Written by Dr. Sanjana V.B Bhms,dbrm,cdn
Founder & medical director of siahmsr wellness.in

Reviewed by SIAHMSR

All rights reserved with siahmsr digital healthcare[siahmsr wellness]

overview

  ADHD is one of the most common neurodevelopmental disorders found in children which can often progress into adulthood. It is mostly a genetically inherited problem affecting brain and nervous system of children. It often runs in families.

   ADHD children may be having poor attention span and focus. They may have problems in paying attention and in controlling impulsive hasty behaviors. ADHD has been classified into different types and the manifestation of symptoms also vary depending on the type of ADHD. It is also characterized by hyperactivity or excessive excitability and movement that are not appropriate to the setting.

ADHD impacts the life of the affected person in various ways affecting the academic performance, professional achievements, interpersonal relationships, and day to day life functions.

    ADHD can be found in any age group however, this disorder usually starts in childhood. In order to confirm the diagnosis of ADHD the symptoms must be present before the individual is 12 years old and must have caused difficulties in more than one setting. The symptoms in ADHD vary in children and adult according to the grades of the disorder. ADHD has no complete cure but it is manageable with medications, nutrition and exercise programs and cognitive behavioral therapy.

What are the Symptoms of ADHD?

Children & adult with ADHD may be having various problems such as:

·       Inattention

·       Lack of focus

·       Talkative nature

·       Forgetfulness

·       Day dreaming

·       Fidgetiness of body

·       Carelessness with impulsivity

·       Temptations

·       Trouble in taking turns

·       Difficulty in socializing or mingling with

     In people having ADHD there will be great difficulty in focusing attention or presence of hyperactive or impulsive behavior.

Symptoms of hyper activity vary in degree or grades. In ADHD children impulsivity and inattention are noticeably greater than expected for their age or developmental level.

What is the cause of ADHD?

 The exact cause of ADHD is not known. It is thought that ADHD is linked with genes and some environmental &neurobiological factors.

ADHD runs in families and the current research shows that genetics plays an important role in the development of ADHD. However, other factors also contribute to the occurrence of ADHD.

Other probable causes and risk factors of ADHD includes:

·       Brain injury

·       Exposure to environmental factors (e.g., lead) during pregnancy or at a young age

·       Alcohol and tobacco use during pregnancy

·       Premature delivery

·       Low birth weight

Types of ADHD

  According to American psychiatric association there are various types of ADHD depending on the symptoms manifested in the child or adult having  this problem.

1.    Predominantly inattentive

2.    Predominantly hyperactive and impulsive

3.    combined

Predominantly inattentive type of ADHD

Inattention

 In this type of ADHD it is difficult for the individual to organize or finish a task. The child/adult cannot pay attention to details of the work given or to follow instructions given or continue in conversations.

Distractions

They get easily distracted or forget details of daily routines. In adults inattention may affect their duty at office or home.

Forgetfulness

Forgetfulness  and mistakes happening in assigned tasks are common in adults with this type of ADHD.

Poor performance in school

The school or academic performance is affected as the child cannot pay attention to minute details of the tasks given. Mistakes and errors are very common due to poor focus.

However, the grades of symptoms vary from person to person. Mild to severe grades can be noticed in inattentive type of ADHD.

In severe grades of inattentive ADHD and also in cases where ADHD coexist with autism and other behavioral disorders, daily life activities and academic performance is badly affected.

Lack of focus

For people with this disorder, it is very difficult for staying focused on tasks or activities, such as lectures, conversations etc. for a long time.

Loss of focus or inattention from assigned tasks happens very quickly. Tasks that require sustained mental effort is very difficult for them.

 The calls from parents or teachers is also not answered or responded well as the child cannot listen to the matter when spoken to.

They cannot follow life according to a fixed time management chart. The child may be very messy and disorganized in doing the task or work. These children will not be concerned about articles and things needed for daily life, such as school books, pens, wallet etc.

ADHD symptoms are more severe in children before12years. In adults it is mostly manifested as problem with work due to inattention and forgetfulness.

These are the chief symptoms that may be noticed in children and adults with predominantly inattentive type ADHD. Symptoms of hyperactivity are very low or absent in them.

In adults often symptoms of ADHD might get unnoticed during childhood and it is often diagnosed in adulthood. On history taking of the individual during consultation by the healthcare provider, it is often observed that ADHD  might have been present in close relatives. Inattentive mild type ADHD might have unnoticed in childhood by the parents and relatives and it is now noticed in adulthood due to difficulties in tasks. However, these symptoms of ADHD must be confirmed by ruling out other similar diseases. Healthcare providers may help in this regard.

 Predominantly Hyperactive-Impulsive ADHD

   Hyperactivity refers to excessive movement such as fidgeting, excessive energy and excitability, not sitting still, and being talkative.

   Hyperactive ADHD children talk continuously or they fidget too much. They are easily excited. It is hard for them to sit still for long time while waiting for a meal, while doing homework etc. They keep on moving either running, jumping or climbing somewhere.

  Impulsivity is another important characteristic of ADHD children with hyperactivity. Impulsivity refers to decisions or actions taken without thinking about the consequences.

 An impulsive child may interrupt others in their work or while talking. These children snatch things from people, or speak at inappropriate times. The child cannot wait till the turn to do things.

The most dangerous and difficult thing in managing hyperactive and impulsive children is that they are more prone to accidents and injuries than others due to impulsive behavior.

   In order to conclude the diagnosis of hyperactive type ADHD following characteristics are noted in the person:

o   Fidgetiness such as tapping hands or feet

o   Not able to sit for some time in a place. Constantly moving, running and climbing.

o   Inability to perform tasks or activities calmly.

o   Talks a lot continuously and at inappropriate places.

o    Hastily replying before a question has been finished. Will not allow to complete a conversation.

o   Difficulty in waiting for his or her turn.

o   Interrupts or intrudes on others while in a conversation. Older teens and adults may take over what others are doing.

     Combined type ADHD

   This type of ADHD is diagnosed when criteria for both inattentive and hyperactive/impulse types are found in a child or adult.                                                                     SIAHMSR

How to diagnose ADHD?

ADHD is typically diagnosed by mental health consultants or primary health care providers.

 A psychiatric evaluation is done by a health care provider, preferably mental health consultants based on symptoms of the patient and narration  from caregivers.

 Healthcare provider may ask the person’s  psychiatric and medical history, family history, and information regarding education, environment, and upbringing etc.

It is important to rule out conditions similar to ADHD such as learning disorders, mood disorders, anxiety, substance use, head injuries, thyroid conditions, and use of some medications such as steroids  before confirming ADHD.

 ADHD may also co-exist with other mental health conditions, such as oppositional defiant disorder or conduct disorder [ODD], anxiety disorders, and learning disorders, depression etc. Therefore a complete psychiatric evaluation is very essential in confirming the diagnosis of ADHD.

There are no specific blood tests or imaging studies for diagnosing ADHD.

   In some patients additional psychological testing (such as neuropsychological or psychoeducational testing) or computer-based tests are done to assess the severity of symptoms.

   According to NIH for considering the diagnosis of ADHD, the symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting, which may impair the person’s functioning, and cause the person to fall behind typical development for their age.

  Stress, sleep disorders, anxiety, depression, and other physical conditions can cause similar symptoms to those of ADHD. It is important to rule out these disorders to confirm ADHD.

  For an adolescent or adult to be diagnosed as patients having ADHD, the symptoms need to have been present before age 12 and currently the symptoms of ADHD must be present for more than 5 months continuously affecting tasks and life functions.

ADHD symptoms can appear as early as between the ages of 3 and 6 and can continue through adolescence and adulthood. Symptoms of ADHD can be misinterpreted as emotional or disciplinary problems by parents or caregivers.

 Sometimes ADHD diagnosis is missed in children who have symptoms of inattention only. Adults with undiagnosed ADHD may have a history of poor academic performance, problems at work, or difficult or failed relationships.

ADHD symptoms can change over time as a person grows into adulthood. In young children with ADHD, hyperactivity-impulsivity is the most predominant symptom. After the age of 12 the symptom of inattention may dominate affecting the child’s academic performance.

In adolescent children, hyperactivity reduces in intensity however feelings of restlessness or fidgeting may remain, along with inattention and impulsivity.  Relationship issues and antisocial behaviors are common during adolescence.

Adults with ADHD may experience poor self-worth, high sensitivity towards criticism. This increased self-criticism possibly is stemming from higher levels of criticism experienced throughout life.

What is the treatment for ADHD?

ADHD has no complete cure, but it is manageable with medications, cognitive behavioral therapy is the most chosen method for management.

However complementary and alternative systems of medicine may help to reduce the symptoms of ADHD in many children and adults.

Behavior therapy and medication

For preschool-aged children (4-5 years of age) with ADHD, behavior therapy is considered first, particularly training for parents. Treatment plans will include close monitoring, follow-ups, and making changes, if needed, along the way.

  ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medications work by increasing the brain chemicals dopamine and norepinephrine, which play essential roles in thinking and attention.

Behavioral therapy is a type of psychotherapy that aims to help a person change their behavior.

 It includes helping in organizing tasks or completing schoolwork, or working through emotionally difficult events.

 Behavioral therapy also teaches a person how to monitor their own behavior.

The recommendations include

·     Healthy eating patterns

  Including plenty of fruits, vegetables, whole grains and lean protein sources in the diet.

·     Promoting physical activity

Getting  involved in physical activity everyday as recommended for the age

·     Reduce screen time

Limiting the duration of watching TVs, computers, phones, and other gadgets.

·     Promote adequate sleep

Get the right amount of sleep each night according to the recommendations for the age.

·    Cognitive behavioral therapy

It helps a person learn how to be aware and accepting of one’s own thoughts and feelings to improve focus and concentration.

It motivates the person with ADHD to adjust to the life changes that come with treatment, such as thinking before acting, or resisting the urge to take unnecessary risks.

·    Stress management for parents of ADHD child

A few stress management techniques may help the parents in increasing their ability to deal with stress associated with managing ADHD children.

Complementary & alternative systems of medicine

Homeopathy

Homeopathy offers some treatment options in the form of nutrition and dietary intervention, cognitive behavioral therapy along with some medications. Homeopathic medications may help to improve symptoms of ADHD.

Homeopathy offers medications for stress management of caregivers also along with counselling.

Nutritional intervention

Diet for ADHD children

MIND diet has crucial role in improving brain health.

Please follow the link  http://siahmsrwellness.in/mind-diet-for-your-brain-health

Mind -body exercises for ADHD

Mind relaxation and focusing exercises help ADHD in children and adults.

Mind relaxation yoga

Mind work-outs or brain training or cognitive training

Promote physical activity in children and adults with ADHD. It has good effects in reducing ADHD related problems.

FAQ  Frequently asked questions

1. Does ADHD run in families?

 ADHD runs in families and the current research shows that genetics plays an important role in the development of ADHD.

2. Are there different types of ADHD and what are they?

 ADHD has been classified into different types and the manifestation of symptoms also vary depending on the type of ADHD. There is inattention type  as well as hyperactivity symptoms dominating types. Combined type is also there.

3. Is ADHD manageable?

Yes, it is manageable under various streams of medicines. Conventional treatment or modern medicine  provides some instructions or directions as well as medications in intractable cases. Complementary and alternative systems also contribute to significant improvement in ADHD.

4. Do ADHD  coexist with other neurodevelopmental disorders?

Yes. ADHD can occur with autism spectrum disorder, defiant disorder etc.

5. Can ADHD occur in adulthood?

Yes, it can. however, symptoms of hyperactivity may be less severe. However, inattention and lack of focus may  affect office work as well as relationships.

Copyright of the article -dr sanjana vb siahmsr

References

1.    https://www.psychiatry.org/patients-families/adhd/what-is-adhd
2.    https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd