ADHD

Attention-Deficit/Hyperactivity Disorder

ADHD stands for Attention-Deficit/Hyperactivity Disorder. This neurodevelopmental disorder affects more boys as compared to girls. In United Kingdom, ADHD impacts 3.9% of the boys and 0.9% of the girls between the ages of 5 to 15 years. This is one of the most prevalent neurodevelopmental disorders worldwide. Let’s dive right into the main topic and see what ADHD really is.

Overview

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder marked by an ongoing pattern of inattention and/or hyperactivity. Neurodevelopmental disorders are those disorders which occur due to differences in development and function of nervous system. Children and adults with ADHD suffer from poor self-esteem, poor relationships and poor academic performance. Symptoms of ADHD lessen with age for some individuals. Some individuals do not outgrow their ADHD symptoms but learn strategies to manage themselves successfully. 

Inattention: Inattention refers to off task behaviors, lack of persistency, inability to remain focused and disorganization which cannot be explained by defiance or comprehension problems.

Hyperactivity: Hyperactivity includes constant movement, excessive involvement in inappropriate behaviors, excessive fidgets, taps, talks etc.

Impulsivity: impulsivity involves hasty actions, risk taking behaviors, behaviors with high potential of harm, inability to delay gratification, interruption in others’ discussion and impulsive decision making without considering consequences.     

Symptoms

The key behaviors of ADHD are Inattention and Hyperactivity/impulsivity. Some people have problems with only one category of behaviors, Inattention or Hyperactivity/Impulsivity. While other people with ADHD have both type of problems. It is not always abnormal to have some inattention, high motor activity or impulsivity but people with ADHD have more severe and recurrent of these behaviors which impacts quality of their overall life.

According to DSM-5, the following are the symptoms of ADHD:

Inattention

  • Overlooking or missing details and making careless mistakes
  • Not being able to focus attention on tasks
  • Seems not being able to listen when spoken directly to
  • No being able to follow instructions
  • Having problems in organizing tasks
  • Avoiding or disliking tasks that require sustained focus
  • Losing important things
  • Getting easily distracted
  • Being forgetful in daily activities

Hyperactivity-Impulsivity

  • Excessive fidgeting
  • Leaving seat in situations when it is expected to be remain seated
  • Running, dashing around and climbing into situations that are inappropriate
  • Not being able to play quietly
  • Remaining on the go always as driven by motor
  • Non-stop talking
  • Blurting out answer before the question being completed
  • Not being able to wait for turn
  • Interrupting others

A diagnosis must only be provided by a licensed and expert pediatrician, psychologist, or psychiatrist with expertise in ADHD after a comprehensive evaluation. For an individual to be diagnosed, the symptoms must be chronic and sever enough to impact the functioning of individual and make that individual to fall behind the typical development of his/her age. A clinician also makes sure that the symptoms are not due to any other medical or psychiatric condition. Mostly, children get diagnosed with ADHD in elementary. To diagnose an adolescent or adult with ADHD, the presence of symptoms before the age of 12 must be present. 

Causes

Researchers are not sure about the exact causes of ADHD. However, a combination of different risk factors seem to be responsible.

Genetics

Genetics seem to play as a significant contributing factors in developing ADHD as it runs in families. According to research, individuals who have parents or siblings with ADHD are at high risk of developing ADHD. The way genetics play its role is quite complex as a single genetic fault does not seem to play the entire role. 

Brain anatomy and brain functions

Although the exact difference in brain structure or function between individuals with ADHD and people without ADHD is not known but researchers have identified a number of differences. Some brain areas are smaller (amygdala and hippocampus) in people with ADHD as compared to people without ADHD as evidenced by research. On the other hand, some researchers have focused on imbalance of neurotransmitters (dopamine and noradrenaline) in people with ADHD.

People at risk of developing ADHD

People who are born pre-mature, have low birth weight, have epilepsy or brain damage are at high risk of developing ADHD.

Theoretical models

Cognitive-energetic models

According to cognitive-energetic models, people with ADHD have defects at three levels, cognitive mechanisms, energetic mechanisms and management/EF deficits. ADHD is not much a structural limitation and more an energetic limitation.  

Brown’s theory of ADHD

According to this theory, people with ADHD have impairments in six areas of cognitive functions. These areas work together in helping individuals in managing tasks in their daily lives.

Treatment

There is no permanent cure of ADHD but there certain treatments including medication, psychotherapy, education/training or a combination of them which can help in reducing symptoms and improving functioning.

Medications

Stimulant is a very common medication for ADHD. Stimulants basically increase brain chemicals like dopamine and norepinephrine which are helpful in improving attention and thinking. Non-stimulant medications are also used for ADHD. Non-stimulants usually take more time in starting their work but these also contribute by improving, attention and impulsive behavior. Anti-depressants are also sometimes used alone or in combination with stimulants, especially if negative side-effects of stimulants are observed.

Psychotherapy and psychosocial treatments

Many psycho-social interventions have found to be helpful for ADHD patients and their families in alleviating symptoms and improving functioning. Parents and families of children with ADHD need psycho-education which help them learn skills to better manage these children and adolescents. Behavioral therapy is also helpful in teaching children with ADHD good behaviors. Cognitive behavioral therapy is also used with people having ADHD. It helps them in understanding their own thoughts and improving their focus. Other psychotherapy options include family and marital therapy.

Other treatment options

Other treatment options include parenting skills training, specific behavioral classroom management interventions and support groups.  

Additional resources

NHS Choices – ADHD https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/

The Mental Health Foundation https://www.mentalhealth.org.uk/