What is Attention Deficit Hyperactivity Disorder (ADHD)?
Attention Deficit-Hyperactivity Disorder (ADHD) is a mental health condition that affects a person’s ability to focus and behave appropriately for their age. People with ADHD may exhibit a constant lack of attention, hyperactivity, or impulsivity. Previously, there were two separate terms for these conditions, but they were merged into one, ADHD, encompassing three categories: mainly inattentive, primarily hyperactive, or a combination of the two.
Symptoms usually start when a person is young, and can include difficulty focusing, disorganization, a lack of concentration, unfinished tasks, forgetfulness, and frequently losing things. To be officially diagnosed with ADHD, these symptoms must have started before the child turned 12, have lasted for at least six months, and disrupt daily life in more than one location, such as both home and school. ADHD can lead to serious problems, including issues with making friends, risky behavior, losing jobs, and struggles at school.
When considering if someone might have ADHD, it’s essential to take into account what can be expected for the person’s age and cultural background. ADHD is often associated with problems in the ‘control center’ of the brain, which affects focus, decision-making, and emotional control. Consequently, children with ADHD tend to struggle with social situations, may easily lose their patience, and can act on impulse. Because of this, they’re often mistakenly labeled as “troublemakers.”
ADHD isn’t a new issue and has had different names over the years. In the 1930s, it was called ‘minimal brain dysfunction,’ but over time it has been renamed ADD and eventually ADHD. There seems to have been an increase in ADHD cases since the 1950s when education standards became more consistent.
It’s essential to identify and treat ADHD early on, so symptoms don’t continue into adulthood, potentially leading to other health issues. Treatment usually involves stimulant medications and therapy. This overview aims to provide more insight into the causes, physiological aspects, and management of ADHD.
What Causes Attention Deficit Hyperactivity Disorder (ADHD)?
The causes of ADHD, or Attention Deficit Hyperactivity Disorder, are linked to both genetics
and the environment. It is one of the mental health conditions that is most strongly influenced by
genetics. In fact, ADHD is more often found in identical twins than in non-identical ones, and brothers
and sisters have a two times higher chance of having ADHD than other people.
Other potential causes include viral infections, smoking while pregnant, not getting enough nutrients,
and exposure to alcohol before birth. However, these are still under investigation as the scientific
findings are not consistent. Brain scans of people with ADHD don’t show a clear pattern.
Research has shown that people with ADHD may have fewer dopamine receptors – a type of protein that
helps send signals in the brain – particularly in the front part of their brain. There’s also evidence
that noradrenaline receptors, another type of protein that plays a role in attention and response actions,
might be involved in ADHD.
Risk Factors and Frequency for Attention Deficit Hyperactivity Disorder (ADHD)
Attention deficit disorders have several subtypes, each having a different rate of prevalence among those afflicted. The subtype characterized by inattentiveness is found in about 18.3% of patients. Contrastingly, the hyperactive/impulsive and combined forms of the disorder occur in 8.3% and 70% of patients, respectively. Interestingly, the inattentive subtype appears more frequently in women. On the whole, these disorders occur more frequently in males, with a 2:1 male to female ratio. These disorders affect roughly 3% – 6% of adults, making it one of the more common conditions that begin in childhood. Some evidence even suggests that these disorders are more widespread in the United States than in other developed countries.
- The inattentive subtype of attention deficit disorders occurs in about 18.3% of the total patients.
- The hyperactive/impulsive and combined types are present in 8.3% and 70% of patients, respectively.
- The inattentive subtype is more common in females.
- Overall, these disorders are more common in males than females, with a 2:1 ratio.
- Between 3% – 6% of the adult population have a form of these disorders.
- Attention deficit disorders are among the most common that start in childhood.
- They could be more common in the United States compared to other developed countries.
Signs and Symptoms of Attention Deficit Hyperactivity Disorder (ADHD)
Diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD) requires a thorough understanding of a person’s history. In children, diagnosis relies heavily on behavioral symptoms outlined by the Diagnostic and Statistical Manual of Mental Disorders (DSM 5). To be diagnosed with ADHD, children must meet at least 6 out of 9 of these symptoms:
- Being careless during tasks and missing small details
- Rushing through tasks
- Not listening when spoken to
- Struggling to organize tasks or items
- Disliking or avoiding tasks that require prolonged mental effort
- Not completing tasks
- Being forgetful and losing objects
- Fidgeting and feeling restless
- Leaving their seat or climbing on things in inappropriate situations
- Speaking excessively or interrupting others
- Struggling to wait their turn
Importantly, these signs must be observed in more than one environment, such as both home and school.
In adults, ADHD might appear differently, with less clear indicators. Adults may exhibit signs like procrastination, emotional instability, and low self-esteem. They might be either inattentive or impulsive, as hyperactivity can be better managed in adulthood. These signs usually become clear when looking back at their childhood. ADHD affects the person’s everyday life, hampering their functionality and development.
To assess the impact of ADHD, various scales or measures are used. For example, the Brown Attention Deficit Disorder Scale helps identify common problem areas for adults. In children, the Vanderbilt ADHD scale is commonly used; it involves input from both teachers and parents. It’s also worth mentioning that a physical examination might not directly aid in diagnosing ADHD, but it can help rule out other medical conditions that can cause similar symptoms, such as thyroid problems. The physical exam can also identify any health issues that might influence the approach to treatment.
Testing for Attention Deficit Hyperactivity Disorder (ADHD)
ADHD (attention-deficit/hyperactivity disorder) is a condition that can’t be diagnosed by typical lab tests or scans like x-rays. In fact, tests related to brain activity are not precise enough to confirm the disorder. So, the diagnosis is mostly dependent on a patient’s medical history.
The evaluation involves using different rating scales and gathering information from several sources, such as school teachers and parents. It’s essential for healthcare providers to also consider and rule out other disorders; sometimes, symptoms appearing as ADHD may actually be due to a different condition. It would be inaccurate to diagnose ADHD if the signs are part of another condition like a psychotic or manic episode.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) details three types of ADHD: predominantly inattentive, predominantly impulsive or hyperactive, and a combination of both. Diagnosis usually occurs before the individual turns 12, and symptoms must be present in multiple settings – such as school, work, or home. This disorder significantly interferes with social, occupational, and academic aspects of the person’s life and must not be better explained by another behavioral disorder.
Treatment Options for Attention Deficit Hyperactivity Disorder (ADHD)
Medication is the primary treatment for patients with ADHD. There are two main types of these medications – stimulants and non-stimulants. Stimulants are the cornerstone of ADHD treatment, and they help roughly 70% of patients. They work by influencing the amount of dopamine, a brain chemical linked to attention and impulse control. Stimulants can be further categorized into amphetamines and methylphenidates. Both forms have different versions like immediate-release or long-acting versions.
Stimulants can result in side effects like altering blood pressure, reducing appetite and sleep, and the risk of dependency. However, it’s important to note that people with ADHD are more likely to struggle with substance abuse, and medicating with stimulants could lower this risk. Doctors can be cautious about prescribing stimulants because they’re controlled substances, but repeated evidence suggests that they can be beneficial for treating ADHD.
There have been worries about using stimulants in patients prone to seizures, but recent research confirms that this treatment is safe for individuals with epilepsy. Some studies also show that people with both ADHD and Tic disorders might experience more frequent tics, but adding alpha-agonists to the treatment could lessen these tics.
Among non-stimulants, there are antidepressants and alpha-agonists. Atomoxetine is a well known antidepressant and acts as a selective norepinephrine reuptake inhibitor. It’s not as effective as stimulants for ADHD, but is a practical choice for kids who do not respond well to stimulants or are anxious. There are other options like bupropion, which affects dopamine and serotonin, and TCAs, which focus on norepinephrine. Although, TCAs are usually a last resort.
Alpha-agonists like clonidine and guanfacine may be used to treat ADHD. However, these can come with side effects like lowering blood pressure, causing sedation, weight gain, and dizziness. They tend to work better in younger children than in adults.
Besides medication, therapeutic interventions can also help someone with ADHD. Families can be educated about the disorder, and cognitive-behavioral training programs can be implemented. These techniques work best when combined with medication. However, unlike other mental disorders, there is ample evidence to support that ADHD can be effectively treated using medication alone.
The FDA has recently approved a new system for children not on medication. It uses low-level electrical pulses from a device to suppress hyperactivity. There is no specific diet recommended for improving ADHD symptoms.
What else can Attention Deficit Hyperactivity Disorder (ADHD) be?
When trying to identify ADHD (Attention Deficit Hyperactivity Disorder), it is crucial to differentiate it from other mental health conditions because they can share common symptoms. These include mood-related disorders like depression and anxiety. It’s easy to misunderstand these conditions as ADHD because they all involve issues with attention, focus, memory, and distractibility.
Also, people with ADHD often have problems with substance abuse, so it’s important to examine that possibility as well. Notably, conditions like hearing issues, learning disorders, and developmental disorders need to be ruled out, as they can show similar signs to ADHD. In a nutshell, diagnosing ADHD requires careful examination to separate it from other related disorders.
What to expect with Attention Deficit Hyperactivity Disorder (ADHD)
The outlook for individuals with ADHD varies, largely depending on their age. Symptoms of ADHD often continue into the teenage years, impacting social and academic areas of life. Around 40% of patients still experience these symptoms into their teenage years, while roughly a quarter concurrently have an antisocial disorder.
Over the long term, symptoms tend to decrease by about 50% by the time ADHD patients reach adulthood. As a general guideline, approximately half of ADHD patients seem to “outgrow” their condition, especially if they receive treatment. An additional 25% appear to manage without treatment as adults.
Two theories suggest why this might occur. The first suggests that stimulants used in treatment could aid the development of the frontal lobe over time. The second theory is that adults with ADHD often choose careers that do not require long periods of focused attention. Consequently, these individuals generally achieve their educational and career aspirations.
Treatment of ADHD is also known to improve symptoms of oppositional defiant disorder and conduct disorder, and it has also been linked with a reduced risk of substance abuse.
Nevertheless, if ADHD is left untreated, it can lead to ongoing issues that may severely affect a person’s life. These potential consequences are not limited to long-term unemployment, a higher risk of car accidents, and increased substance use.
Preventing Attention Deficit Hyperactivity Disorder (ADHD)
Those diagnosed with ADHD need regular check-ups to monitor their symptoms and any associated conditions. The importance of educating patients about their condition cannot be overstated as this strategy helps achieve treatment goals. Particularly in the case of children with ADHD, it’s essential that parents are given comprehensive information about the disorder. This helps them understand the reasoning behind the diagnosis. Effective medication treatment depends on constant communication between the primary caregiver and the family.