What is Attention deficit hyperactivity disorder (ADHD)?
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder most prevalent in childhood.
People with ADHD may find it hard to pay attention, are disorganized, have trouble concentrating, and act impulsively. They are easily distracted and seem restless.
ADHD could present other associated challenges such as difficulties with anger, being disorganized, and feeling unmotivated.
It affects 11 percent of school-age children and is more common among boys than girls with girls usually developing it later than boys.
Although it is usually first diagnosed in childhood, symptoms often continue through adolescence into adulthood as the majority do not outgrow it.
Warning signs and symptoms of ADHD
It’s completely normal for children to forget doing things, daydream, act impulsively, or get fidgety.
Figuring out what is ADHD and what is normal ‘child behavior’ can be a difficult task. When the child exhibits signs or symptoms occasionally then it is not ADHD.
Only when the child shows a number of ADHD signs and symptoms such as hyperactivity or inattention, consistently in all situations, then it’s time to take a closer look.
It is important to know that ADHD presents differently in different patients and everyone experiences ADHD in their own way.
Inattention, impulsivity, and hyperactivity should be considered warning signs.
These symptoms get in the way of functioning or development. People who have ADHD have combinations of these symptoms:
- Overlook or miss details, make careless mistakes in schoolwork, at work, or during other activities
- Have problems sustaining attention in tasks or play, including conversations, lectures, or lengthy reading
- Seem to not listen when spoken to directly
- Fail to not follow through on instructions, fail to finish schoolwork, chores, or duties in the workplace, or start tasks but quickly lose focus and get easily sidetracked
- Have problems organizing tasks and activities, such as doing tasks in sequence, keeping materials and belongings in order, keeping work organized, managing time, and meeting deadlines
- Avoid or dislike tasks that require sustained mental effort, such as schoolwork or homework, or for teens and older adults, preparing reports, completing forms, or reviewing lengthy papers
- Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
- Become easily distracted by unrelated thoughts or stimuli
- Forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments
The main signs of inattentiveness are:
- having a short attention span and being easily distracted
- making careless mistakes – for example, in schoolwork
- appearing forgetful or losing things
- being unable to stick to tasks that are tedious or time-consuming
- appearing to be unable to listen to or carry out instructions
- constantly changing activity or task
- having difficulty organising tasks
Hyperactive and Impulsive
- Constantly fidgeting with hands or feet and squirming while seated
- Restless, moving around in situations when staying seated is expected.
- Running or dashing around or climbing in situations where it is inappropriate, or, in teens and adults, often feeling restless
- Being unable to play or engage in hobbies quietly
- Being constantly in motion or “on the go,” or acting as if “driven by a motor”
- Talking nonstop and interrupting others
- Blurting out an answer before a question has been completed, finishing other people’s sentences, or speaking without waiting for a turn during a conversation.
- Having trouble waiting for his or her turn
What causes ADHD?
The cause(s) and risk factors for ADHD are unknown, but current research shows that there is a genetic predisposition for the disorder. Like many other illnesses, a number of factors may contribute to ADHD such as:
- Genes (Many studies indicate that ADHD is highly heritable)
- Nicotine consumption, alcohol use, or drug use during pregnancy
- Exposure to environmental toxins, such as pesticides or lead, in early childhood.
- Low birth weight/premature birth
- Brain injuries
Stress in the family, too much sugar, or too many video games are not known causes for ADHD but can worsen ADHD symptoms.
Types of ADHD
There are 3 different types of ADHD, depending on which types of symptoms are strongest in the individual:
- Predominantly Inattentive Presentation: It is hard for the individual to pay attention to details. The person is not focused and is easily distracted. This is also referred to as attention deficit disorder or ADD.
- Predominantly Hyperactive-Impulsive Presentation: The person has the constant need to move, so fidgets and talks a lot. They don’t have any attention problems but find it very hard to sit still for long (e.g., for a meal or while doing homework). The individual generally feels restless and has trouble with impulsivity. May be restless enough to interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.
- Combined Presentation: Symptoms of the above two types- hyperactivity/impulsivity and inattention are equally present in the person.
Because symptoms can change over time, the presentation may change as they age.
Diagnosis of ADHD
Deciding if a child has ADHD is a complex process and requires a comprehensive evaluation. As several other conditions such as anxiety, depression, sleep problems, etc can have similar symptoms it is important to rule out the other causes to arrive at an accurate diagnosis.
One step of the process involves having a medical exam, including hearing and vision tests, to rule out other problems with symptoms like ADHD.
Diagnosing ADHD usually done by clinical psychologists, clinical social workers, neurologists, child psychiatrists, and pediatricians. It includes a variety of tools, scales, and criteria for rating ADHD symptoms and taking a thorough history of the child from parents, teachers, and sometimes, the child.
The approach to the treatment of ADHD has been changing. Treating ADHD often requires a combination of medical, educational, behavioral, and psychological interventions. Depending on the age of the individual a comprehensive approach using a combination of treatments needs to be planned. This may include:
- parent training – Helping them understand that inattentiveness or impulsivity is not due to lack of caring.
- classroom management
- medication (usually prescribed for older children)
- skills training/coping strategies.
- counseling, talk therapy
- behavioral therapy/behavior modification
- educational supports
- basic education regarding ADHD explaining how symptoms impact the individual.
In most cases, treatment for ADHD is multifaceted and done with a combination of behavior therapy and medication. For young children (4-5 years of age) with ADHD, behavior therapy, mostly training for parents, is recommended as the first line of treatment before any medication is tried. Treatment plans are changed or modified as needed depending on what works best. To manage symptoms it is also important to eat healthily, participate in some active sport or physical activity, limit screen time, and get the recommended amount of sleep. Here is the recommended amount of sleep as per age-: Pre-schoolers- 10-13hrs of sleep, school-age children – 9-12 hrs and teens- 8-10 hrs of sleep
ADHD in Adults
ADHD can last into adulthood and the symptoms include difficulty with time management, forgetfulness, organization, emotional regulation, etc.
It is common for some adults to have ADHD but have never been diagnosed. The symptoms can affect the psychological well-being and cause difficulty at work, at home, or with relationships.
Symptoms are different in the older ages, and for example, hyperactivity may appear as extreme restlessness.
There are many positive traits associated with those who have ADHD. Positive traits that are directly tied to their active, impulsive minds. They have a creative mind, are quick in thinking, and have high energy levels, qualities that are associated with entrepreneurship.
Brief History of ADHD
Hippocrates 460-375BC was the first to report a condition that can be compared to what we call ADHD. He recommended a bland diet with fish and meat, proper hydration, and exercise.
Many years later German Melchior Adam Weikard and the Scottish physician Sir Alexander Crichton, in their textbooks had a conceptualization of attention and descriptions of individuals with abnormal degrees of attention, distractibility, and overactivity.
English philosopher and physician John Locke wrote the essay “Some Thoughts Concerning Education,” in which he discussed, among other things, a group of students who could not “keep their mind from straying.”
In the 1800s medical textbooks did refer to children with symptoms similar to those of ADHD by using terms such as “nervous child,” “hypermetamorphosis,” “mental instability,” “unstable nervous system,” and “simple hyperexcitability”.
The English physician John Haslam, in 1809 provided in his book “Observations on madness and melancholy” a description of the symptoms of a young 2-year-old child who was mischievous and uncontrollable, both at school and at home, and was cruel to animals.
Then in 1902, Sir George Frederic Still, a British pediatrician delivered three lectures about a group of children who had difficulty paying attention and concentration for a long time. He described them as aggressive or very emotional and defiant.
In 1908 doctors began trying to associate postencephalitic behavior disorder (PBD) to the symptoms of ADHD. The disorder was the result of the encephalitis lethargica epidemic, a form of brain inflammation caused by a virus that spread around the world affecting millions. PBD was wrongly believed to lead to inattention and hyperactivity and other changes in children, but today, experts know that those children never had ADHD but a condition that displayed similar symptoms.
Researchers during this time were also studying the effects of benzedrine, the first amphetamine, and a very potent stimulant. In Rhode Island, Dr. Charles Bradley who benzedrine to treat headaches in children noticed that it had no effect on headaches but improved the behavior and academic performance of some. Dr. Bradley and others were curious and conducted a trial to find why a medication that was a stimulant would help children calm down. and later identified children who could benefit from it.
An alternative to benzedrine appeared in 1944, when methylphenidate, another stimulant, was developed by Leandro Panizzon and marketed as “Ritalin”.
The author acknowledges the use of authentic medical literature from reputed media to structure this article.
The contents of this article are not meant to be a substitute for medical advice, diagnosis, or treatment, and should not be construed or treated as such. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. We make no representations, warranties, or guarantees, whether express or implied, that the content on our website is accurate, complete, or up to date.
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