Attention-Deficit/ Hyperactivity Disorder (ADHD)

Imagine sitting in front of the glaring screen, for days, waiting for tasks to finish themselves. Feeling deflated and discouraged, avoiding the missed deadlines. Struggling to be perfect for every task, that even beginning it feels stressful. This leads to endless procrastination. Being restless, anxious along with other symptoms is a part of Attention-Deficit/ Hyperactivity Disorder (ADHD)

ADHD

ADHD is a neurodevelopmental disorder that mainly has a persistent pattern of inattention and/or hyperactivity. It is one of the most common disorders affecting children, but is also found in adults.

ADHD is now known due to popularization by the media. Children and adults whose symptoms are apparent such as the inability to sit still, difficulty paying attention, hasty acts resulting in negative outcomes such as household disruption, academic underachievement, and poor social relationships.

Symptoms

The symptoms of ADHD are exhibited in three categories-

• Inattentiveness: Inattentiveness is exhibited in daydreaming, distractibility, inability to focus on or complete a task, wandering off task, lacking persistence, and being disorganized, and is not due to defiance or lack of comprehension.

• Hyperactivity: Hyperactivity involves excessive energy (such as a child running about) when it is not appropriate, or excessive fidgeting, tapping, excessive talking, and an inability to sit still. In adults, hyperactivity comes up as extreme restlessness or tiring others with their activity.

• Impulsivity: Impulsivity is social intrusiveness (blurting out answers, interrupting others’ conversations and inability to take turns), taking decisions without thinking of long-term consequences (e.g., darting into the street without looking).

Diagnostic criteria as per DSM-V

A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with

functioning or development, as characterized by (1) and/or (2):

1. Inattention- Six or more of these symptoms have to be present for at least 6 months and negatively impact social or developmental life.

2. Fail to give attention to detail, careless mistakes

3. Difficulty sustaining attention to activities

4. Not listening when talking to (daydreaming)

5. Not following through with instructions, failing to do as directed

6. Difficulty organizing activities and tasks

7. Avoiding mentally tiring tasks

8. Distracted by something unrelated

9. Forgetful in daily activities

2. Hyperactivity- Six or more of these symptoms have to be present for at least 6 months and negatively impact social or developmental life.

1. Fidgeting, squirming in seat

2. Not staying seated when expected to do so

3. Running or climbing in socially inappropriate situations

4. Unable to engage in relaxing activities quietly

5. Never still, constantly doing something

6. Excessive talking

7. Blurting out the answer even before the question is stated completely

8. Cannot wait for their turn

9. Interrupting others

In children, these symptoms have to be manifested before the age of 12 years old, and present in multiple settings (school, home, other activities). They also should reduce normal functioning in all these settings. It can be of varying intensity (mild, moderate, severe) in individuals. These diagnostic criteria are mentioned in accordance with DSM V.

Types

• Inattentive subtype children show symptoms of only inattention.

• Hyperactivity subtype children show symptoms of hyperactivity/impulsivity.

• Combined type children show symptoms of all three categories.

Causes and risk factors

ADHD has various causes and risk factors which include-

• Traits such as negative emotionality, enhanced novelty-seeking, effortful constraints predispose children to ADHD who do not have it.

• Low birth weight is associated with a higher risk of ADHD.

• Acquired brain damage.

• Birth complications.

• Exposure to environmental toxins such as lead, polychlorinated biphenyls, pesticides.

• Consumption of drugs, alcohol and smoking during pregnancy.

• Child abuse, neglect.

• Infectious diseases (encephalitis).

• Stress from the marital life of parents.

• High heritability rate of 76%.

• The involvement of genes related to dopamine which controls rewards is associated with ADHD.

• Sociocultural influences such as culture.

Effects

ADHD affects a lot of aspects of life. It affects school, work, family, and social settings.

In Children-

• Reduced academic performance,

• problems in reading and writing,

• disciplinary and attention problems,

• requiring special attention.

In Adolescents-

Researchers believed that symptoms reduced as children grew into adolescents. However, this is not the case. The symptoms persist well into adulthood.

• The symptoms show up in the form of behavioral, academic, and interpersonal problems,

• Less maturity and greater conflicts with parents,

• Poor social skills,

• Engaging in high-risk activities.

In Adults-

• Poor occupational performance,

• Social rejection,

• High probability of unemployment,

• Substance use disorders,

• Deficits in working memory

• Sustained attention,

• Verbal fluency and processing speed,

• Executive functions such as self-reflection, self-control, planning, forethought,

• Delay of gratification,

• Affect regulation.

Time blindness and rejection-sensitivity dysphoria are also some of the neglected symptoms.

Prevalence

Population surveys suggest that ADHD occurs in most cultures in about 5% of children and about 2.5% of adults. ADHD is also more commonly found in boys than girls. More specifically, boys are 4 to 5 times more likely to be diagnosed with ADHD. The reason for this could be that symptoms in girls are less overt. Or they may be seen as having depressive or anxiety disorder, and not receive appropriate treatment. This is a global view.

From the Indian perspective, a study in Coimbatore found the prevalence higher in India at 11.32% and between the ages of 9 to 10, it was highest. Other ADHD studies conducted in different parts of India also suggested prevalence between 2% to as high as 17%.

In Adults

Once viewed as a disorder only found in children, recently this myth has been busted. The symptoms of ADHD appear in different forms in adults compared to children. Adults with ADHD may have difficulties in devising routines, organizing tasks, performing more poorly on tasks that involve prioritizing activities based on importance, failing at time management, and missing deadlines. Men are at a higher risk of road accidents. This is not the case with women though.

The inability to focus limits their ability to succeed. Unfortunately, this can prevent them from achieving their life goals. Only a limited number of people can channel their energy to creativity.

All these symptoms can severely affect relationships in different settings. Adults may be looking to start arguments as they get easily bored. The difficulty of listening, interrupting others, moodiness, impulsivity, forgetfulness, lack of dependability, chronic lateness, disorganization is very irritating for individuals around them.

ADHD And ADD

ADHD was also previously referred to as ADD(Attention Deficit Disorder). ADD is a milder representation with only inattention, and excluding hyperactivity. ADD is no longer a diagnosis, only ADHD is a diagnosis for both inattention and hyperactivity types.

The difference between ADHD and ADD is that in ADD, the inattention included being easily distracted and cannot focus on a task anywhere, not listening when talking to, overlooking small things, losing things, careless mistakes and disorganization. ADHD has these symptoms divided into three with some additional symptoms.

Interventions

No cure as such has been found for ADHD. Right now, it is a combination of pharmacological and non-pharmacological treatments. Medicines help balance neurotransmitters and symptoms. Stimulants and non-stimulants are available, but because of hesitancy towards medications, parents avoid medicines.

Non-pharmacological interventions are:

• Psychosocial which include behavior therapies (reinforcing positive behaviour and extinguishing negative behavior), parent training, peer training, body.

• Cognitive Behavioral Therapy (CBT) such as play therapy, assigning homework and tasks.

• Mindfulness-based interventions which are body-focused, physical exercise to reduce restlessness, yoga to help calm and similar breathing therapies, music-based therapies.

Takeaway Message

Being healthy is important for everyone, especially children with ADHD. Maintaining a healthy diet, limiting screen time, and healthy sleeping habits help maintain symptoms better. It’s important to not treat adults, and children with ADHD as diseased. They are also individuals trying to do their best and fit in this world.

If you’re a parent of a child with ADHD, make them understand that ADHD can’t be used as an excuse but it is probably why they have a harder time with certain things. It is not all bad. The flip side of ADHD is individuals can be hyper focused, very resilient, creative, high on social intelligence, spontaneous, courageous, and these all are sometimes superpowers.

So where there’s a will, there’s a way.

References

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 (5th ed.). American Psychiatric Publishing.

• Beidel, D. C., Bulik, C. M., & Stanley, M. A. (2017). Abnormal Psychology: A Scientist-Practitioner Approach, Books a la Carte Plus MyLab Psychology -- Access Card Package (4th Edition) (4th ed.). Pearson.

• N. (2020, February 10). Millions of Indian Children (and Parents) Struggle with ADHD Medications. Neeuro. Retrieved December 5, 2021, from https://www.neeuro.com/blog/adhd-india

• Whitbourne, S. K. (2019). Abnormal Psychology: Clinical Perspectives on Psychological Disorders (9th ed.). McGraw-Hill Education.