Attention Deficit Hyperactivity Disorder (ADHD) is a neuro-developmental disorder that is usually diagnosed during childhood. Although it is more commonly diagnosed in boys, this is mostly because boys tend to show their symptoms more, externally. However, there is no evidence to suggest that actual incidence is higher in males than in females. Sometimes, symptoms may go unnoticed or not be given much attention in children, leading to cases being identified later on in adulthood. However, these are generally cases that have gone undiagnosed in childhood, which is when symptoms ideally begin to manifest.

Symptoms

ADHD may present in any of these three forms:

• Predominant inattentiveness – this may include:
  • difficulty to stay focused on a task / activity / conversation / reading, etc.
  • lacking attention to detail
  • making careless mistakes
  • not completing tasks
  • getting easily distracted
  • losing things
  • being forgetful
  • avoiding tasks that require prolonged attention and mental effort
  • forgetting tasks including daily chores
• Predominant hyperactivity / impulsiveness – hyperactivity may include:
  • Fidgeting
  • difficulty in sitting or standing still
  • having excessive energy and thus running, climbing, constantly being on the move, etc. where inappropriate
  • talking too much
  • being impatient in conversation
  • difficulty in waiting their turn in a queue
  • interrupting or intruding;

impulsiveness involves taking actions or decisions without thinking them through and having little to no sense of danger

• A combination of the two

Complications

In some cases, not all, children with ADHD may also show signs of other conditions such as:

• oppositional defiant disorder (ODD) – showing negative or disruptive behaviour, particularly towards authority
• anxiety disorder – being nervous or worrying too much, sometimes causing an increased heart rate, dizziness, sweating
• conduct disorder – showing antisocial behaviour such as harming people and/or animals, fighting, stealing, vandalism
• autism spectrum disorder (ASD) – affecting behaviour, communication, social interaction
• dyspraxia – affecting physical coordination
• learning difficulties such as dyslexia
• depression
• Tourette’s syndrome
• epilepsy

Some adults with ADHD may also show signs of:

• obsessive compulsive disorder (OCD)
• bipolar disorder – causing extreme mood swings
• personality disorder – differing in thoughts, feelings, perceptions and relatability to others

Causes

While a specific cause for ADHD is yet unknown, there appears to be increasing evidence to suggest a hereditary link to the condition as, in most cases, relatives of affected individuals have also been found to have ADHD. People with ADHD seem to have certain anatomical differences in their brains, with most showing reduced grey matter and white matter, as well as differences in brain region activation during specific tasks.

Non-genetic factors associated with ADHD include premature birth, low birth weight, brain injury, extreme stress experienced by the mother during pregnancy, exposure of the mother to toxins such as lead, alcohol, smoking or other environmental toxins during pregnancy, or drug use during pregnancy.

Contrary to what some people believe, ADHD is not medically associated with excessive sugar consumption, excessive screen time or parenting style.

Diagnosis

In general, a minimum of six of the above-mentioned symptoms should be observed in a child (five in an adult) in order to diagnose a case as being ADHD. These symptoms must be observed in more than one environment (i.e., not only at school/work or home alone, but elsewhere, too) in order to rule out the possibility of a stressful environment or certain people being the causative factor for changed behaviour.

Diagnosis of ADHD is typically confirmed by means of a psychiatric evaluation. This involves speaking to the individual concerned, their family, caregivers and teachers, and gathering information regarding their medical history, family history, upbringing, living environment, education, etc. by means of conversation and filling out questionnaires.

In some cases, patients may be referred for further medical evaluation in order to rule out the possibility of other conditions that may mimic ADHD such as anxiety, thyroid conditions, mood or learning disorders, reactions to certain medications, etc. Patients diagnosed with ADHD may also be referred for further psychiatric or computer-based testing in order to determine the severity of the condition.

Prevention

Since ADHD is believed to have a genetic predisposition, there is little that can be done in terms of prevention. However, given the apparent association of the other causative factors mentioned above, it is important that pregnant women avoid exposure to alcohol, smoking, environmental toxins, drugs and unnecessary medication in order to support a safe pregnancy and the baby’s overall health.

Treatment

Treatment for ADHD usually involves a combination of medicine and behavioural therapy, as well as training for those involved in caring for the affected child or individual.

• Medication – Psychostimulants such as amphetamines and methylphenidate are usually used in the first-line medicinal treatment of ADHD. Selective norepinephrine reuptake inhibitors and alpha agonists are among several other medications that may be used. Which type of drug is prescribed depends on the presentation of each individual. The principal aim of medication is to activate or enhance the brain’s attentiveness while slowing down hyperactivity and instigating better self-control.
• Behaviour therapy – This usually involves having a therapist work on the child (or individual) to help them improve their emotional, social and organisational skills in order to be able to carry out day-to-day tasks and activities in an improved manner. Psychoeducation may also be incorporated to encourage the child to discuss, understand and make sense of the implications of living with ADHD.
• Parent training – Being the parent of a child with ADHD can be quite challenging and exhausting. They are therefore encouraged to attend special education and training programs that facilitate learning different ways in which children with ADHD can be approached to elicit a better response – through conversation, reaction, activities and even playing. These programs are also usually designed to help parents to cope with the stress of dealing with someone with ADHD while taking care of their own mental health and well-being.
• Support from school – Apart from providing information about a child’s behaviour and educational progress in school, teachers and other school staff can also help by educating themselves on how to deal with ADHD children. This would help make the interaction better for both the child as well as for themselves. In some cases, children with ADHD may be recommended for schools that provide special education for the differently abled or individuals with learning impairments.

ADHD is not a curable disease as such and usually continues well into an affected child’s adult life. However, an early diagnosis and the use of the correct tools and support, as mentioned above, could help to improve an individual’s ability to live a more normal life, as well as help those around them to handle and take care of themselves and the affected individual better.

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