50–80 percent), although 

the hyperactivity may lessen over time. 

and working memory. Recently, deficits in 

executive function have emerged as key factors 

affecting academic and career success. Executive 

function is the brain’s ability to prioritize and 

manage thoughts and actions. This ability 

permits individuals to consider the long-term 

consequences of their actions and guide 

their behavior across time more effectively. 

Individuals who have issues with executive 

functioning may have difficulties completing 

tasks or may forget important things. 

Co-occurring Disorders 

More than two-thirds of children with ADHD 

have at least one other co-existing condition. 

Any disorder can co-exist with ADHD, but 

certain disorders seem to occur more often. 

These disorders include oppositional defiant 

and conduct disorders, anxiety, depression, 

tic disorders or Tourette syndrome, substance 

abuse, sleep disorders and learning disabilities. 

When co-existing conditions are present, 

academic and behavioral problems, as well as 

emotional issues, may be more complex. 

These co-occurring disorders can continue 

throughout a person’s life. A thorough diagnosis 

and treatment plan that takes into account all of 

the symptoms present is essential. 

Teens with ADHD present a special challenge. 

During these years, academic and life demands 

increase. At the same time, these kids face typical 

adolescent issues such as emerging sexuality, 

establishing independence, dealing with peer 

pressure and the challenges of driving. 

More than 75 percent of children with ADHD 

continue to experience significant symptoms 

in adulthood. In early adulthood, ADHD may be 

associated with depression, mood or conduct 

disorders and substance abuse. Adults with 

ADHD often cope with difficulties at work and in 

their personal and family lives related to ADHD 

symptoms. Many have inconsistent performance 

at work or in their careers; have difficulties 

with day-to-day responsibilities; experience 

relationship problems; and may have chronic 

feelings of frustration, guilt or blame. 

Individuals with ADHD may also have difficulties 

with maintaining attention, executive function 

Causes 

Despite multiple studies, researchers have 

yet to determine the exact causes of ADHD. 

However, scientists have discovered a strong 

genetic link since ADHD can run in families. More 

than 20 genetic studies have shown evidence 

that ADHD is strongly inherited. Yet ADHD is a 

complex disorder, which is the result of multiple 

interacting genes. (Cortese, 2012.) 

Other factors in the environment may increase 

the likelihood of having ADHD: 

• exposure to lead or pesticides in early 

childhood 

• premature birth or low birth weight 

• brain injury 

Scientists continue to study the exact 

relationship of ADHD to environmental factors, 

but point out that there is no single cause that 

help4adhd.org 

3

explains all cases of ADHD and that many factors 

may play a part. 

Previously, scientists believed that maternal 

stress and smoking during pregnancy could 

increase the risk for ADHD, but emerging 

evidence is starting to question this belief 

(Thapar, 2013.) However, further research is 

needed to determine if there is a link or not. 

The following factors are NOT known causes, 

but can make ADHD symptoms worse for some 

children: 

• watching too much television 

• eating sugar 

• family stress (poverty, family conflict) 

• traumatic experiences 

ADHD symptoms, themselves, may contribute to 

family conflict. Even though family stress does 

not cause ADHD, it can change the way the ADHD 

presents itself and result in additional problems 

such as antisocial behavior (Langley, Fowler et 

al., 2010.) 

Problems in parenting or parenting styles 

may make ADHD better or worse, but these 

do not cause the disorder. ADHD is clearly 

a neurodevelopmental disorder. Currently 

research is underway to better define the areas 

and pathways that are involved. 

Diagnosis 

There is no single test to diagnose ADHD. 

Therefore, a comprehensive evaluation is 

necessary to establish a diagnosis, rule 

out other causes, and determine the presence 

or absence of co-existing conditions. Such 

an evaluation requires time and effort and 

should include a careful history and a clinical 

assessment of the individual’s academic, social, 

and emotional functioning and developmental 

level. 

There are several types of professionals who can 

diagnose ADHD, including clinical psychologists, 

clinical social workers, nurse practitioners, 

neurologists, psychiatrists and pediatricians. 

Regardless of who does the evaluation, the use 

of the DSM-5 diagnostic criteria for ADHD is 

necessary. 

Determining if a child has ADHD is a complex 

process. Many biological and psychological 

problems can contribute to symptoms similar 

to those exhibited by children with ADHD. 

For example, anxiety, depression and certain 

types of learning disabilities may cause similar 

symptoms. In some cases, these other conditions 

may actually be the primary diagnosis; in others, 

these conditions may co-exist with ADHD. A 

thorough history should be taken from the 

parents and teachers, and when appropriate, 

from the child. Checklists for rating ADHD 

symptoms and ruling out other disabilities are 

often used by clinicians; these instruments 

factor in age-appropriate behaviors and show 

when symptoms are extreme for the child’s 

developmental level. 

For adults, diagnosis also involves gathering 

information from multiple sources, which can 

include ADHD symptom checklists, standardized 

behavior rating scales, a detailed history of 

past and current functioning, and information 

obtained from family members or significant 

others who know the person well. ADHD cannot 

be diagnosed accurately just from brief office 

observations or just by talking to the person. The 

person may not always exhibit the symptoms of 

ADHD in the office, and the diagnostician needs 

to take a thorough history of the individual’s life. 

A diagnosis of ADHD must include consideration 

of the possible presence of co-occurring conditions. 

As part of the evaluation, a physician should 

conduct a thorough examination, including 

assessment of hearing and vision to rule out 

other medical problems that may be causing 

symptoms similar to ADHD. In rare cases, 

persons with ADHD may also have a thyroid 

dysfunction. Diagnosing ADHD in an adult 

requires an evaluation of the history of childhood 

help4adhd.org 

4

problems in behavior and academic domains, as 

well as examination of current symptoms and 

coping strategies. 

Treatment 

Treatment in children with ADHD 

ADHD in children often requires a 

comprehensive approach to treatment that 

includes the following: 

• Parent and child education about diagnosis 

and treatment 

• Parent training in behavior management 

techniques 

• Medication 

• School programming and supports 

• Child and family therapy to address personal 

and/or family stress concerns 

Treatment should be tailored to the unique 

needs of each child and family. Research from 

the landmark NIMH Multimodal Treatment 

Study of ADHD showed significant improvement 

in behavior at home and school in children 

with ADHD who received carefully monitored 

medication in combination with behavioral 

treatment. These children also showed better 

relationships with their classmates and family 

than did children receiving this combination 

of treatment ( Hinshaw, et al., 2015.) Further 

research confirms that combining behavioral 

and stimulant treatments are more effective than 

either treatment alone (Smith & Shapiro, 2015.) 

Medication 

Psychostimulants are the 

most widely used class 

of medication for the 

management of ADHD 

related symptoms. 

Approximately 70 to 80 

percent of children with 

ADHD respond positively 

to psychostimulant 

medications (MTA 1999.) 

Significant academic 

improvement is shown by students who take 

these medications: increases in attention and 

concentration, compliance and effort on tasks, as 

well as amount and accuracy of schoolwork, plus 

decreased activity levels, impulsivity, negative 

behaviors in social interactions and physical 

and verbal hostility (Spencer, 1995; Swanson 

1993.) These improvements show up clearly in 

the short term, however, long-term effectiveness 

is still being studied by researchers ( Hinshaw, 

et al., 2015.) A nonstimulant medication— 

atomoxetine— appears to have similar 

effects as the stimulants. Antidepressants, 

antihypertensives and other medications 

may decrease impulsivity, hyperactivity and 

aggression. However, each family must weigh 

the pros and cons of taking medication. 

Medications may carry the risk of side effects. 

Physicians need to monitor their patients who 

take medication for potential side effects, such 

as mood swings, hypertension, depression and 

effects on growth. 

Behavioral interventions 

Behavioral interventions are also a major 

component of treatment for children who have 

ADHD. Important strategies include being 

consistent and using positive reinforcement 

and teaching problem-solving, communication 

and self-advocacy skills. Children, especially 

teenagers, should be actively involved as 

respected members of the school 

planning and treatment teams. 

School success may require a variety of 

classroom accommodations and behavioral 

interventions. Most children with ADHD can 

be taught in the regular classroom with minor 

adjustments to the environment. Some children 

may require special education services. These 

services may be provided within the regular 

education classroom or may require a special 

placement outside of the regular classroom that 

meets the child’s unique learning needs. 

ADHD treatment for adults 

Adults with ADHD can benefit by identifying the 

areas of their life that are most impaired by their 

ADHD and then seeking treatment to address 

them. Adults with ADHD may benefit from 

treatment strategies similar to those used to 

treat ADHD in children, particularly medication 

and learning to structure their environment. 

Medications effective for childhood ADHD 

help4adhd.org 

5

continue to be helpful for adults who have ADHD. 

Various behavioral management techniques can 

be useful. Some adults have found that working 

with a coach, either formally or informally, to be 

a helpful addition to their ADHD treatment plans. 

In addition, mental health counseling can offer 

much-needed support to adults dealing with 

ADHD in themselves or someone they care about. 

Since ADHD affects the entire family, receiving 

services from ADHD-trained therapists skilled in 

Cognitive-Behavioral Therapy can help the adult 

with ADHD learn new techniques to manage 

living with ADHD. 

Suggested reading and references 

Barkley, R.A. (ed.) (2015.) Attention Deficit 

Hyperactivity Disorders: A Handbook for 

Diagnosis and Treatment (4th edition.) New 

York: Guilford Press. 

Barkley, R.A. (2010). Attention Deficit 

Hyperactivity Disorder in Adults: The Latest 

Assessment and Treatment Strategies. Jones and 

Bartlett Publishers. 

NBrown, T.E. (2013). A New Understanding 

of ADHD in Children and Adults: Executive 

Function. Routledge. 

Cortese, S. (2012). The neurobiology and 

genetics of Attention-Deficit/ Hyperactivity 

Disorder (ADHD): What every clinician should 

know. European Journal of Paediatric Neurology, 

16(5):422-33. 

Kessler, R.C., et al. (2006.) The prevalence and 

correlates of adult ADHD in the United States: 

Results from the National Comorbidity Survey 

Replication. American Journal of Psychiatry, 

163(4):716–723. 

MTA Cooperative Group. (1999). A 14-month 

randomized clinical trial of treatment strategies 

for attention deficit hyperactivity disorder. 

Archives of General Psychiatry, 56, 12. 

Hinshaw, S.P. & Arnold, L.E. for the MTA 

Cooperative Group (2015 Jan–Feb). Attention 

deficit hyperactivity disorder, multimodal 

treatment, and longitudinal outcome: Evidence, 

paradox, and challenge. WIREs Cognitive Science, 

6(1):39-52. 

Owens, E., Cardoos, S.L., Hinshaw, S.P. (2015). 

Developmental progression and gender 

differences among individuals with ADHD. 

in Barkley, Russell A. (Ed.) Attention-deficit 

hyperactivity disorder: A handbook for diagnosis 

and treatment (4th ed.). , (pp. 223–255). New 

York, NY: Guilford Press. 

Smith, B.H. & Shapiro, C.J. (2015). Combined 

treatments for ADHD in Barkley, R.A. (Ed), 

(2015). Attention-Deficit Hyperactivity Disorder: 

A Handbook For Diagnosis and Treatment (4th 

ed.), (pp. 686–704). New York, NY: Guilford 

Press. 

Thapar, Anita; Cooper, Miriam; et al. (January 

2013). Practitioner Review: What have we learnt 

about the causes of ADHD?, Journal of Child 

Psychology and Psychiatry, 54(1):3-16. 

Visser, S.N., Danielson, M.L., Bitsko, R.H., et al. 

(2014). Trends in the Parent-Report of Health 

Care Provider-Diagnosis and Medication 

Treatment for ADHD disorder: United States, 

2003–2011. Journal of the American Academy of 

Child & Adolescent Psychiatry, 53(1):34–46. e2. 

Find your local CHADD Chapter 

For further information, please contact 

National Resource Center on ADHD: 

A Program of CHADD 

4601 Presidents Drive, Suite 300 

Lanham, MD 20706-4832 

1-800-233-4050 

www.chadd.org/nrc 

This factsheet is supported by Cooperative Agreement Number NU38DD005376 from the Centers for Disease Control and Prevention (CDC). The contents are solely the 

responsibility of the authors and do not necessarily represent the official views of CDC. Permission is granted to photocopy and freely distribute this factsheet for 

non-commercial, educational purposes only, provided that it is reproduced in its entirety, including the CHADD and NRC names, logos and contact information. 

© 2017 Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). All Rights Reserved.



Attachment B 

Adult ADHD Self-Report Scale 

Symptoms Checklist 


Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist 

Instructions 

The questions on the back page are designed to stimulate dialogue between you and your patients and to help 

confirm if they may be suffering from the symptoms of attention-deficit/hyperactivity disorder (ADHD). 

Description: The Symptom Checklist is an instrument consisting of the eighteen DSM-IV-TR criteria. 

Six of the eighteen questions were found to be the most predictive of symptoms consistent with 

ADHD. These six questions are the basis for the ASRS v1.1 Screener and are also Part A of the 

Symptom Checklist. Part B of the Symptom Checklist contains the remaining twelve questions. 

Instructions: 

Symptoms 

1. Ask the patient to complete both Part A and Part B of the Symptom Checklist by marking an X 

in the box that most closely represents the frequency of occurrence of each of the symptoms. 

2. Score Part A. If four or more marks appear in the darkly shaded boxes within Part A then the 

patient has symptoms highly consistent with ADHD in adults and further investigation is 

warranted. 

3. The frequency scores on Part B provide additional cues and can serve as further probes into the 

patient’s symptoms. Pay particular attention to marks appearing in the dark shaded boxes. The 

frequency-based response is more sensitive with certain questions. No total score or diagnostic 

likelihood is utilized for the twelve questions. It has been found that the six questions in Part A 

are the most predictive of the disorder and are best for use as a screening instrument. 

Impairments 

1. Review the entire Symptom Checklist with your patients and evaluate the level of impairment 

associated with the symptom. 

2. Consider work/school, social and family settings. 

3. Symptom frequency is often associated with symptom severity, therefore the Symptom 

Checklist may also aid in the assessment of impairments. If your patients have frequent 

symptoms, you may want to ask them to describe how these problems have affected the ability 

to work, take care of things at home, or get along with other people such as their 

spouse/significant other. 

History 

1. Assess the presence of these symptoms or similar symptoms in childhood. Adults who have 

ADHD need not have been formally diagnosed in childhood. In evaluating a patient’s history, 

look for evidence of early-appearing and long-standing problems with attention or self-control. 

Some significant symptoms should have been present in childhood, but full symptomology is not 

necessary.

Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist 

Patient Name 

Today’s Date 

Please answer the questions below, rating yourself on each of the criteria shown using the 

scale on the right side of the page. As you answer each question, place an X in the box that 

best describes how you have felt and conducted yourself over the past 6 months. Please give 

this completed checklist to your healthcare professional to discuss during today’s 

appointment. 

Never 

Rarely 

Sometimes 

Often 

Very Often 

1. How often do you have trouble wrapping up the final details of a project, 

once the challenging parts have been done? 

2. How often do you have difficulty getting things in order when you have to do 

a task that requires organization? 

3. How often do you have problems remembering appointments or obligations? 

4. 

When you have a task that requires a lot of thought, how often do you avoid 

or delay getting started? 

5. How often do you fidget or squirm with your hands or feet when you have 

to sit down for a long time? 

6. How often do you feel overly active and compelled to do things, like you 

were driven by a motor? 

Part A 

7. How often do you make careless mistakes when you have to work on a boring or 

difficult project? 

8. How often do you have difficulty keeping your attention when you are doing boring 

or repetitive work? 

9. How often do you have difficulty concentrating on what people say to you, 

even when they are speaking to you directly? 

10. How often do you misplace or have difficulty finding things at home or at work? 

11. How often are you distracted by activity or noise around you? 

12. How often do you leave your seat in meetings or other situations in which 

you are expected to remain seated? 

13. How often do you feel restless or fidgety? 

14. How often do you have difficulty unwinding and relaxing when you have time 

to yourself? 

15. How often do you find yourself talking too much when you are in social situations? 

16. When you’re in a conversation, how often do you find yourself finishing 

the sentences of the people you are talking to, before they can finish 

them themselves? 

17. How often do you have difficulty waiting your turn in situations when 

turn taking is required? 

18. How often do you interrupt others when they are busy? 

Part B

The Value of Screening for Adults With ADHD 

Research suggests that the symptoms of ADHD can persist into adulthood, having a significant 

impact on the relationships, careers, and even the personal safety of your patients who may 

suffer from it. 1-4 Because this disorder is often misunderstood, many people who have it do not 

receive appropriate treatment and, as a result, may never reach their full potential. Part of the 

problem is that it can be difficult to diagnose, particularly in adults. 

The Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist was developed 

in conjunction with the World Health Organization (WHO), and the Workgroup on Adult 

ADHD that included the following team of psychiatrists and researchers: 

• Lenard Adler, MD 

Associate Professor of Psychiatry and Neurology 

New York University Medical School 

• Ronald C. Kessler, PhD 

Professor, Department of Health Care Policy 

Harvard Medical School 

• Thomas Spencer, MD 

Associate Professor of Psychiatry 


As a healthcare professional, you can use the ASRS v1.1 as a tool to help screen for ADHD in 

adult patients. Insights gained through this screening may suggest the need for a more in-depth 

clinician interview. The questions in the ASRS v1.1 are consistent with DSM-IV criteria and 

address the manifestations of ADHD symptoms in adults. Content of the questionnaire also 

reflects the importance that DSM-IV places on symptoms, impairments, and history for a correct 

diagnosis. 4 

The checklist takes about 5 minutes to complete and can provide information that is critical 

to supplement the diagnostic process. 

References: 

1. Schweitzer JB, et al. Med Clin North Am. 2001;85(3):10-11, 757-777. 

2. Barkley RA. Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. 2nd ed. 1998. 

3. Biederman J, et al. Am J Psychiatry.1993;150:1792-1798. 

4. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. 

Washington, DC, American Psychiatric Association. 2000: 85-93.


Attachment C 

Dream Jobs for Adults with ADHD 


8 Dream Jobs 

for Adults 

with ADHD 

From the ADHD Experts at

A trusted source of advice and information for families touched by attention-deficit disorder— 

and a voice of inspiration to help people with ADHD find success at home, at school, and on the job. 

ADDitudeMag.com 

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FOUNDER: Ellen Kingsley (1951-2007) 

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Sandy Maynard, M.S. (Coaching) 

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ADMINISTRATIVE ASSISTANT: Madalyn Baldanzi 

SCIENTIFIC ADVISORY BOARD 

CHAIRMAN: 

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Georgetown University 

Medical School 

Washington, DC 

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South Carolina 

Charleston, SC 

Carol Brady, Ph.D. 

Baylor College of Medicine 

Houston, TX 

Thomas E. Brown, Ph.D. 

Yale University 

School of Medicine 

New Haven, CT 

William Dodson, M.D. 

ADHD Treatment Center 

Denver, CO 

Edward M. Hallowell, M.D. 

The Hallowell Center 

Sudbury, MA 

Peter Jaksa, Ph.D. 

ADD Centers of 

America 

Chicago, IL 

Peter Jensen, M.D. 

Columbia University College 

of Physicians and Surgeons 

New York, NY 

Harold Koplewicz, M.D. 

New York University 

Medical School 

New York, NY 

Michele Novotni, Ph.D. 

Wayne Counseling Center 

Wayne, PA 

Roberto Olivardia, Ph.D. 


Boston, MA 

Patricia Quinn, M.D. 

National Center for Gender 

Issues and AD/HD 

Washington, DC

8 Dream Jobs 

for Adults 

with ADHD 

Professions that utilize your strengths and 

minimize your challenges 

BY THE EDITORS OF ADDITUDE 

“What would you do if you knew you could not fail?” Dr. Edward Hallowell 

poses this bold question to patients struggling to choose a career path. The 

answer often helps to clarify what they value most in a profession — serving 

others, earning high wages, being treated with respect, meeting interesting 

people — and points his patients in some discreet directions. 

“I have my clients write down everything they’ve liked about different jobs 

they’ve held, and everything they’ve hated about them,” says Kerch McConlogue, 

an ADHD coach in Baltimore, Maryland. “Do you like standing on 

your feet? Dealing with the public? Working alone?” 

Ask yourself some of these questions to determine which aspects of work 

you love, and which of them you dread. Although just about every job will 

involve some mundane task, doing work that – for the most part – fascinates 

you is critical to your ultimate job satisfaction and performance. Boredom 

can sidetrack you and cause you to underperform. Conversely, if a job ties in 

to your passions, you’ll thrive. 

Second, maintain a realistic assessment of your strengths and weaknesses in 

the workplace. Get started by listing the aspects of past job that helped you 

shine, or made you falter. “The key is to be realistic,” says Kathleen Nadeau, 

Ph.D., a psychologist in Silver Spring, Maryland. “Some people are so determined 

to master their difficulties that they stick with a job they’re poorly 

suited for. Your efforts will be better spent if you choose a job that uses 

your strengths.” 

Learn more about 

aligning your passions 

and your career at 

http://additu.de/job 

8 Dream Jobs 

for Adults 

with ADHD 

from the editors of 

3

Though there’s no one correct career path, some jobs are more ADHDfriendly 

than others. ADDitude has compiled a list of eight professions that 

may help you reach your full potential by putting your natural skills to work: 

1. Teacher 

Many adults with ADHD find joy working directly with children — in careers 

such as teaching or childcare. These jobs rely on your sparkling ADHD personality 

and thoughtful creativity, though they’re sure to test your patience. 

To succeed in a kid-focused career, you must be able to think on your feet and 

transition from one task to another quickly – because when you’re working 

with kids, anything can happen! 

Words from a Daycare Worker: “I love working with toddlers 

and preschoolers; they understand me! We jump from one 

project to the next and they rarely know when I’m off task.” 

— Lori, an ADDitude reader 

2. Journalist 

Adults with ADHD working in journalism find the work exciting, creative, 

and rewarding. Journalists must roll with day-to-day changes in their work 

settings and assignments — covering a broad range of topics, interacting 

with a variety of people, and delivering a quick turnaround on assignments. 

This flexibility jives well with people who exhibit loads of energy, a short attention 

span, a low boredom threshold, and problems with sustained focus 

over hours or days. Hard deadlines, however, may be a challenge. 

Words from a Copy Editor: “My best job was in a busy newsroom as 

a copy editor. There was constant activity and fast deadlines. If I had 15 

things to focus on at once, I was golden!” — Patti, an ADDitude reader 

3. Food Industry Worker 

Many adults with ADHD go into the culinary arts because the work is creative 

and relatively unaffected by ADHD-related deficits. Cooking requires 

you to focus on the task at hand and take immediate steps to create a finished 

product, while not demanding long-range planning or lots of working 

memory. Unusual or flexible hours, with sporadic ebb-and-flow pacing, add 

just the right touch of excitement to keep you alert and focused on the job. 

Words from a Chef: “I left corporate America to join culinary school 

because that was my passion. People with ADHD aren’t mentally [inferior 

to] anyone else. They are extremely creative. If you are able to manage 

it, understand what your strengths are, and not feel bad about your 

symptoms, it’s not something horrible.” — Alexis Hernandez, Chef Contestant 

on The Next Food Network Star 

You got the interview. 

Now, get the job 

— with the ADHDfriendly 

interview tips 

at http://additu.de/ 

interview 

8 Dream Jobs 

for Adults 

with ADHD 


4

4. Beautician 

Hairstylists, manicurists, and cosmetologists are constantly meeting with 

new clients — each one providing a unique creative challenge requiring only 

short-term focus. They often remain on their feet all day and jump from 

task to task quickly, an ideal working environment for a hyperactive-type 

adult with lots of energy. Plus, the constant influx of customers provides 

ample social interactions and quick task turnover, leaving little opportunity 

for boredom. 

Words from a Hairstylist: “Being a hairstylist is the best job for this 

ADHD mama. I get a new client every 45 minutes and each person is 

so different! I can work 10-12 hours and feel like I haven’t worked more 

than 3.” — Robin, an ADDitude reader 

5. Small Business Owner 

Starting a small business suits the strengths of ADHD. The hours are usually 

quite flexible, and an entrepreneur is her own boss. Work settings can vary 

from day to day, which accommodates the restlessness and boredom that 

many adults with ADHD experience. Plus, you’ll be able to focus on what 

you’re truly passionate about, making your career meaningful. 

Words from an Entrepreneur: “I got the feedback in my old jobs 

that I was good at starting things but not at finishing projects. Being 

a self-employed grant writer is a way around that, because there 

are defined projects with a defined life to them.” — Daniel G., an 

ADDitude reader 

“I have always felt 

that the way the brain 

thinks, there’s a beauty 

in that, and if I’m able 

to look at the beauty in 

it, I can live my life the 

way I want.” — Alexis 

Hernandez, Celebrity Chef 

with ADHD 

6. Emergency First-Responders 

EMTs, police officers, and firefighters must work well under pressure and be 

able to make split-second decisions. These jobs allow you to work in a variety 

of settings, while providing the kind of adrenaline-pumping excitement 

that helps many adults with ADHD focus their minds. When others start to 

panic, the ADHD brain kicks into high gear, allowing you to see problems 

clearly and complete the task at hand. 

Words from a Nurse: “I’m a nurse in surgery, which is good for my 

ADHD because it rolls with my fleeting attention, but has enough structure 

to keep me focused.” — Rebecca, an ADDitude reader 

7. High-Teach Startup 

The under-stimulated frontal lobe of an adult with ADHD gets jump-started 

in the over-stimulated environment of a tech startup. Computer technicians 

rove throughout a company working with others to solve computer problems, 

while software developers generally work independently creating and 

8 Dream Jobs 

for Adults 

with ADHD 


5

troubleshooting computer code for programs, websites, or apps. Both jobs 

provide ample opportunity to problem solve and harness that ADHD hyperfocus 

on small details. 

Words from a Software Developer: “Most software tasks only take 

a few weeks, which helps to prevent monotony. As a software developer, 

the problems I deal with are diverse, interesting, and require constant 

hands on thinking – great for keeping the ADHD mind on track.” 

— Adam, an ADDitude reader 

8. The Arts 

It should come as no surprise that adults with ADHD succeed when surrounded 

by other artists in a fast-paced, artistic environment. Whether it’s 

as a TV producer, choreographer, or concert pianist, adults with ADHD are 

happiest when their work allows them to express their artistic abilities. After 

all, “There’s no business like show business!” 

Words from a Theatrical Stage Manager: “As a stage manager, 

it’s up to me to facilitate every part of a production: from meetings and 

rehearsals to performances. It gives me plenty to focus on and no two 

days are the same. Plus, it helps that theater people are some of kindest, 

kookiest people on the planet. I fit right in!” — Jessi, an ADDitude reader 

Still not sure? Ask 

yourself these 18 

questions that will 

help reveal your ideal 

career: http://additu. 

de/18-questions 

What if none of these jobs sparks your interest? Don’t get discouraged if your 

dreams and talents don’t perfectly align; the world is paved with interesting 

side roads. For example, if you want to be a chef but find that you’re dangerously 

clumsy with knives, you might use your writing skills to make a career 

as a cookbook author or restaurant critic. 

Dr. Hallowell shares the story of a client with a natural talent for art and a 

passion for the environment. Her dream was to become an environmental 

engineer, but after being rejected from all of her chosen engineering programs, 

she was forced to re-evaluate. Eventually, she applied to an art institute, 

where she was accepted and performed very well. She now uses her 

artistic talent to increase public awareness of environmental issues by designing 

and creating scale models of habitats. 

Matching up your abilities with your interests is what ultimately determines 

a successful career. You will succeed if you learn to work with what you have, 

and recognize and accept yourself for who you are. No amount of money or 

prestige can lead to fulfillment or happiness without self-acceptance – love 

yourself, and it will be easier to love what you do. 

8 Dream Jobs 

for Adults 

with ADHD 


6

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XX Succession Planning Q-4 2019 

XXI The Budget* Bonus #1 

XXII Data-Driven Resource Allocation* Bonus #2 

Vol. VI 2020 Missions 

XXIII Critical Thinking Q-1 2020 

XXIV 

The Advocacy Foundation 

Endowments Initiative Project 

Q-2 2020 

XXV International Labor Relations Q-3 2020 

XXVI Immigration Q-4 2020 

Vol. VII 2021 Community Engagement 

XXVII 

The 21 st Century Charter Schools 

Initiative 

Q-1 2021 

XXVIII The All-Sports Ministry @ ... Q-2 2021 

XXIX Lobbying for Nonprofits Q-3 2021 

XXX 

XXXI 

Advocacy Foundation Missions - 

Domestic 

Advocacy Foundation Missions - 

International 

Q-4 2021 

Bonus 


Vol. VIII 

2022 ComeUnity ReEngineering 

XXXII 

The Creative & Fine Arts Ministry 

@ The Foundation 

Q-1 2022 

XXXIII The Advisory Council & Committees Q-2 2022 

XXXIV 

The Theological Origins 

of Contemporary Judicial Process 

Q-3 2022 

XXXV The Second Chance Ministry @ ... Q-4 2022 

Vol. IX 2023 Legal Reformation 

XXXVI The Fifth Amendment Project Q-1 2023 

XXXVII The Judicial Re-Engineering Initiative Q-2 2023 

XXXVIII 

The Inner-Cities Strategic 

Revitalization Initiative 

Q-3 2023 

XXXVIX Habeas Corpus Q-4 2023 

Vol. X 2024 ComeUnity Development 

XXXVX 

The Inner-City Strategic 

Revitalization Plan 

Q-1 2024 

XXXVXI The Mentoring Initiative Q-2 2024 

XXXVXII The Violence Prevention Framework Q-3 2024 

XXXVXIII The Fatherhood Initiative Q-4 2024 

Vol. XI 2025 Public Interest 

XXXVXIV Public Interest Law Q-1 2025 

L (50) Spiritual Resource Development Q-2 2025 


LI 

Nonprofit Confidentiality 

In The Age of Big Data 

Q-3 2025 

LII Interpreting The Facts Q-4 2025 

Vol. XII 2026 Poverty In America 

LIII 

American Poverty 

In The New Millennium 

Q-1 2026 

LIV Outcome-Based Thinking Q-2 2026 

LV Transformational Social Leadership Q-3 2026 

LVI The Cycle of Poverty Q-4 2026 

Vol. XIII 2027 Raising Awareness 

LVII ReEngineering Juvenile Justice Q-1 2027 

LVIII Corporations Q-2 2027 

LVIX The Prison Industrial Complex Q-3 2027 

LX Restoration of Rights Q-4 2027 

Vol. XIV 2028 Culturally Relevant Programming 

LXI Community Culture Q-1 2028 

LXII Corporate Culture Q-2 2028 

LXIII Strategic Cultural Planning Q-3 2028 

LXIV 

The Cross-Sector/ Coordinated 

Service Approach to Delinquency 

Prevention 

Q-4 2028 


Vol. XV 2029 Inner-Cities Revitalization 

LXIV 

LXV 

LXVI 

Part I – Strategic Housing 

Revitalization 

(The Twenty Percent Profit Margin) 

Part II – Jobs Training, Educational 

Redevelopment 

and Economic Empowerment 

Part III - Financial Literacy 

and Sustainability 

Q-1 2029 

Q-2 2029 

Q-3 2029 

LXVII Part IV – Solutions for Homelessness Q-4 2029 

LXVIII 

The Strategic Home Mortgage 

Initiative 

Bonus 

Vol. XVI 2030 Sustainability 

LXVIII Social Program Sustainability Q-1 2030 

LXIX 

The Advocacy Foundation 

Endowments Initiative 

Q-2 2030 

LXX Capital Gains Q-3 2030 

LXXI Sustainability Investments Q-4 2030 

Vol. XVII 2031 The Justice Series 

LXXII Distributive Justice Q-1 2031 

LXXIII Retributive Justice Q-2 2031 

LXXIV Procedural Justice Q-3 2031 

LXXV (75) Restorative Justice Q-4 2031 

LXXVI Unjust Legal Reasoning Bonus 


Vol. XVIII 2032 Public Policy 

LXXVII Public Interest Law Q-1 2032 

LXXVIII Reforming Public Policy Q-2 2032 

LXXVIX ... Q-3 2032 

LXXVX ... Q-4 2032 


The e-Advocate Monthly Review 

2018 

Transformational Problem Solving January 2018 

The Advocacy Foundation February 2018 

Opioid Initiative 

Native-American Youth March 2018 

In the Juvenile Justice System 

Barriers to Reducing Confinement April 2018 

Latino and Hispanic Youth May 2018 


Social Entrepreneurship June 2018 

African-American Youth July 2018 


Gang Deconstruction August 2018 

Social Impact Investing September 2018 

Opportunity Youth: October 2018 

Disenfranchised Young People 

The Economic Impact of Social November 2018 

of Social Programs Development 

Gun Control December 2018 

2019 

The U.S. Stock Market January 2019 

Prison-Based Gerrymandering February 2019 

Literacy-Based Prison Construction March 2019 

Children of Incarcerated Parents April 2019 

African-American Youth in The May 2019 

Juvenile Justice System 


Racial Profiling June 2019 

Mass Collaboration July 2019 

Concentrated Poverty August 2019 

De-Industrialization September 2019 

Overcoming Dyslexia October 2019 

The Advantages 

of Attention Deficit November 2019 


The e-Advocate Quarterly 

Special Editions 

Crowdfunding Winter-Spring 2017 

Social Media for Nonprofits October 2017 

Mass Media for Nonprofits November 2017 

The Opioid Crisis in America: January 2018 

Issues in Pain Management 

The Opioid Crisis in America: February 2018 

The Drug Culture in the U.S. 

The Opioid Crisis in America: March 2018 

Drug Abuse Among Veterans 

The Opioid Crisis in America: April 2018 

Drug Abuse Among America’s 

Teens 

The Opioid Crisis in America: May 2018 

Alcoholism 


The e-Advocate Journal 

of Theological Jurisprudence 

Vol. I - 2017 

The Theological Origins of Contemporary Judicial Process 

Scriptural Application to The Model Criminal Code 

Scriptural Application for Tort Reform 

Scriptural Application to Juvenile Justice Reformation 

Vol. II - 2018 

Scriptural Application for The Canons of Ethics 

Scriptural Application to Contracts Reform 

& The Uniform Commercial Code 

Scriptural Application to The Law of Property 

Scriptural Application to The Law of Evidence 


Legal Missions International 



Vol. I 2015 

I 

II 

God’s Will and The 21 st Century 

Democratic Process 

The Community 

Engagement Strategy 

Q-1 2015 

Q-2 2015 

III Foreign Policy Q-3 2015 

IV 

Public Interest Law 

in The New Millennium 

Q-4 2015 

Vol. II 2016 

V Ethiopia Q-1 2016 

VI Zimbabwe Q-2 2016 

VII Jamaica Q-3 2016 

VIII Brazil Q-4 2016 

Vol. III 2017 

IX India Q-1 2017 

X Suriname Q-2 2017 

XI The Caribbean Q-3 2017 

XII United States/ Estados Unidos Q-4 2017 

Vol. IV 2018 

XIII Cuba Q-1 2018 

XIV Guinea Q-2 2018 

XV Indonesia Q-3 2018 

XVI Sri Lanka Q-4 2018 


Vol. V 2019 

XVII Russia Q-1 2019 

XVIII Australia Q-2 2019 

XIV South Korea Q-3 2019 

XV Puerto Rico Q-4 2019 


Vol. VI 2020 

XVI Trinidad & Tobago Q-1 2020 

XVII Egypt Q-2 2020 

XVIII Sierra Leone Q-3 2020 

XIX South Africa Q-4 2020 

XX Israel Bonus 

Vol. VII 2021 

XXI Haiti Q-1 2021 

XXII Peru Q-2 2021 

XXIII Costa Rica Q-3 2021 

XXIV China Q-4 2021 

XXV Japan Bonus 

Vol VIII 2022 

XXVI Chile Q-1 2022 


The e-Advocate Juvenile Justice Report 

______ 

Vol. I – Juvenile Delinquency in The US 

Vol. II. – The Prison Industrial Complex 

Vol. III – Restorative/ Transformative Justice 

Vol. IV – The Sixth Amendment Right to The Effective Assistance of Counsel 

Vol. V – The Theological Foundations of Juvenile Justice 

Vol. VI – Collaborating to Eradicate Juvenile Delinquency 


The e-Advocate Newsletter 

Genesis of The Problem 

Family Structure 

Societal Influences 

Evidence-Based Programming 

Strengthening Assets v. Eliminating Deficits 

2012 - Juvenile Delinquency in The US 

Introduction/Ideology/Key Values 

Philosophy/Application & Practice 

Expungement & Pardons 

Pardons & Clemency 

Examples/Best Practices 

2013 - Restorative Justice in The US 

2014 - The Prison Industrial Complex 

25% of the World's Inmates Are In the US 

The Economics of Prison Enterprise 

The Federal Bureau of Prisons 

The After-Effects of Incarceration/Individual/Societal 

The Fourth Amendment Project 

The Sixth Amendment Project 

The Eighth Amendment Project 

The Adolescent Law Group 

2015 - US Constitutional Issues In The New Millennium 


2018 - The Theological Law Firm Academy 

The Theological Foundations of US Law & Government 

The Economic Consequences of Legal Decision-Making 

The Juvenile Justice Legislative Reform Initiative 

The EB-5 International Investors Initiative 

2017 - Organizational Development 

The Board of Directors 

The Inner Circle 

Staff & Management 

Succession Planning 

Bonus #1 The Budget 

Bonus #2 Data-Driven Resource Allocation 

2018 - Sustainability 

The Data-Driven Resource Allocation Process 

The Quality Assurance Initiative 

The Advocacy Foundation Endowments Initiative 

The Community Engagement Strategy 

2019 - Collaboration 

Critical Thinking for Transformative Justice 

International Labor Relations 

Immigration 

God's Will & The 21st Century Democratic Process 

The Community Engagement Strategy 

The 21st Century Charter Schools Initiative 

2020 - Community Engagement 


Extras 

The Nonprofit Advisors Group Newsletters 

The 501(c)(3) Acquisition Process 

The Board of Directors 

The Gladiator Mentality 

Strategic Planning 

Fundraising 

501(c)(3) Reinstatements 

The Collaborative US/ International Newsletters 

How You Think Is Everything 

The Reciprocal Nature of Business Relationships 

Accelerate Your Professional Development 

The Competitive Nature of Grant Writing 

Assessing The Risks 



About The Author 

John C (Jack) Johnson III 

Founder & CEO 

Jack was educated at Temple University, in Philadelphia, Pennsylvania and Rutgers 

Law School, in Camden, New Jersey. In 1999, he moved to Atlanta, Georgia to pursue 

greater opportunities to provide Advocacy and Preventive Programmatic services for atrisk/ 

at-promise young persons, their families, and Justice Professionals embedded in the 

Juvenile Justice process in order to help facilitate its transcendence into the 21 st Century. 

There, along with a small group of community and faith-based professionals, “The Advocacy Foundation, Inc." was conceived 

and developed over roughly a thirteen year period, originally chartered as a Juvenile Delinquency Prevention and Educational 

Support Services organization consisting of Mentoring, Tutoring, Counseling, Character Development, Community Change 

Management, Practitioner Re-Education & Training, and a host of related components. 

The Foundation’s Overarching Mission is “To help Individuals, Organizations, & Communities Achieve Their Full Potential”, by 

implementing a wide array of evidence-based proactive multi-disciplinary "Restorative & Transformative Justice" programs & 

projects currently throughout the northeast, southeast, and western international-waters regions, providing prevention and support 

services to at-risk/ at-promise youth, to young adults, to their families, and to Social Service, Justice and Mental 

Health professionals” everywhere. The Foundation has since relocated its headquarters to Philadelphia, Pennsylvania, and been 

expanded to include a three-tier mission. 

In addition to his work with the Foundation, Jack also served as an Adjunct Professor of Law & Business at National-Louis 

University of Atlanta (where he taught Political Science, Business & Legal Ethics, Labor & Employment Relations, and Critical 

Thinking courses to undergraduate and graduate level students). Jack has also served as Board President for a host of wellestablished 

and up & coming nonprofit organizations throughout the region, including “Visions Unlimited Community 

Development Systems, Inc.”, a multi-million dollar, award-winning, Violence Prevention and Gang Intervention Social Service 

organization in Atlanta, as well as Vice-Chair of the Georgia/ Metropolitan Atlanta Violence Prevention Partnership, a state-wide 

300 organizational member, violence prevention group led by the Morehouse School of Medicine, Emory University and The 

Original, Atlanta-Based, Martin Luther King Center. 

Attorney Johnson’s prior accomplishments include a wide-array of Professional Legal practice areas, including Private Firm, 

Corporate and Government postings, just about all of which yielded significant professional awards & accolades, the history and 

chronology of which are available for review online. Throughout his career, Jack has served a wide variety of for-profit 

corporations, law firms, and nonprofit organizations as Board Chairman, Secretary, Associate, and General Counsel since 1990. 

www.TheAdvocacyFoundation.org 

Clayton County Youth Services Partnership, Inc. – Chair; Georgia Violence Prevention Partnership, Inc – Vice Chair; Fayette 

County NAACP - Legal Redress Committee Chairman; Clayton County Fatherhood Initiative Partnership – Principal 

Investigator; Morehouse School of Medicine School of Community Health Feasibility Study - Steering Committee; Atlanta 

Violence Prevention Capacity Building Project – Project Partner; Clayton County Minister’s Conference, President 2006-2007; 

Liberty In Life Ministries, Inc. – Board Secretary; Young Adults Talk, Inc. – Board of Directors; ROYAL, Inc - Board of 

Directors; Temple University Alumni Association; Rutgers Law School Alumni Association; Sertoma International; Our 

Common Welfare Board of Directors – President)2003-2005; River’s Edge Elementary School PTA (Co-President); Summerhill 

Community Ministries; Outstanding Young Men of America; Employee of the Year; Academic All-American - Basketball; 

Church Trustee. 


www.TheAdvocacyFoundation.org

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