ADHD is a disorder characterised by three primary symptoms: hyperactivity, impulsivity and inattention (difficulty focusing and sustaining attention).
There are three types; inattentive type, impulsivity-hyperactivity type and a combination type including both inattention and impulsivity-hyperactivity.
ADHD is a neurological condition and runs in families.
Diagnosis requires a comprehensive assessment and involves a team of professionals.
Treatment includes medical, psychological and educational intervention as well as behavioural management.
With appropriate intervention and support, people with ADHD can function successfully in society.
What is attention-deficit hyperactivity disorder (ADHD)?
Occasionally, we may all have difficulty sitting still, paying attention or controlling impulsive behaviour.
For a person with ADHD, though, these problems become so pervasive and persistent that their ability to function effectively in daily life is compromised.
ADHD is a neurological syndrome, found in children as well as adults, that is characterised by easy distractibility, low tolerance for frustration or boredom, a greater tendency to say or do whatever comes to mind (impulsivity) and a predilection for situations with high intensity.
The name Attention-Deficit Hyperactivity Disorder reflects the importance of the inattention/ distraction aspect of the disorder as well as the hyperactivity/ impulsivity aspect.
The disorder ADHD symptoms arise in early childhood, unless associated with some type of brain injury later in life.
ADHD is caused by differences in neurotransmitter patterns in certain parts of the brain. Neurotransmitters are chemicals that make it possible for nerve impulses to travel from one nerve cell to another, and therefore play an essential role in the functioning of the brain. The brain performs a vast range of tasks or functions, allowing us, for instance, to see, hear, think, speak and move. Each function is performed by a different part of the brain. In individuals with ADHD there are lower than normal levels of certain neurotransmitters (especially dopamine) in the regions of the brain that are responsible for regulating behaviour and attention. Research also confirms that the Norepinephrine system is also involved in some patients.
ADHD has a genetic component and a group of genes involved has been identified. The genetic component is confirmed with epidimiological studies looking at family groups. Research has shown that in the case of identical twins, if one of the twins has ADHD there is an almost 100% chance that the other twin will show symptoms of ADHD.
ADHD can also be present in some patients with neurological damage occurring either before or after birth. Certain developmental disorders or syndromes, like Fetal Alcohol Syndrome, are associated with a higher incidence of ADHD.
Diet is often cited as the cause for ADHD. Patients with malnutrition or a poor diet may manifest some of the symptoms. In a small subgroup dietary factors may play a role in the worsening of symptoms, especially that of impulsitvity/hyperactivity in younger children. Ongoing research is looking at the role that essential fatty acids play in some patients. Poisoning with heavy metals like lead will create a similar clinical picture in some patients.
Although environmental factors do not play a causal role in ADHD, a disorganised, chaotic and stressful environment can cause behaviour which mimics that of ADHD.
Symptoms There are three primary subtypes of ADHD:
ADHD primarily inattentive type
Fails to give close attention to details or makes careless mistakes.
Has difficulty sustaining attention.
Does not appear to listen.
Struggles to follow through on instructions.
Has difficulty with organisation.
Avoids or dislikes tasks requiring sustained mental effort.
Is easily distracted.
Is forgetful in daily activities.
Clinically they present as the classical dreamers, disorganised and often living in their own little world. This leads to major problems with planning and task completion.
ADHD primarily hyperactive/impulsive type
Fidgets with hands or feet or squirms in chair.
Has difficulty remaining seated.
Runs about or climbs excessively.
Difficulty engaging in activities quietly.
Acts as if driven by a motor.
Talks excessively.
Blurts out answers before questions have been completed.
Difficulty waiting or taking turns.
Interrupts or intrudes upon others.
The classical hyperactive group are often a danger to themselves because of the impulsive behaviour
ADHD combined type
The individual meets both sets of inattention and hyperactive/impulsive criteria, constantly fidgeting and busy with something other than what it expected of them at that moment.
Coexisting disorders
As many as 40 percent of individuals with ADHD present with at least one other major disorder. The most common of these coexisting disorders are briefly described below.
Disruptive Behaviour Disorders
Oppositional-Defiant Disorder (ODD) and Conduct Disorder (CD): ODD involves a pattern of arguing with multiple adults, losing one's temper, refusing to follow rules, blaming others, deliberately annoying others, and being angry, resentful, spiteful and vindictive.
CD is associated with efforts to break rules without getting caught. Such children may be aggressive to people or animals, destroy property, lie or steal things from others, run away, be truant from school, or break curfews. CD is often described as delinquency.
Mood Disorders Depression
ADHD is often associated with depression, which usually appears after ADHD has developed. Depression is characterised by sadness (a child may cry frequently, and for no apparent reason), social withdrawal, loss of appetite, self recrimination, insomnia or excessive sleeping, and a loss of interest in activities that were previously enjoyed.
Mania/Bipolar Disorder
Bipolar Disorder may present with symptoms of ADHD in the prepubertal child. A family history of bipolar disorder is an important indicator. This disorder takes the form of periods of abnormally elevated mood (mania) alternating with episodes of depression. In children, the manic phase usually manifests as pervasive irritability and unprovoked aggression.
The manic phase in adults is usually characterised by an expansive mood, such that the person feels euphoric and extremely confident. The manic individual may go for days without sleeping, tends to speak rapidly and incessantly, and is inclined to behave inappropriately in social settings (having lost their normal inhibitions). During a manic phase people often develop an unrealistic belief in their capabilities, as a result of which they engage in activities or projects which are doomed to failure and which often lead them into financial or other difficulties.
Anxiety
Approximately one third of children with ADHD will also have an anxiety disorder. People with anxiety disorders often worry excessively about a number of things and may feel edgy, stressed out or tired, tense, and have trouble getting restful sleep. A small number of patients may report brief episodes of severe anxiety (panic attacks) with complaints of pounding heart, sweating, shaking, choking, difficulty breathing, nausea or stomach pain, dizziness, and fears of going crazy or dying. These episodes may occur for no reason.
Tourette's Disorder
About seven percent of those with ADHD have Tourette's Disorder. This disorder involves movements and vocal tics. Tics are sudden, rapid, recurrent, non-rhythmic, involuntary movements or vocalisations. The diagnosis of ADHD may precede the onset of tics.
Learning Disabilities
Up to 60 percent of individuals with ADHD have some form of learning disability. Learning disabled persons may have a specific problem reading or calculating, but usually have normal IQ. Dyslexia may have a major impact.
Substance Abuse
Recent research suggests that adolescents with ADHD are at increased risk for very early cigarette use, which is likely to be followed by alcohol and drug abuse if their symptoms are not controlled.
Three to five percent of children are affected by ADHD. Until recent years, it was believed that children outgrow ADHD in adolescence. Hyperactivity often does diminish during the teen years, but it is now known that symptoms can continue into adulthood. In fact, up to 70 percent of children with ADHD will continue to exhibit symptoms in adulthood and in a major proportion it may still have a negative impact on their functioning in all aspects of life and society.
Males are far more likely to get ADHD, with the ratio of males to females with ADHD being 6 to 1. However, ADHD tends to be underdiagnosed in girls as they more frequently present with the inattentive type, which is more difficult to identify than the hyperactive-impulsive type.
In certain conditions a higher incidence of ADHD are found ie Tourette’s syndrome or Fetal Alcohol Syndrome.
Although individuals with ADHD can be very successful in life, without identification and proper treatment ADHD can have serious consequences, including failure at school, low self esteem, depression, behavioural problems and substance abuse. Early identification and treatment increases the likelihood of a positive long-term outcome. Up to 70 percent of children with ADHD will continue to present symptoms in adulthood.
It is important to note that, despite their difficulties, people with ADHD possess positive personality characteristics, particularly those wo receive appropriate intervention and support. People with ADHD can be:
Intelligent, imaginative, creative and original.
Inquisitive, exploratory, and open to new experiences.
Active and energetic.
Enthusiastic, spontaneous, and keen to try out new things.
Entertaining and interesting to talk to and be with.
If you notice that your child is exhibiting some of the symptoms described in this article, if your child's teacher tells you that your child is negatively influenced by his/her concentration problems and is difficult or disruptive at school - then seek a medical and psychological opinion. Emotional and other behavioural issues may stem from the individuals inability to cope and full evaluation may determine whether ADHD is the issue, or part of the problem.
