Attention Deficit Hyperactivity Disorder (ADHD)

Attention-deficit hyperactivity disorder or ADHD is a psychiatric disorder in which a person suffers from a lack of attention and hyperactivity. It is a very common disorder worldwide and can easily be managed with pharmacological and therapeutic treatment.

What Is Attention Deficit Hyperactivity Disorder?

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that is characterized by an inability to sustain attention along with highly increased levels of activity. According to research, [mfn] Wilens, T. E., & Spencer, T. J. (2010). Understanding attention-deficit/hyperactivity disorder from childhood to adulthood. Postgraduate medicine, 122(5), 97–109. https://doi.org/10.3810/pgm.2010.09.2206 [/mfn] ADHD can often be lifelong, with its prominent symptoms starting in childhood and continuing till adulthood.

ADHD may result in disrupted social interactions, poor academic performance, and an overall decreased quality of life. It can however be effectively managed with medication, therapy, and adequate coping skills. However, if left untreated, people with ADHD can develop:

• Behavioral and conduct disorders
• Substance abuse disorders
• Antisocial and other personality disorders

In fact, severe ADHD is often linked to the long-term inability to work, increased car accidents, theft, assault, etc.

According to data from around the world [mfn] Magnus W, Nazir S, Anilkumar AC, et al. Attention Deficit Hyperactivity Disorder. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441838/ [/mfn], the global prevalence of attention deficit hyperactivity disorder is about 18.3%. Studies suggest that ADHD exists in a 2:1 male-to-female ratio [mfn] Cabral, M., Liu, S., & Soares, N. (2020). Attention-deficit/hyperactivity disorder: diagnostic criteria, epidemiology, risk factors and evaluation in youth. Translational pediatrics, 9(Suppl 1), S104–S113. https://doi.org/10.21037/tp.2019.09.08 [/mfn] and affects about 3%-6% of the adult population in early childhood.

Case Example

From a very young age, Jia had been quite good at sports and physical activities but she could never get herself to sit down and study for a sustained period of time. It was next to impossible to hold her attention for more than a few minutes. Jia also had a habit of interrupting and shouting answers in class out of turn.

With age, Jia’s hyperactivity reduced. However, she constantly struggled to prioritize and organize her life and had a chronic habit of misplacing things such as her keys and phone. She was often running late to appointments and missing deadlines, as a result of which she had also received multiple warnings from her superiors at work.

Case Analysis

It is apparent that Jia had been suffering from lack of inattention and high activity levels since her childhood which continued into her adulthood. These symptoms are typical of attention deficit hyperactivity disorder or ADHD.

Symptoms Of ADHD

The primary signs of attention-deficit hyperactivity disorder are inattention and hyperactivity. Accompanying them are a bevy [mfn] Wilens, T. E., & Spencer, T. J. (2010). Understanding attention-deficit/hyperactivity disorder from childhood to adulthood. Postgraduate medicine, 122(5), 97–109. https://doi.org/10.3810/pgm.2010.09.2206 [/mfn] of other symptoms such as:

1. Aggression
2. Impulsivity
3. Irritability
4. Lack of restraint
5. Persistent repetition of words or actions
6. Absent-mindedness
7. Difficulty in focusing and concentrating
8. Forgetfulness
9. Low moods like anxiety, boredom, etc.
10. Mood swings, etc.

ADHD symptoms can present differently in different age groups.

Signs Of ADHD In Children

Attention-deficit hyperactivity disorder typically has its onset in childhood and late teenage years and it impacts everyday functioning, social relationships, academic performance, learning experiences, and extracurricular activities. Childhood ADHD symptoms up to the age of 16 can manifest as [mfn] Centers for Disease Control and Prevention. (2018). Symptoms and diagnosis of ADHD. Centers for Disease Control and Prevention. Available from: https://www.cdc.gov/ncbddd/adhd/diagnosis.html [/mfn]:

1. Making careless mistakes in schoolwork and other tasks
2. Having trouble concentrating on play and work
3. Repeatedly interrupting when someone is talking
4. Not being able to finish homework and chores or follow through with directions
5. Failing to organize things properly
6. Constantly losing stationery and other items

Signs Of ADHD In Adults

Attention-deficit hyperactivity disorder can manifest quite differently in adulthood [mfn] Gentile, J. P., Atiq, R., & Gillig, P. M. (2006). Adult ADHD: Diagnosis, Differential Diagnosis, and Medication Management. Psychiatry [Edgmont (Pa. : Township)], 3(8), 25–30. [/mfn], although the basic symptoms of inattention and hyperactivity remain. Most of the time, it is a continuation of childhood ADHD.

Some of these symptoms are

1. Taking a long time to get started on things/ procrastinating
2. Failing to organize and prioritize tasks
3. Having a very low tolerance for frustration and giving up easily
4. Not being able to follow through with activities that require sustained mental effort
5. Having a chaotic lifestyle

Attention-deficit hyperactivity disorder in adults has also been found to be associated with substance abuse and other comorbid mental disorders.

Interestingly, recent research [mfn] Ramtekkar, U. P., Reiersen, A. M., Todorov, A. A., & Todd, R. D. (2010). Sex and age differences in attention-deficit/hyperactivity disorder symptoms and diagnoses: implications for DSM-V and ICD-11. Journal of the American Academy of Child and Adolescent Psychiatry, 49(3), 217–28.e283. [/mfn] reveals that the types of ADHD vary to a certain extent based on gender. For instance, men tend to have symptoms related to hyperactivity, such as talkativeness, mood swings, always being on the go, etc. Women, on the other hand, have more ‘internalized’ symptoms that border on attention deficiency and cognitive shortcomings like disorganization, listening problems, etc.

What Causes ADHD?

Attention-deficit hyperactivity disorder is a multifactorial disorder and there is no single cause for it. However, certain risk factors [mfn] Soheilipour, F., Shiri, S., Ahmadkhaniha, H. R., Abdollahi, E., & Hosseini-Baharanchi, F. S. (2020). Risk factors for attention-deficit/hyperactivity disorder: a case-control study in 5 to 12 years old children. Medicine and pharmacy reports, 93(2), 175–180. https://doi.org/10.15386/mpr-1407 [/mfn] have been implicated in its origin.

Research [mfn] National Guideline Centre (UK). Evidence reviews for risk factors for ADHD: Attention deficit hyperactivity disorder: diagnosis and management: Evidence review A. London: National Institute for Health and Care Excellence (NICE); 2018 Mar. (NICE Guideline, No. 87.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK578094/ [/mfn] attributes the potential causes of ADHD to

1. Genetics

According to a 2012 study [mfn] Thapar, A., Cooper, M., Jefferies, R., & Stergiakouli, E. (2012). What causes attention deficit hyperactivity disorder?. Archives of disease in childhood, 97(3), 260–265. https://doi.org/10.1136/archdischild-2011-300482 [/mfn], attention-deficit hyperactivity disorder seems to share an “inherited liability” with other neurodevelopmental problems and psychiatric disorders. Its mean heritability is almost 74%.

2. Traumatic brain injury

Traumatic brain injury that brings about structural and functional changes [mfn] Shem-Tov, S., Chodick, G., Weitzman, D., & Koren, G. (2019). The Association Between Attention-Deficit Hyperactivity Disorder, Injuries, and Methylphenidate. Global pediatric health, 6, 2333794X19845920. https://doi.org/10.1177/2333794X19845920 [/mfn] in the brain can enhance the risk of ADHD.

3. Premature birth

[mfn] Lindström, K., Lindblad, F., & Hjern, A. (2011). Preterm birth and attention-deficit/hyperactivity disorder in schoolchildren. Pediatrics, 127(5), 858–865. https://doi.org/10.1542/peds.2010-1279 [/mfn] Preterm and early-term birth can increase the risk of ADHD as per research.

4. Low birth weight

Research [mfn] Mick, E., Biederman, J., Prince, J., Fischer, M. J., & Faraone, S. V. (2002). Impact of low birth weight on attention-deficit hyperactivity disorder. Journal of developmental and behavioral pediatrics : JDBP, 23(1), 16–22. https://doi.org/10.1097/00004703-200202000-00004 [/mfn] shows that 13.8% of all ADHD cases can be attributed to low birth weight (LBW). Such cases are usually linked to preterm/ early-term birth.

5. Lead poisoning

Lead poisoning [mfn] Daneshparvar, M., Mostafavi, S. A., Zare Jeddi, M., Yunesian, M., Mesdaghinia, A., Mahvi, A. H., & Akhondzadeh, S. (2016). The Role of Lead Exposure on Attention-Deficit/ Hyperactivity Disorder ‎in Children: A Systematic Review. Iranian journal of psychiatry, 11(1), 1–14. [/mfn] and contamination [mfn] Thapar, A., Cooper, M., Jefferies, R., & Stergiakouli, E. (2012). What causes attention deficit hyperactivity disorder?. Archives of disease in childhood, 97(3), 260–265. https://doi.org/10.1136/archdischild-2011-300482 [/mfn] by pesticides and fertilizers lead to cognitive impairment and, in some cases, trigger ADHD.

6. Unhealthy diet

According to a 2019 study [mfn] Del-Ponte, B., Quinte, G. C., Cruz, S., Grellert, M., & Santos, I. S. (2019). Dietary patterns and attention deficit/hyperactivity disorder (ADHD): A systematic review and meta-analysis. Journal of affective disorders, 252, 160–173. https://doi.org/10.1016/j.jad.2019.04.061 [/mfn], consuming a lot of refined sugar and saturated fat can increase the risk of attention-deficit hyperactivity disorder.

7. Maternal consumption of substances during pregnancy

Studies find that stress and prenatal use of substances such as alcohol, tobacco, antidepressants, and other drugs [mfn] Forray A. (2016). Substance use during pregnancy. F1000Research, 5, F1000 Faculty Rev-887. https://doi.org/10.12688/f1000research.7645.1 [/mfn] by the expecting mother, expose the offspring in the womb to ADHD risks.

8. A family history of ADHD

If ADHD or learning problems run in a person’s family, it can make them more vulnerable to developing ADHD.[mfn] Thapar, A., & Stergiakouli, E. (2008). An Overview on the Genetics of ADHD. Xin li xue bao. Acta psychologica Sinica, 40(10), 1088–1098. https://doi.org/10.3724/SP.J.1041.2008.01088 [/mfn]

9. Psychosocial adversities

In other cases, a number of psychosocial adversities contribute to a person developing a. These include

• Bullying
• Poverty
• Domestic violence
• Family discord, etc.

Read More About Bullying Here

ADHD Diagnosis

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5, attention-deficit hyperactivity disorder can be diagnosed [mfn] Substance Abuse and Mental Health Services Administration. (2016). DSM-5 Changes: Implications for Child Serious Emotional Disturbance. Substance Abuse and Mental Health Services Administration (US). Available from: https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t3/ [/mfn] if at least 7 symptoms from each of the categories of inattention and hyperactivity have been noticed for 6 months or more.

A clinician usually takes a detailed account of the symptoms and other relevant details from the patient as well as the informant (usually a parent or a teacher) before diagnosing attention deficit hyperactivity disorder. Some clinical assessments such as Conners Behavior Checklist [mfn] Gaba, P., & Giordanengo, M. (2019). Attention Deficit/Hyperactivity Disorder: Screening and Evaluation. American family physician, 99(11), 712. Available from: https://www.aafp.org/pubs/afp/issues/2019/0601/p712.html [/mfn] may also be used to accurately assess the symptoms.

ADHD Treatment

The mainstay of ADHD treatment is pharmacological therapy, which is sometimes supplemented by psychological treatment and training methods. These methods have been further elaborated on below:

Medication

Medication for attention-deficit hyperactivity disorder primarily aims to correct the neurotransmitter imbalances that cause the disorder, targeting the brain’s secretions of dopamine, serotonin, norepinephrine, etc. It involves the use of two types of drugs:

• Stimulants (like amphetamines and methylphenidates)
• Non-stimulants (like antidepressants and alpha agonists)

However, recently, experts have warned that pharmacological therapy in ADHD treatment is linked to several side effects [mfn] Stoffers, J., Völlm, B. A., Rücker, G., Timmer, A., Huband, N., & Lieb, K. (2010). Pharmacological interventions for borderline personality disorder. The Cochrane database of systematic reviews, (6), CD005653. https://doi.org/10.1002/14651858.CD005653.pub2 [/mfn] like cardiovascular diseases (CVD), weight gain, dizziness, substance abuse, sleep loss, and risks of dependency.

Psychotherapy

Therapeutic methods have been proven to be quite effective for ADHD. Some common therapies used in the treatment of attention-deficit hyperactivity disorder are:

• Cognitive-behavioral therapy [mfn] Safren, S. A., Otto, M. W., Sprich, S., Winett, C. L., Wilens, T. E., & Biederman, J. (2005). Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms. Behaviour research and therapy, 43(7), 831–842. https://doi.org/10.1016/j.brat.2004.07.001 [/mfn] [Read more]
• Trigeminal nerve stimulation system (for children) [mfn] Magnus W, Nazir S, Anilkumar AC, et al. Attention Deficit Hyperactivity Disorder. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441838/ [/mfn]
• Parent-Child Interaction Therapy [mfn] Wagner, S. M., & McNeil, C. B. (2008). Parent-Child Interaction Therapy for ADHD: A Conceptual Overview and Critical Literature Review. Child & Family Behavior Therapy, 30(3), 231–256. https://doi.org/10.1080/07317100802275546 [/mfn]
• Family therapy [mfn] Everett, C. A., & Everett, S. V. (2001). Family therapy for ADHD: Treating children, adolescents, and adults. Guilford Press. Available from: https://psycnet.apa.org/record/1999-04197-000 [/mfn]

Other methods such as mindfulness-based therapy and self-control therapy may also be used.

The prognosis of attention-deficit hyperactivity disorder depends on the age of the patient as well as the timely and correct diagnosis of the disorder. [mfn] Magnus W, Nazir S, Anilkumar AC, et al. Attention Deficit Hyperactivity Disorder. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441838/ [/mfn] ADHD, however, may not be completely cured and persists to some extent throughout a person’s lifetime.

Nevertheless, the symptoms gradually decrease by about 50% in adulthood, enabling people with ADHD to achieve their educational and/or career goals. In some cases, ADHD goes away without treatment and this can be attributed to structural brain changes and occupational factors that do not require attention.

Takeaway

Attention-deficit hyperactivity disorder is a complex but common disorder that mostly affects children and youth. If untreated, its symptoms can grow more severe and negatively impact your mental and physical health, social relationships, financial prospects, and quality of life.

Thankfully, many treatment methods are available that can help a person effectively manage their ADHD symptoms and live a normal and happy life.

At A Glance

1. Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder, characterized by attention deficiency and hyperactivity.
2. It is most common in children and young adults.
3. There are three types of ADHD.
4. The symptoms of attention-deficit hyperactivity disorder include impulsivity, restlessness, forgetfulness, mood swings, motor dysfunction, irritability, and aggression.
5. It can be caused by brain injury, premature birth, low birth weight, lead poisoning, a family history of ADHD, etc.
6. Attention-deficit hyperactivity disorder can be easily treated with therapy and medication.

Frequently Asked Questions (FAQs)