Attention-Deficit Hyperactivity Disorder – ADHD
Attention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder affecting millions worldwide. Symptoms include impulsivity, hyperactivity, and inattention, making it difficult for individuals to function. ADHD typically appears in early childhood and lasts into adulthood.
What is Attention-Deficit Hyperactivity Disorder (ADHD)?
The history of ADHD dates back to the late 19th century when doctors first began to describe similar symptoms in children. However, it wasn’t until the 1960s and 1970s that ADHD officially became recognized as a disorder. In 1980, the Diagnostic and Statistical Manual of Mental Disorders (DSM) included ADHD as a diagnosis.
ADHD is a complex disorder with multiple causes, including genetic factors. Research has found that genes account for about 70% of all cases of Attention-Deficit Hyperactivity Disorder. Others may be related to environmental factors such as exposure to toxins or maternal smoking during pregnancy.
History of Attention-Deficit Hyperactivity Disorder
The history of ADHD dates back to the late 19th century when doctors first began to describe similar symptoms in children. However, it wasn’t until the 1960s and 1970s that ADHD officially became recognized as a disorder. In 1980, the Diagnostic and Statistical Manual of Mental Disorders (DSM) included ADHD as a diagnosis.
ADHD is a complex disorder with multiple causes, including genetic factors. Research has found that genes account for about 70% of all cases of ADHD. Others may be related to environmental factors such as exposure to toxins or maternal smoking during pregnancy.
The brain chemical dopamine plays a role in the symptoms associated with ADHD. Dopamine helps regulate movement, emotion, thinking, and feeling — all areas where people with ADHD struggle.
Research suggests that children with ADHD have lower levels of dopamine than people without ADHD. It may be because they are less able to use receptors on their nerve cells called D1 receptors that help send dopamine signals between nerve cells in the brain’s reward system (hypothalamus).
In addition to having lower levels of D1 receptors, they have higher levels of D2 dopamine receptors in regions of the brain’s prefrontal cortex (the front part of your brain) where most executive functions occur (planning, organizing).
“Mental illness is not a weakness, it’s a medical condition. It takes strength to seek help.”
Attention-Deficit Hyperactivity Disorder In Children
Attention deficit hyperactivity disorder (ADHD) is a common neurobehavioral disorder affecting people of all ages. However, more commonly diagnosed in children.
About 8.4% of children and 2.5% of adults have been diagnosed with ADHD. Symptoms of ADHD include trouble staying focused and paying attention, difficulty controlling behavior, poor organizational skills, and chronic forgetfulness. People with ADHD also tend to be overly active or impulsive. Males usually express hyperactivity with other symptoms, and females tend to present with inactivity.
The symptoms of Attention-Deficit Hyperactivity Disorder can vary widely from one child to another. Some children are hyperactive and impulsive, while others are inattentive and show no hyperactivity. The symptoms typically begin before age seven and continue into adulthood if not treated properly.
Although there are no specific tests for diagnosing ADHD, doctors can usually diagnose the condition by looking at symptoms and evaluating a child’s behavior at home and school. Children with ADHD may receive a referral to specialists such as behavioral therapists or psychologists. These professionals can help treat symptoms using behavioral therapy and medication if needed.
Adult Attention-Deficit Hyperactivity Disorder
People with ADHD can have cognitive, emotional, and behavioral problems. They may also be less able to focus on tasks or new information than people without ADHD.
The symptoms of ADHD are not just a childhood disorder — 80 percent of those with the condition continue to meet the criteria for it as adults. However, the symptoms often change over time and can be more subtle. For example, children with ADHD have trouble paying attention at school, but adults may have more problems with memory, organization, or planning ahead of time.
Several factors can influence whether someone will get diagnosed with ADHD:
- When they seek help or make their symptoms known
- Whether they were diagnosed with other learning disabilities in school
- Whether they have underlying issues like anxiety or depression that could cause similar symptoms
- The doctor’s level of familiarity with diagnosing and treating adult ADHD
Many adults with ADHD do not realize they have the disorder. A comprehensive evaluation typically includes a review of past and current symptoms, a medical exam and history, and the use of adult rating scales or checklists. Adults with ADHD may require medication, psychotherapy, or a combination. Behavior management strategies, such as ways to minimize distractions and increase structure and organization.
3 Sub-Types of Attention-Deficit Hyperactivity Disorder
There are three subtypes of ADHD: predominantly inattentive (type 1), predominantly hyperactive-impulsive (type 2), and combined type (type 3).
Inattentive Type
The inattentive subtype has milder symptoms than the other two types. People with this subtype have difficulty focusing on details or staying on task and tend to have trouble completing tasks. They may also experience difficulty when concentrating, listening, and organizing their thoughts. It may also be challenging to manage time and prioritize tasks. They may appear easily distracted by external stimuli or new ideas sparked during a conversation.
Hyperactive-Impulsive Type
People with the hyperactive-impulsive subtype have difficulty controlling their behavior, which may manifest as fidgety movements, trouble sitting still, or talking excessively. Their behavior can be disruptive in social settings and interfere with their ability to focus on tasks.
Combined Type
People with the combined subtype display symptoms from both categories — they may be more impulsive than others but still experience attention, focus, and distractibility problems.
What causes ADHD?
The exact causes of Attention Deficit Hyperactivity Disorder (ADHD) are not yet fully understood. However, research suggests that it is likely due to genetic, neurobiological, and environmental factors.
Genetic Factors
Research suggests that there may be a genetic component to ADHD. Studies have found that children who have a parent with ADHD are at greater risk of developing the disorder themselves. The findings suggest that the risk of developing ADHD is between 30% and 80%, depending on the study.
Advanced paternal age is associated with an increased risk of having a child with ADHD. It means that men who are older when they have children have a greater chance of having children with ADHD than younger men when they have children. The reasons for this relationship remain unclear, but this finding supports the idea that there is a genetic component to ADHD.
Neurobiological Factors
Research has shown that people with ADHD have differences in the structure and function of certain parts of their brains compared to those without the condition.
Environmental Toxins
Research also suggests that environmental toxins may increase the risk of developing ADHD.
Some of these include:
- environmental toxins such as lead or mercury exposure during pregnancy; birth complications;
- premature birth (before 33 weeks), or low birth weight;
- head injury during childhood;
- premature weaning from breast milk or formula;
- maternal smoking during pregnancy;
- exposure to secondhand smoke at home or work;
- early exposure to alcohol or other drugs by a pregnant woman’s fetus through her bloodstream;
- certain dietary deficiencies in iron, zinc, magnesium, and omega-3 fatty acids.
Other environmental factors, such as social, emotional, or economic stress, can also contribute to the development of ADHD.
Treatment
Currently, the most commonly used psychiatric medications for ADHD are stimulants, such as Ritalin and Adderall. These medications work by increasing neurotransmitters such as dopamine and norepinephrine levels in the brain, which can help improve focus and attention. However, they can also have side effects such as decreased appetite and insomnia.
In addition to medication, several strategies can help to improve the effects of ADHD. These include:
Therapy: Behavioral therapy, cognitive-behavioral therapy, and other forms of treatment can help individuals with ADHD to learn strategies for managing their symptoms.
Organization: Establishing a routine and using tools such as calendars and to-do lists can help individuals with ADHD stay on task and manage their time more effectively.
Exercise: Regular physical activity can help to improve focus and attention and can also help to reduce symptoms of anxiety and depression.
Diet: Eating a healthy and balanced diet can provide the body with the necessary nutrients to support brain function and help to reduce symptoms of ADHD.
Sleep: Getting enough sleep is essential for overall health and well-being, and it can also help to reduce symptoms of ADHD.
It is important to note that everyone with ADHD is different, and what works for one person may not work for another. Working with a healthcare professional to develop an individualized treatment plan is essential.
Attention-Deficit Hyperactivity Disorder in School
In the school setting, behavioral interventions include positive reinforcement systems, cognitive behavioral therapy, social skills training, and academic tutoring. For adolescents with ADHD who have significant impairments in their executive functioning abilities, neurofeedback may be an adjunct to medication treatment.
Types of Medication
Medications are the most commonly used treatments for ADHD. They can improve symptoms by increasing the ability to focus, manage time and remain calm in situations that would otherwise cause distress.
ADHD medications include:
- Stimulants (methylphenidate or amphetamine)
- Non-stimulants (atomoxetine)
- Alpha agonists (clonidine)
- Atypical antidepressants (bupropion)
- Guanfacine
The choice of medication depends on several factors. These include the individual’s age and coexisting conditions, safety considerations for younger children, side effects, cost considerations, and personal preferences of the patient/parent/caregiver.
Stimulants
The most common stimulant medications are methylphenidate (Ritalin), dexmethylphenidate (Focalin), dextroamphetamine (Adderall), and lisdexamfetamine (Vyvanse). These medications have been available for years and studied in children and adults with ADHD. Stimulants are generally safe when taken as prescribed by a doctor; however, there are risks associated with their use — especially if not taken according to instructions.
Non-Stimulants
The non-stimulant medication atomoxetine (Strattera) treats ADHD in children and adults but risk side effects such as low blood pressure, sleepiness, and decreased appetite that make it less appealing than stimulant medications for some people with ADHD.
Other Medications
Some people may need to take other medications along with their stimulant medication to help control their symptoms or prevent side effects. Examples include:
Antidepressants — such as fluoxetine (Prozac) or sertraline (Zoloft) — may be needed if anxiety is a significant problem.
Take as Prescribed
Some Attention-Deficit Hyperactivity Disorder medications come in pill form, while others are liquid or applied as a patch. Medication must be taken regularly for at least two weeks before any effect may be visible.
If you’re taking an immediate-release medication, you’ll need to take it several times a day at regular intervals. Extended-release medications generally need only be taken once or twice a day. Long-acting formulations may be taken once daily in the morning or evening without regard to food intake; however, some may require eating before consuming, so check with your doctor if you have questions about this.
In children older than six, stimulant medications and behavior therapy are the most common. Stimulants are medications that improve attention span, decrease hyperactivity and impulsivity, and increase alertness. Behavioral therapeutic modalities include family counseling or individual psychotherapy to address underlying problems such as poor social skills or low self-esteem.
Contact East Coast Telepsychiatry to develop an individualized treatment plan for your Attention-Deficit Hyperactivity Disorder right away!