Attention Deficit Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is characterized by a pattern of difficulty paying attention and a tendency to be overactive and impulsive that interferes with day-to-day tasks and personal development.

Last Updated: February 26, 2024

Inattention is defined as a person who may have trouble staying on task, focused, and organized.

A person with hyperactivity is seen to move around all the time even when inappropriate, or fidgets, taps, and talks too much.

Impulsivity is defined as acting without thinking or having difficulty  with self-control. Impulsive people interrupt others or make big decisions without thinking long-term.

Different subtypes of attention deficit disorders have different prevalence rates. The inattentive subtype affects 18.3% of individuals, while hyperactive/impulsive and combination affect 8.3% and 70%, respectively. Also, the inattentive subtype is more common in the female population. Different studies show that there are twice as many men with the disorders as women. It affects somewhere between 3% and 6% of adults and is one of the most common childhood disorders.

ADHD has genetic and environmental causes. It's a heritable psychiatric illness. Viruses, smoking during pregnancy, nutritional inadequacy, and fetal alcohol exposure are additional possible causes. Lastly, the frontal lobes of the brain of ADHD patients have fewer dopaminergic receptors.

Some people with ADHD primarily exhibit signs of inattention. Others display hyperactive-impulsive traits. Both forms of symptoms can occur in some individuals.

Inattention, impulsivity, and unfocused motor activity are all common in many people, but they appear differently in persons with ADHD. It is more severe, more frequent, and interferes with or degrades their ability to perform socially, academically, or at work.

Signs of inattention include but are not limited to the following:

  • In school, job, or other activities, overlook or miss details and make casual mistakes;
  • Have trouble staying focused on games or tasks, like conversations, lectures, or extended reading;
  • Not seem to listen when directly spoken to;
  • Find it hard to do what they're told or finish schoolwork, chores, or work duties. They may start tasks but lose focus and get sidetracked easily.

Signs of hyperactivity-impulsivity include but are not limited to the following:

  • Sit restlessly
  • Leave their chairs when staying seated is expected, such as in class or the workplace
  • Run, dash, or climb inappropriately;
  • Can't play or do a hobby quietly.

ADHD is a disorder that is clinically diagnosed, and there are no particular laboratory or radiological diagnostics.

Most of the time, a person with ADHD is evaluated with the help of different rating scales and multiple sources of information, such as teachers and parents. Doctors use the Brown Attention Deficit Illness Scale to diagnose the disease by finding common areas of difficulty. The Vanderbilt ADHD scale features a teacher and parent component for children.

In diagnosing ADHD, clinicians will first look for other disorders that could be causing a child's symptoms. It is not diagnosed based on the symptoms of another condition, like a psychotic or a manic episode.

Further, according to DSM-5, there are three types of ADHD

  • Predominantly inattentive
  • Predominantly impulsive or hyperactive
  • Combination of the above

The onset is usually before age 12, and symptoms present at school, work, or home. The disturbance causes significant impairment in social, occupational, and academic functioning.

Treatment

Current ADHD therapies may lessen symptoms and enhance functionality: medication, psychotherapy, education, training, or a combination of these options.

There are two types of drugs that are used to address ADHD symptoms, stimulants, and non-stimulant. It may appear counterintuitive to treat ADHD with a stimulant; however, it boosts dopamine and norepinephrine, which are necessary for thinking and focus. Amphetamines and methylphenidates are examples of stimulants drugs. In contrast, non-stimulant drugs take longer to function than stimulants but help ADHD patients with focus, attention, and impulsivity. Atomoxetine and Bupropion are examples of non-stimulant drugs. 

Psychosocial treatment is also employed for patients. This treatment comprises psychoeducation for the patient and family and cognitive-behavioral training to attain short- and long-term goals. When combined with medication, these training regimens are quite beneficial. 

Lastly, doctors prescribe drugs like clonidine and guanfacine as well; however, side effects such as hypotension, sedation (more so with clonidine than with guanfacine), weight gain, dizziness, etc. should be considered when prescribing these drugs. These drugs also seem to work better with younger children than with adults.

The strategies you can do to handle the disorder are the following:

  • Time-management training;
  • Relaxation and stress management training;
  • Occupational therapy to organize home and work activities;
  • Job coaching or mentoring to improve working relationships and job performance.

There are ways that family members and parents deal with a family member who has ADHD. Family and marital therapy helps handle disruptive behaviors, encourage behavioral changes, and improve interactions with ADHD patients. Parenting skills training teaches parents how to promote and reward healthy behavior. Parents are taught to use rewards and punishments to change their children's behavior, for example, by giving immediate, positive feedback for good behavior, and ignoring or redirecting bad behavior. Specific behavioral classroom management treatments or academic adjustments for children and teens have been found to improve functioning at school and with peers. Interventions may include behavior management or organizational or study skills. Accommodation includes preferential seating, reduced classwork, and extended testing time.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Magnus W, Nazir S, Anilkumar AC, et al. Attention Deficit Hyperactivity Disorder. [Updated 2022 Aug 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441838/

Cleveland Clinic (2022). Attention-Deficit/Hyperactivity Disorder (ADHD) in Adults. Retrieved October 25, 2022, from https://my.clevelandclinic.org/health/diseases/5197-attention-deficit-hyperactivity-disorder-adhd-in-adults#symptoms-and-causes

Last Updated: February 26, 2024