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Attention-deficit hyperactivity disorder

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Overview of attention deficit hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD) is a chronic neurological disorder that affects millions of children. About 60% of children diagnosed with ADHD retain the condition until their adulthood.1 People suffering from this condition are inattentive, hyperactive and show impulsive behavior.2 They also struggle with low self-esteem, troubled personal relationships and poor performance at school or at work.

If this condition is left untreated, it leads to associated behavioral, emotional, social, vocational and academic problems.1 Antipsychostimulant drugs are prescribed to subside the symptoms. These drugs can sometimes have side-effects. Community support, counseling, special accommodations in the classroom and family are other kinds of treatments in treating ADHD.

Epidemiology (Occurrence of ADHD in different groups)

The incidence of ADHD in the parents of children, diagnosed with ADHD is 25% indicating a strong genetic predisposition.3 Some studies have shown that boys are affected approximately five times more often than girls. Other studies have suggested that ADHD cannot be diagnosed easily in girls, as girls with ADHD show their symptoms differently.4

Statistical analysis has suggested that heredity is responsible for approximately half of the explainable variance in hyperactivity and inattentiveness. The link between poor family conditions and perinatal factors with hyperactivity is weak.5

Children and teenagers who are suffering from this disorder usually show health-threatening behaviors like smoking, alcohol intake and substance abuse.

Signs and Symptoms of attention deficit hyperactivity disorder

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A child is said to have ADHD if it shows signs and symptoms of the disease for 6 or more months and its ability to function in two areas, i.e., at school and home is affected.

The signs and symptoms of ADHD are discussed under three types as given below.

  • Predominantly inattentive type
  • Hyperactivity–impulsive type
  • Combined type

Predominantly Inattentive Type

Children who are inattentive show the following symptoms.

  • Avoiding and disliking in engaging the tasks that require constant attention.
  • Being disorganized at home and school.
  • Being easily distracted.
  • Being forgetful in daily activities.
  • Losing things like toys, books, tools, assignments etc.
  • Making careless mistakes in schoolwork and activities.
  • Being unable to complete tasks like schoolwork and chores.
  • Being unable to continue an activity.
  • Daydreaming noticed in girls.

The above problems cause developmental problems in children and adolescents.4 Adults show symptoms like:

  • Struggling daily in regulating their attention and emotion.
  • Have trouble staying focused.
  • Difficulty in getting organized.
  • Unable to manage time and money.
  • Unable to remember little things in daily life.

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Hyperactivity–Impulsive Type

Symptoms of hyperactivity in children include the following:6

  • Often restless with hands, feet, or squirms or wriggles in seat.
  • Often gets up from seat when remaining in seat is expected.
  • Often runs about or climbs when and where it is not appropriate
  • Often have trouble playing or enjoying leisure activities quietly.
  • Is always ‘on the go’ or acts as if ‘driven by a motor’.
  • Often talks excessively.

Hyperactive behavior gradually decreases with age. Symptoms of impulsivity in children include the following:

  • Aggressive behavior
  • Blurts out responses
  • Generally impatient
  • Intrudes others in conversations
  • Fear, depression, and mood swings are seen in girls

In adults, the symptoms include the following:

  • Erratic temper, aggressiveness
  • History of excessive job changing
  • Impulsive purchasing, decision making
  • Substance abuse
  • Tendency to injure themselves and others

Combined Type

Combined type of ADHD shows both of the above discussed symptoms.

Causes of attention deficit hyperactivity disorder

Children affected with ADHD show very low performance at school. Neuroimaging studies suggest that the brains of children with ADHD are different from those of other children. In these children, neurotransmitters (including dopamine, serotonin and adrenalin) function differently when compared to normal children.7 These neurotransmitters play a major role in controlling emotions and reactions.

Researchers believe that a majority of ADHD arises from the combination of various genes, many of such genes affect dopamine (hormone and a neurotransmitter) transporters. This results in confusing behavioral problems, depression, sleep deprivation and learning disabilities.8

Researches on genomes have identified regions on the chromosomes and have predicted to contain genes that contribute to the ADHD condition, but the gene, which is responsible for ADHD is not yet identified.9

Risk Factors for attention deficit hyperactivity disorder

The risk factors for ADHD include the following:

  • Injury to the brain.
  • Brain trauma experienced by a child during pregnancy, delivery and postpartum.
  • Pregnant mothers abusing alcohol and drug can cause poor motor development, muscular development and sensory impairment.
  • Environmental toxins like polychlorinated biphenyls (PCBs) and lead found in paint and pipes of older buildings affect children when exposed.
  • This condition is highly heritable. Children having relatives with a past or present history of ADHD can be affected.

Diagnosis of attention deficit hyperactivity disorder

A qualified health care professional or physician does the diagnosis of ADHD. A complete medical examination is done. This is necessary to identify other conditions that may be responsible for the symptoms that coexist with ADHD and require treatment. The most important diagnostic tool is the clinical interview, as there are no diagnostic laboratory tests for ADHD.

Clinical interview includes:

  • Evaluation of signs and symptoms.
  • Family history.
  • Home environment and academics.
  • Social and emotional functioning.
  • Developmental level.

Apart from this, psychological tests are also used to diagnose ADHD, such as:

  • The Conners’ Parent and Teacher Rating Scale: Used for treating children.
  • Brown Attention Deficit Disorder Scale (BADDS): Used for teens and adults.

Treatment of attention deficit hyperactivity disorder

The physician or a health care professional should be very effective in treating this condition. To help families regarding the treatment, the National Institute of Mental Health (NIMH) has funded many studies on treatments for ADHD and has conducted the most intensive study for evaluating the treatment of this disorder. This study is known as the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (MTA).10

Pharmacotherpy

The medications that seem to be the most effective, are a class of drugs known as stimulants (drugs that temporarily increase alertness and awareness).11

Some of the stimulants include the following:

  • Amphetamine
  • Methylphenidate
  • Pemoline
  • Dextroamphetamine
  • Dexmethylphenidate

These stimulants have minor side-effects, but when taken in higher dosage they cause:

Over-the-Counter Drugs (OTC)—Stimulants like amphetamine-type are available as OTC. Care should be taken in not abusing it.

Alternate Therapies

The following are some of the alternate therapies available.

  • Psychotherapy: Patients suffering from ADHD are allowed to discuss their problems with a psychiatrist or a health care provider. They can take help to explore their negative behavior and learn to deal with their symptoms.
  • Behavior Therapy:This therapy is very useful, as it involves parents and teachers to learn strategies, to deal with the child’s behavior.
  • Family Therapy:In this therapy, parents and siblings learn to deal with the stress, of those suffering from ADHD.
  • Social Skills Training:This therapy helps the children suffering from ADHD to learn proper social behavior.
  • Support Groups:These groups help in providing social support, information and education to adults and children suffering from ADHD. These groups also support their parents, friends and relatives.

Living with attention deficit hyperactivity disorder

The confusion is created when living with ADHD. Parents of children with ADHD are often exhausted and frustrated. Managing a child with ADHD is a challenge, but not impossible. Some of the following tips help to deal with the child at home and class room.

  • Provide a planned structure to carry out the daily activities
  • Keep instructions brief
  • Emphasize the positive things
  • Work as a team
  • Become educated by reading and knowing more about the disease
  • Do not label the child

Prevention of attention deficit hyperactivity disorder

Attention-deficit hyperactivity disorder cannot be prevented. Avoiding alcohol, drugs, and smoking during pregnancy may help to prevent the child from developing behavior similar to ADHD and also other health problems.

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References

1. Available at: www.webmd.com/add-adhd/guide/adhd-adults. Accessed on: 2nd April 2008.

2. Diagnostic and Statistical Manual of American Psychiatric Association, 2000.

3. Biederman J, Faraone SV, Keenan K, Knee D, Tsuang MT. Family-genetic and psychosocial risk factors in DSM-III attention deficit disorder. J Am Acad Child Adolesc Psychiatry. 1990; 29(4): 526¬–533.

4. Available at: www.neurologychannel.com/adhd/index.shtmlss. Accesssed on: 2nd April, 2008.

5. Goodman R, Stevenson J. A twin study of hyperactivity - II. The aetiological role of genes, family relationships and perinatal adversity. J Child Psychol Psychiat. 1989; 30: 691¬–709.

6. Available at: http://www.cdc.gov/ncbddd/adhd/symptom.htm. Accessed on: 3rd April, 2008.

7. Available at: www.nlm.nih.gov/medlineplus/ency/article/001551.htm#References. Accessed on: 3rd April, 2008.

8. Roman T, Rohde LA, Hutz MH. "Polymorphisms of the dopamine transporter gene: influence on response to methylphenidate in attention deficit-hyperactivity disorder." Am J Pharmacogenom. 2004; 4(2): 83–92.

9. Acosta MT, Arcos-Burgos M, Muenke M. Attention deficit/hyperactivity disorder (ADHD): Complex phenotype, simple genotype?.  Genet Med. 2004; 6 (1): 1–15.

10. The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit hyperactivity disorder (ADHD). Arch Gen Psychiatr.1999; 56: 1073–1086.

11. Jensen P, Garcia J, Glied S, Crowe M, Foster M, Schlander M. Cost- effectiveness of ADHD treatments: Findings from the multimodal treatment study of children with ADHD”. Am J Psychiatr. 2005; 162: 1628–1636.

Written by: healthplus24.com team

Date last updated: February 06, 2015