Neuropsychological Insights into ADHD

By Jasmine Chan

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in childhood. In the US alone, around 6.1 million children suffer from it. Children with ADHD are typically impulsive, have poor concentration and high levels of activity, although some are predominantly attention deficit, some hyperactive, and the others a mixture of both. The disorder greatly hinders students ’ academic, social and emotional development, and leaves countless parents and schools frustrated.

ADHD is usually diagnosed by mental health professionals or other specialists through procedures like physical assessments, interviews and listening to the reports of significant people such as parents and teachers, with accordance to the guidelines in the American Psychiatric Association ’ s Diagnostic and Statistical Manual, Fifth edition (DSM-5). However, this psychological method of diagnosis is inevitably subjective as it often includes self-reporting assessments. For instance, if parents believe their child has ADHD and needs medication, they will likely say that he or she can never pay attention and is always overly active, when in reality, it might not be the case. Hence, it is suspected that there are misdiagnoses for the disorder.

Attention deficit hyperactivity disorder, otherwise known as ADHD

ADHD misdiagnosis might be attributed to age and sex. Schools sort children into grades according to age, creating an age gap between those at the two ends of the categories, i.e. a child who has just turned five could be in the same grade as one who is almost six, and their age difference is around 20%. This is particularly problematic as diagnoses might take into account the child’ s performance relative to their peers instead of his or her actual abilities, yet it is not a fair comparison because their level of development should not be the same. A study even found that boys and girls born in December are 30% and 70% more likely to be diagnosed with ADHD than those born in January respectively. Similarly, sex might have also caused misdiagnoses. Boys are found to be 3 to 9 times more likely to be considered to have ADHD than girls, but if ADHD is a neurodevelopmental disorder, the chance of having it should be equal among the two sexes. This hints that there is a possibility of misdiagnosis.

Misdiagnosis contributes to the stigmatization of ADHD. Psychological methods of diagnosis cannot show that ADHD patients are biologically different from those without ADHD because they only evaluate patients ’ behaviour, leading some to believe that ADHD is not an actual mental disorder, but an excuse for people to be lazy. It casts a stereotype on ADHD patients, labelling them as academically incompetent, and causes some to lose confidence in their abilities. Additionally, people might believe that ADHD should only occur in boys because currently diagnosed ADHD patients are predominantly male. Girls with ADHD are thought to have something very wrong with them. Therefore, psychology seeks to discover identifiable biological differences between individuals with ADHD and without, and develop a definitive test for it, in order to steer clear of misdiagnoses and remove the stigma surrounding it. To achieve this, psychology has to merge with neurology.

Neuroscience has revealed through various neuroimaging studies that ADHD patients do have differences in the brain compared to healthy controls, for instance, having smaller total cerebral volume, delayed brain maturation, and less white matter, a type of tissue in the brain that is responsible for the communication between brain regions. Some scientists have even developed machine learning approaches to distinguish ADHD patients from controls with data obtained through functional magnetic resonance imaging (fMRI), a neuroimaging technique. Unfortunately, those algorithms may not be able to diagnose ADHD on their own yet because ADHD cannot be attributed to the dysfunction of specific brain regions, but a multitude of brain anomalies and etiologies. Though, they are not without utility as they could be an objective and reliable screening method to assist clinical diagnoses by psychological methods by human professionals, mitigating variations among them.

The knowledge of neurological differences between ADHD patients and other individuals and novel methods of diagnosis clear up misconceptions and stigma surrounding ADHD. It is definitely helpful to relieve the stress placed on patients due to stigmatization, as the symptoms of ADHD already create great obstacles to patients and those around them. Not only do patients underperform in school during childhood and adolescence, ADHD is carried into adulthood for some, straining interpersonal relationships and butchering employability in the long run. Major long-term longitudinal studies estimated that 10 to 20% of patients with childhood ADHD develop antisocial problems later in life, such as having poor temper in social situations and committing crimes. The extra barrier of social discrimination is removed through establishing an objective understanding of the condition among the public, allowing patients to interact with others and achieve well-being more easily. This is an instance in which psychology and neurology combine as neuropsychology to enhance our understanding of the very nature of our minds, and attempts to improve the lives of many by sharing the knowledge. Yet even so, the essential part of making patients ’ lives better is our own willingness to accept that knowledge, respect those who are different from us, and create a safe space for them.

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