Understanding Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) 

Introduction 

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disease marked by excessive quantities of impulsivity, hyperactivity, and inattention that are widespread, detrimental in numerous contexts, and generally age-inappropriate. 

It is a neurological condition that impacts your ability to focus, maintain stillness, and regulate your behavior. It occurs in kids and teenagers and can last until adulthood. 

Symptoms in children 

Symptoms are grouped into three types: 

Inattentive. A child with ADHD: 

  • Is easily distracted 

  • Doesn't follow directions or finish tasks 

  • Doesn't seem to be listening 

  • Doesn't pay attention and makes careless mistakes 

  • Forgets about daily activities 

  • Has problems organizing daily tasks 

  • Doesn’t like to do things that require sitting still 

  • Often loses things 

  • Tends to daydream 

 

Hyperactive-impulsive. A child with ADHD: 

  • Often squirms fidgets, or bounces when sitting 

  • Doesn't stay seated 

  • Has trouble playing quietly 

  • Is always moving, such as running or climbing on things. (In teens and adults, this is more often described as restlessness.) 

  • Talks excessively 

  • Is always “on the go,” as if “driven by a motor” 

  • Has trouble waiting for their turn 

  • Blurts out answers 

  • Interrupts others 

Combined. This involves signs of both other types. 

 

Symptoms in adults 

Symptoms in adults may change as a person gets older. They include: 

  • Often being late or forgetting things 

  • Anxiety 

  • Low self-esteem 

  • Problems at work 

  • Trouble controlling anger 

  • Impulsiveness 

  • Substance misuse or addiction  

  • Trouble staying organized 

  • Procrastination 

  • Easily frustrated 

  • Often bored 

  • Trouble concentrating when reading 

  • Mood swings 

  • Depression 

  • Relationship problems 

 

Causes 

  • Genes 

          There is a familial tendency for ADHD. 

  • Chemicals 

           There may be an imbalance in the brain chemistry of those who have ADHD. 

  • The brain morphs 

           In youngsters with ADHD, the brain's attention-controlling regions are less active. 

  • Infections, inadequate nutrition, smoking, drinking, and substance abuse when pregnant. The growth of a baby's brain may be impacted by several factors. 

  • Poisons, for e.g., lead.  

          They might impact a child's cognitive growth. 

  • Either a brain disorder or damage 

Problems with impulse control and mood regulation can result from damage to the front of the brain, sometimes known as the frontal lobe. 

 

Diagnosis and Testing 

It can be hard to diagnose ADHD, especially in children. No one test will spot it. Doctors diagnose ADHD in children and teens after discussing symptoms at length with the child, parents, and teachers, and then observing the child's behaviors. 

Doctors use the American Psychiatric Association’s guidelines, which are based on how many symptoms a person has and how long they’ve had them. They’ll also rule out other things that may be causing the symptoms, such as health conditions or problems in daily life. 

To confirm a diagnosis of ADHD or learning differences, a child may take a battery of tests to check their neurological and psychological status. The tests should be given by a pediatrician or mental health provider with experience in diagnosing and treating ADHD. Your primary care doctor might refer you to a specialist such as a psychiatrist, psychologist, or psychotherapist. The tests may include:  

  • A medical and social history of both the child and the family. 

  • A physical exam and neurological assessment that includes screenings of vision, hearing, and verbal and motor skills. More tests may be given if hyperactivity may be related to another physical problem. 

  • An evaluation of intelligence, aptitude, personality traits, or processing skills. These are often done with input from the parents and teachers if the child is of school age. 

  • A scan called the Neuropsychiatric EEG-Based Assessment Aid (NEBA) System, which measures theta and beta brain waves. The theta/beta ratio has been shown to be higher in children and adolescents with ADHD than in children without it. 

 

Management 

There are several approaches to treating ADHD. But research suggests that for many children, the best way to manage symptoms is a multimodal approach. This involves multiple methods of treatment that work together. Many symptoms of ADHD can be managed with medication and therapy. Close cooperation among therapists, doctors, teachers, and parents is very important. 

 

  1. Medication 

Although there is controversy about their possible overuse, stimulants are the most commonly prescribed medications for treating ADHD. They can help control hyperactive and impulsive behavior and improve attention span. They act on the brain chemicals, like dopamine, that can make impulsive behavior worse. 

They include: 

Stimulant medications don’t work for everyone with ADHD. People older than 6 may take nonstimulant medications such as: 

In some cases, doctors may prescribe antidepressants, such as drugs called SSRIs, bupropion (Wellbutrin), or venlafaxine (Effexor). 

Side effects of ADHD medicines can include: 

1. Anxiety 

  • Loss of appetite 

  • Fatigue 

  • Most side effects are minor and improve with time. In some cases, doctors may lower a dosage to ease side effects. 

  • In rare cases, stimulants can have more serious side effects. For instance, some are linked to a higher risk of heart problems and death in children with heart disease. They may also worsen psychiatric conditions like depression or anxiety or cause a psychotic reaction. 

  • Before your child starts ADHD medicine, talk to your doctor about the risks and benefits. Remember that it can take some trial and error to find the right medicine and dose. 

2. Therapy 

These treatments focus on changing behavior. 

  • Special education helps a child learn at school. Having structure and a routine can help children with ADHD a lot. 

  • Behavior modification teaches ways to replace bad behaviors with good ones. Let your child know what behaviors you expect of them. Make simple, clear rules. When they lose control, have them face consequences that you’ve set up, like time-outs or losing privileges. Keep an eye out for good behavior. When they keep their impulses in check, reward them. 

  • Psychotherapy (counseling) can help someone with ADHD learn better ways to handle their emotions and frustration. It could help improve their self-esteem. Counseling may also help family members better understand a child or adult with ADHD. 

  • Social skills training can teach behaviors, such as taking turns and sharing. 

3. Medical device 

The FDA has approved the Monarch external Trigeminal Nerve Stimulation (eTNS) System for children 7 to 12 who aren’t taking ADHD medications. It’s about the size of a cellphone and is attached to electrodes on a patch that you put on a child’s forehead. It sends low-level impulses to the part of their brain that’s thought to cause ADHD. The device is usually worn at night. 

4. Support groups  

Support groups of people with similar problems and needs can help you learn more about ADHD and how to manage your symptoms. These groups are helpful for adults with ADHD or parents of children with ADHD. 

5. Education and ADHD 

Educating parents about the disorder and its management is another important part of ADHD treatment. This may include learning parenting skills to help a child manage their behavior. In some cases, the child's entire family may be involved. 

6. Natural remedies 

Dietary supplements with omega-3s have shown some benefits for people who have ADHD. 

 

Dr. Roshni Gautam 

Danphe Care