What is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common chronic mental disorders that affects children and continues into adulthood.

It is a neurodevelopmental disorder that affects the development of the nervous system, leading to abnormal brain function.

It is characterized by symptoms of inattention (inability to keep focus), hyperactivity (higher than normal activity), and impulsiveness (acting spontaneously without thought).

ADHD is often first diagnosed in school-going children when it causes disturbances or problems with school tasks.

ADHD can be quite debilitating because it adversely affects the individual’s academic achievements, relationships, and daily functioning. In children, it leads to poor self-esteem and poor performance in school,

Adults with ADHD also experience poor self-esteem and are highly sensitive to criticism. They are highly critical of themselves due to experiencing criticism throughout life.

In some individuals, symptoms lessen with age while some people never completely outgrow their ADHD symptoms.

It is estimated that 8.4% of children and 2.5% of adults suffer from ADHD. Rates of diagnosis of ADHD are rising rapidly throughout America and the rest of the world.

In the U.S., rates of its diagnosis among the youth have jumped to 40% from just a decade ago. Adults with ADHD are now the fastest-growing section of the population receiving medication.

While treatment won’t cure ADHD, it can alleviate symptoms to a great extent. Treatment is with medications and behavioral therapy. Early diagnosis and treatment can significantly improve the prognosis.

Causes and risk factors of ADHD in children and adults

We still do not know what causes ADHD. However, though scientists have not identified any specific gene, there is growing evidence that genetics plays a significant role in its etiology because several genes have been associated with the disorder. The odds are one in 4 that a parent of a child with ADHD  also has it.

Anatomical differences are seen in the brains of children with ADHD. Studies have indicated that there is reduced grey and white brain matter and that the frontal lobes, caudate nucleus, and cerebellar vermis are smaller in the brain of ADHD individuals.

Several non-genetic risk factors have been identified as being associated with this disorder:

They include:

  • low birth weight
  • brain injury
  • premature birth
  • exposure to toxins such as alcohol, tobacco, lead, etc. during pregnancy, and
  • extreme stress during pregnancy

Research does not support the belief that ADHD is caused by eating too much sugar, watching too much television, parenting, or social problems such as poverty or family squabbles. However, these factors may worsen the symptoms in some people.

 Symptoms

Many children may have difficulties sitting still and paying attention. You will find them being nervous, fidgety, hyperactive and they act impulsively.

These symptoms are noticeably greater in these children than expected for their age. They cause suffering and problems in relationships at home, at school, or place of work.

A child with ADHD might:

  • Be inattentive
  • forget a lot
  • lose things
  • be nervous and is fidgety
  • talk too much
  • make careless mistakes
  • give in to temptation
  • have difficulty getting along with others

Types

There are three main types of ADHD depending on which types of symptoms are present in the individual:

  1. Predominantly inattentive type. A child who shows an inattentive pattern faces challenges with carrying out a task, focusing, and organizing tasks. It is hard for the individual to pay attention to details, or follow instructions, or understand conversations. He does not like tasks that require sustained mental effort. The person’s attention is easily diverted, forgets details of daily tasks, and frequently loses things.
  2. Predominantly hyperactive/impulsive type. The person is hyperactive, fidgety, and talks a lot. The individual shows excessive energy and it is hard for this type of individual to sit still for long. Smaller children may run and jump frequently. The individual is restless and impulsive. He may interrupt often or speak out of turn. It is hard for the individual to wait for something or listen to instructions.
  3. Combined Presentation: Symptoms of the above two types are equally present in the person.

Diagnosis

There are no specific blood or imaging tests to diagnose ADHD. It is essentially diagnosed by mental health providers from the symptoms described by the patient or family members and questionnaires answered by the patient, family members, and teachers.

The health provider also takes a complete psychiatric and medical history, family history, and seeks information regarding education, environment, and upbringing. He may also want to rule out other medical conditions and may make appropriate referrals to other specialties.

The diagnosis is based on the presence of persistent symptoms that have been noticeable over the past six months.

ADHD begins in childhood but may be diagnosed at any age. For diagnosis, the symptoms should start before the individual is 12 years old. The symptoms should also occur in more than one location. For example, besides at home, the symptoms should also be noticed in other locations.

Other conditions that can mimic ADHD include

  • learning disorders,
  • mood disorders,
  • anxiety,
  • substance abuse,
  • thyroid conditions, and
  • use of certain medications such as steroids

Other mental conditions that can coexist with ADHD include:

  • oppositional defiant disorder
  • conduct disorder
  • anxiety disorders
  • learning disorders

Treatment

In most cases, doctors find it best to treat ADHD with a combination of behavior therapy and medication. For preschool-aged children (4-5 years of age) with ADHD, the first-line treatment of choice usually is behavioral therapy, which includes parent management training. Medication is avoided.

Close monitoring and follow-ups are strongly recommended so that changes in therapy if needed, can be made.

According to current guidelines, psychostimulants (amphetamines and methylphenidate) are recommended as the first line of treatment for ADHD.

Amphetamines are the only FDA-approved medication for preschool children with ADHD. Guidelines, however, recommend that methylphenidate rather than amphetamines may be more helpful if behavioral therapy has not given the desired effect.

Other FDA-approved options include alpha agonists (clonidine and guanfacine) and the selective norepinephrine reuptake inhibitor (SNRI), atomoxetine.

There are newer FDA-approved medications for ADHD treatment. They include Jornay, Xelstrym, Elbree, Adhansia, Dyanavel, Mydayis, and Cotempla.

Depending on the efficacy and tolerability, doctors often have to alternate between various medications.  Treatment aims to give relief from symptoms and restore proper functioning at home and school.

ADHD and schoolchildren

Children with attention-deficit/hyperactivity disorder (ADHD) experience a lot more problems in achieving success than the average student.

Their inability to pay attention, difficulty sitting still, and difficulty controlling impulses make it hard for children with ADHD to do well in school.

For such children, some schools offer

  • Behavioral classroom management or organizational training
  • Special education services
  • Separate accommodations to make learning easier

Teachers can provide parents and doctors with feedback about the child’s behavior and learning at school to help the doctor evaluate behavior and learning problems. This will help the doctor properly diagnose and choose the right treatment option.

Children with ADHD can benefit from special education services and separate accommodations, alternative teaching techniques, and a modified curriculum.

ADHD and Adults

Many adults with ADHD do not realize they have the disorder because the diagnosis of ADHD is missed during childhood.

Many children with ADHD will continue to have ADHD-associated problems later in life and may exhibit impairments that will require treatment.

A comprehensive diagnostic evaluation, which includes taking a review of the past and present symptoms, a medical exam, and the use of adult rating checklists confirms the diagnosis.

These adults are then treated with medication, psychotherapy, or a combination of both. Behavior management strategies can also be helpful.

At the workplace, certain modifications are made. For more information about workplace adjustments, please visit https://chadd.org/for-adults/workplace-issues/